Urinary Disorders NCLEX Practice | Quiz #1

Correct Answer: D. "Even with insulin, kidney damage is still a concern." Kidney damage is still a concern. Microvascular changes occur in both of the patient's kidneys as a complication of the diabetes. Diabetic nephropathy is the leading cause of end-stage renal disease. The kidneys continue to produce urine until the end stage. Nephropathy occurs even with insulin management.

A 22 y.o. patient with diabetic nephropathy says, "I have two kidneys and I'm still young. If I stick to my insulin schedule, I don't have to worry about kidney damage, right?" Which of the following statements is the best response? A. "You have little to worry about as long as your kidneys keep making urine." B. "You should talk to your doctor because statistics show that you're being unrealistic." C. "You would be correct if your diabetes could be managed with insulin." D. "Even with insulin, kidney damage is still a concern."

Correct Answer: C. Bladder distention Autonomic dysreflexia is a potentially life-threatening complication of spinal cord injury, occurring from obstruction of the urinary system or bowel. In about 85% of cases, this stimulus is from a urological source such as a UTI, a distended bladder, or a clogged Foley catheter. The etiology is a spinal cord injury, usually above the T6 level. It is unlikely to occur if the level is below T10. The higher the injury level, the greater the severity of the cardiovascular dysfunction.

A 27-year old client, who became paraplegic after a swimming accident, is experiencing autonomic dysreflexia. Which condition is the most common cause of autonomic dysreflexia? A. Upper respiratory infection B. Incontinence C. Bladder distention D. Diarrhea

Correct Answer: B. Avoid taking blood pressures in the arm with the fistula. Don't take blood pressure readings in the arm with the fistula because the compression could damage the fistula. Do not let anyone put a blood pressure cuff on the access arm. An AV fistula causes extra pressure and extra blood to flow into the vein, making it grow large and strong. The larger vein provides easy, reliable access to blood vessels. Without this kind of access, regular hemodialysis sessions would not be possible.

A 30 y.o. female patient is undergoing hemodialysis with an internal arteriovenous fistula in place. What do you do to prevent complications associated with this device? A. Insert I.V. lines above the fistula. B. Avoid taking blood pressures in the arm with the fistula. C. Palpate pulses above the fistula. D. Report a bruit or thrill over the fistula to the doctor.

Correct Answer: A. A rounded swelling above the pubis. The best way to assess for a distended bladder in either a male or female client is to check for a rounded swelling above the pubis. The swelling represents the distended bladder rising above the pubis into the abdominal cavity. Determine the condition of the skin in the perianal area. In patients with chronic neurogenic bladder, the skin typically shows areas of chronic irritation manifested by areas of excoriation and redness, usually superseded by fungal infection.

A 72-year old male client is brought to the emergency room by his son. The client is extremely uncomfortable and has been unable to void for the past 12 hours. He has known for some time that he has an enlarged prostate but has wanted to avoid surgery. The best method for the nurse to use when assessing for bladder distention in a male client is to check for: A. A rounded swelling above the pubis. B. Dullness in the lower left quadrant. C. Rebound tenderness below the symphysis. D. Urine discharge from the urethral meatus.

Correct Answer: D. Check for the presence of clots, and make sure the catheter is draining properly. Blood clots and blocked outflow of urine can increase spasms. Bladder irrigation helps remove and prevent blood clots in the bladder. The blood clots stop urine from flowing through the catheter. The urine collects in the bladder and causes pain that gets worse as the bladder fills.

A client had a transurethral prostatectomy for benign prostatic hypertrophy. He's currently being treated with a continuous bladder irrigation and is complaining of an increase in severity of bladder spasms. Which of the interventions should be done first? A. Administer an oral analgesic. B. Stop the irrigation and call the physician. C. Administer a belladonna and opium suppository as ordered by the physician. D. Check for the presence of clots and make sure the catheter is draining properly.

Correct Answer: D. Assess the AV fistula for a bruit and thrill. Assessment of the AV fistula for bruit and thrill is important because, if not present, it indicates a non-functioning fistula. Thrill is caused by turbulence of high-pressure arterial blood flow entering a low-pressure venous system and should be palpable above the venous exit site. Bruit is the sound caused by the turbulence of arterial blood entering the venous system and should be audible by stethoscope, although may be very faint.

A client has a history of chronic renal failure and received hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which of the following interventions is included in this client's plan of care? A. Keep the AV fistula site dry. B. Keep the AV fistula wrapped in gauze. C. Take the blood pressure in the left arm. D. Assess the AV fistula for a bruit and thrill.

Correct Answer: B. Ensure that the catheter is draining freely. The ureteral catheter should drain freely without bleeding at the site. Ensure nephrostomy is secure at all times with drain fixation dressing (and secondary film dressing if required). Check drainage tubing is patent and not kinked/twisted. At night, the patient and/or carer should be taught to attach a larger-volume night drainage bag to ensure a comfortable night's sleep.

A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter would be to: A. Irrigate the catheter with 30 ml of normal saline every 8 hours. B. Ensure that the catheter is draining freely. C. Clamp the catheter every 2 hours for 30 minutes. D. Ensure that the catheter drains at least 30 ml an hour.

Correct Answer: C. Infection Infection is the major complication to watch for in clients on cyclosporine therapy because it's an immunosuppressive drug. Urinary tract infections are common within the first 6 months. Opportunistic infections are more likely to occur 1-6 months after transplantation, reflecting the greater impact of immunosuppression during this time. Reactivation of latent pathogens such as polyomavirus BK, hepatitis C virus (HCV), and mycobacterium tuberculosis may also occur.

A client has just received a renal transplant and has started cyclosporine therapy to prevent graft rejection. Which of the following conditions is a major complication of this drug therapy? A. Depression B. Hemorrhage C. Infection D. Peptic ulcer disease

Correct Answer: C. Composition of calculus The calculus should be analyzed for the composition to determine appropriate interventions such as dietary restrictions. Development of the stones is related to decreased urine volume or increased excretion of stone-forming components such as calcium, oxalate, uric acid, cystine, xanthine, and phosphate. Calculi may also be caused by low urinary citrate levels or excessive urinary acidity.

A client has passed a renal calculus. The nurse sends the specimen to the laboratory so it can be analyzed for which of the following factors? A. Antibodies B. Type of infection C. Composition of calculus D. Size and number of calculi

Correct Answer: C. Involuntary urination with minimal warning. A characteristic of urge incontinence is involuntary urination with little or no warning. Urge incontinence is a type of urinary incontinence in adults, which involves sudden compelling urges to void and results in involuntary leakage of urine. This is a serious and debilitating condition and has a social stigma attached to it. To avoid the huge socioeconomic burden and high morbidity associated with this condition, early diagnosis, treatment, and referral concepts must be widely practiced among clinicians.

A client has urge incontinence. Which of the following signs and symptoms would the nurse expect to find in this client? A. Inability to empty the bladder. B. Loss of urine when coughing. C. Involuntary urination with minimal warning. D. Frequent dribbling of urine.

Correct Answer: A. Polyuria Polyuria occurs early in chronic renal failure and if untreated can cause severe dehydration. Polyuria progresses to anuria, and the client loses all normal functions of the kidney. It is suggested that at this stage of chronic renal failure the mechanism of a diuresis increase is not due to osmotic diuresis but rather to secretion of prostaglandin E2 which inhibits cation reabsorption and stimulates diuresis.

A client is admitted to the hospital and has a diagnosis of early-stage chronic renal failure. Which of the following would the nurse expect to note on assessment of the client? A. Polyuria B. Polydipsia C. Oliguria D. Anuria

Correct Answer: D. Monitor the client's electrolyte levels. Post-obstructive diuresis seen in hydronephrosis can cause electrolyte imbalances; lab values must be checked so electrolytes can be replaced as needed. Obstructive uropathy is a hindrance to normal urinary flow that can be caused by a variety of structural and functional etiologies. This is a common and potentially serious condition that affects people across all ages and walks of life.

A client is admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed and post obstructive diuresis is occurring. Which of the following interventions should be done? A. Take vital signs every 8 hours. B. Weigh the client every other day. C. Assess for urine output every shift. D. Monitor the client's electrolyte levels.

Correct Answer: A. Strain all urine. Urine should be strained for calculi and sent to the lab for analysis. Strain all urine. Document any stones expelled and sent to the laboratory for analysis. Retrieval of calculi allows identification of type of stone and influences choice of therapy.

A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which of the following interventions is important? A. Strain all urine. B. Limit fluid intake. C. Enforce strict bed rest. D. Encourage a high calcium diet.

Correct Answer: B. Strictly follow the hemodialysis schedule. To prevent life-threatening complications, the client must follow the dialysis schedule. Compliance in hemodialysis patients is most often measured by monitoring levels of blood urea nitrogen, potassium, and phosphorus and by observing the amount of weight gain between dialysis treatments. The most compliant patients tend to be married, skilled professionals with a high level of self-concept.

A client is diagnosed with chronic renal failure and told she must start hemodialysis. Client teaching would include which of the following instructions? A. Follow a high potassium diet. B. Strictly follow the hemodialysis schedule. C. There will be a few changes in your lifestyle. D. Use alcohol on the skin and clean it due to integumentary changes.

Correct Answer: C. Prostate-specific antigen (PSA) The PSA test is used to monitor prostate cancer progression; higher PSA levels indicate a greater tumor burden. Elevated Prostate-Specific Antigen (PSA) levels (usually greater than 4 ng/ml) in the blood is how 80% of prostate cancers initially present even though elevated PSA levels alone correctly identify prostate cancer only about 25% to 30% of the time. We recommend at least 2 abnormal PSA levels or the presence of a palpable nodule on DRE to justify a biopsy and further investigation.

A client is diagnosed with prostate cancer. Which test is used to monitor the progression of this disease? A. Serum creatinine B. Complete blood cell count (CBC) C. Prostate-specific antigen (PSA) D. Serum potassium

Correct Answer: D. Monitor the client for signs and symptoms of cystitis. Cystitis is the most common adverse reaction of clients undergoing radiation therapy; symptoms include dysuria, frequency, urgency, and nocturia. Document the color of the patient's urine. Be aware that patients who complain of dysuria may require a urinalysis to rule out infection.

A client is receiving a radiation implant for the treatment of bladder cancer. Which of the following interventions is appropriate? A. Flush all urine down the toilet. B. Restrict the client's fluid intake. C. Place the client in a semi-private room. D. Monitor the client for signs and symptoms of cystitis.

Correct Answer: D. Respiratory paralysis If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal anesthesia is used, the client is likely to develop respiratory paralysis. Artificial ventilation is required until the effects of the anesthesia subside. The patient's hemodynamics requires monitoring in the immediate post-op period until the resolution of the anesthetic. Nurses and physicians from other fields managing the patient need to be aware of the nature of anesthesia that patient underwent.

A client is scheduled to undergo a transurethral resection of the prostate gland (TURP). The procedure is to be done under spinal anesthesia. Postoperatively, the nurse should be particularly alert for early signs of: A. Convulsions B. Cardiac arrest C. Renal shutdown D. Respiratory paralysis

Correct Answer: C. Check the catheter for kinks or obstruction. The first intervention should be to check for kinks and obstructions because that could be preventing drainage. Peritoneal catheter outflow problems are common and many PD patients transfer to hemodialysis because of catheter related issues. Peritoneal outflow failure can be defined as the incomplete recovery of instilled dialysate consistently within 45 minutes of beginning a drain.

A client is undergoing peritoneal dialysis. The dialysate dwell time is completed, and the dwell clamp is opened to allow the dialysate to drain. The nurse notes that the drainage has stopped and only 500 ml has drained; the amount the dialysate instilled was 1,500 ml. Which of the following interventions would be done first? A. Change the client's position. B. Call the physician. C. Check the catheter for kinks or obstruction. D. Clamp the catheter and instill more dialysate at the next exchange time.

Correct Answer: C. Explain that the pain will subside after the first few exchanges. Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however, the pain usually disappears after 1 to 2 weeks of treatment. The infusion amount should not be decreased, and the infusion should not be slowed or stopped.

A client newly diagnosed with renal failure is receiving peritoneal dialysis. During the infusion of the dialysate the client complains of abdominal pain. Which action by the nurse is most appropriate? A. Slow the infusion. B. Decrease the amount to be infused. C. Explain that the pain will subside after the first few exchanges. D. Stop the dialysis.

Correct Answer: D. Elevated BUN and creatinine levels In a client with acute renal graft rejection, evidence of deteriorating renal function is expected. In renal transplantation matching of MHC class II antigens are more critical than MHC class I antigen compatibility in determining graft survival. Matching of the ABO blood group system is also essential since A and B antigens can express endothelium. When there is a genetic disparity between donor and receptor, MHC class I and II can be seen as foreign by the immune system.

A client received a kidney transplant 2 months ago. He's admitted to the hospital with the diagnosis of acute rejection. Which of the following assessment findings would be expected? A. Hypotension B. Normal body temperature C. Decreased WBC count D. Elevated BUN and creatinine levels

Correct Answer: A. Administer oxygen. Airway and oxygenation are always the first priority. Because the client is complaining of shortness of breath and his oxygen saturation is only 89%, the nurse needs to try to increase his levels by administering oxygen. Evaluate development of tachypnea, dyspnea, increased respiratory effort. Drain dialysate, and notify the physician.

A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of 200/100, a heart rate of 110, and a respiratory rate of 36. Oxygen saturation in room air is 89%. He complains of shortness of breath, and +2 pedal edema is noted. His last hemodialysis treatment was yesterday. Which of the following interventions should be done first? A. Administer oxygen. B. Elevate the foot of the bed. C. Restrict the client's fluids. D. Prepare the client for hemodialysis.

Correct Answer: C. When the drainage becomes bright red. The decision made by the surgeon to insert a catheter after a TURP or prostatectomy depends on the amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the drainage becomes brighter red. The color indicates the presence of blood. Increasing the flow of irrigating solution helps flush the catheter well so clots do not plug it.

A client underwent a TURP, and a large three-way catheter was inserted into the bladder with continuous bladder irrigation. In which of the following circumstances would the nurse increase the flow rate of the continuous bladder irrigation? A. When the drainage is continuous but slow. B. When the drainage appears cloudy and dark yellow. C. When the drainage becomes bright red. D. When there is no drainage of urine and irrigating solution.

Correct Answer: C. Conveys urine from the ureters to a stoma opening in the abdomen. An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected and one end of the segment is closed. The ureters are surgically attached to this segment of the ileum, and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma. The client must wear a pouch to collect the urine that continually flows through the conduit. The bladder is removed during the surgical procedure and the ileal conduit is not reversible.

A client who has been diagnosed with bladder cancer is scheduled for an ileal conduit. Preoperatively, the nurse reinforces the client's understanding of the surgical procedure by explaining that an ileal conduit: A. Is a temporary procedure that can be reversed later. B. Diverts urine into the sigmoid colon, where it is expelled through the rectum. C. Conveys urine from the ureters to a stoma opening in the abdomen. D. Creates an opening in the bladder that allows urine to drain into an external pouch.

Correct Answer: B. Strain the urine carefully Intermittent pain that is less colicky indicates that the calculi may be moving along the urinary tract. Fluids should be encouraged to promote movement, and the urine should be strained to detect the passage of the stone. Strain all urine. Document any stones expelled and sent to the laboratory for analysis. Retrieval of calculi allows identification of the type of stone and influences choice of therapy.

A client who has been diagnosed with calculi reports that the pain is intermittent and less colicky. Which of the following nursing actions is most important at this time? A. Report hematuria to the physician. B. Strain the urine carefully. C. Administer meperidine (Demerol) every 3 hours. D. Apply warm compresses to the flank area.

Correct Answer: C. Blood pressure Terazosin (Hytrin) is an antihypertensive drug that is also used in the treatment of BPH. Blood pressure must be monitored to ensure that the client does not develop hypotension, syncope, or postural hypotension. The client should be instructed to change positions slowly. Statistically significant adverse effects associated with terazosin detected in placebo-controlled trials listed in the FDA database include dizziness, headache, weakness, postural hypotension, and nasal congestion.

A client with BPH is being treated with terazosin (Hytrin) 2 mg at bedtime. The nurse should monitor the client's: A. Urinary nitrites B. White blood cell count C. Blood pressure D. Pulse

Correct Answer: D. VS and weight. Following dialysis, the client's vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client's predialysis weight to determine the effectiveness of fluid extraction.

A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the client's status after dialysis? A. Potassium level and weight. B. BUN and creatinine levels. C. VS and BUN. D. VS and weight.

Correct Answer: D. Disturbed Body Image related to the creation of a urinary diversion. It is normal for clients to express fears and concerns about the body changes associated with a urinary diversion. Allowing the client time to verbalize concerns in a supportive environment and suggest that she discuss these concerns with people who have successfully adjusted to ostomy surgery can help her begin coping with these changes in a positive manner.

A female client with a urinary diversion tells the nurse, "This urinary pouch is embarrassing. Everyone will know that I'm not normal. I don't see how I can go out in public anymore." The appropriate nursing diagnosis for this patient is: A. Anxiety related to the presence of urinary diversion. B. Deficient Knowledge about how to care for the urinary diversion. C. Low Self-Esteem related to feelings of worthlessness D. Disturbed Body Image related to creation of a urinary diversion.

Correct Answer: B. Palpation of a thrill over the fistula. The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. Thrill is caused by turbulence of high-pressure arterial blood flow entering a low-pressure venous system and should be palpable above the venous exit site.

A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic renal failure. Which finding indicates that the fistula is patent? A. Absence of bruit on auscultation of the fistula. B. Palpation of a thrill over the fistula. C. Presence of a radial pulse in the left wrist. D. Capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand.

Correct Answer: D. 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. Encourage increased oral fluid intake (2 to 3 liters a day if no contraindication). Fluid intake facilitates urine production and flushes bacteria from the urinary tract.

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

Correct Answer: C. Stress Stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-abdominal pressure, such as with coughing or sneezing. Stress incontinence happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on the bladder, causing to leak urine.

A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs, sneezes, or lifts heavy objects? A. Overflow B. Reflex C. Stress D. Urge

Correct Answer: B. Evaluate the patient's circulation and vital signs. A total UO of 120ml is too low. Assess the patient's circulation and hemodynamic stability for signs of hypovolemia. Normal urine output is 1-2 ml/kg/hr. To determine the urine output of your patient, you need to know their weight, the amount of urine produced, and the amount of time it took them to produce that urine.

A patient returns from surgery with an indwelling urinary catheter in place and empty. Six hours later, the volume is 120ml. The drainage system has no obstructions. Which intervention has priority? A. Give a 500 ml bolus of isotonic saline. B. Evaluate the patient's circulation and vital signs. C. Flush the urinary catheter with sterile water or saline. D. Place the patient in the shock position and notify the surgeon.

Correct Answer: A. At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral). Cyclosporine suppresses the immune response to prevent rejection of the transplanted kidney. The use of cyclosporine places the patient at risk for tumors. Cyclosporine works to suppress cell-mediated immune reactions. Research has detected no effects on phagocytic function in animals, and it does not cause bone marrow suppression in animal or human models.

A patient who received a kidney transplant returns for a follow-up visit to the outpatient clinic and reports a lump in her breast. Transplant recipients are: A. At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral). B. Consumed with fear after the life-threatening experience of having a transplant. C. At increased risk for tumors because of the kidney transplant. D. At decreased risk for cancer, so the lump is most likely benign.

Correct Answer: A. Apply pressure to the needle site upon discontinuing hemodialysis. Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped. Bleeding may continue for 10 minutes in some patients. The AV fistula is the safest type of vascular access. It can last for years and is least likely to get infections or blood clots. A surgeon connects an artery (a large blood vessel that carries blood from the heart) and a vein (a blood vessel that carries blood to the heart) under the skin in the arm. Usually, they do the AV fistula in the non-dominant arm.

A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do you include in his plan of care? A. Apply pressure to the needle site upon discontinuing hemodialysis. B. Keep the head of the bed elevated 45 degrees. C. Place the left arm on an arm board for at least 30 minutes. D. Keep the left arm dry.

Correct Answer: C. Protein Because of damage to the nephrons, the kidney can't excrete all the metabolic wastes of protein, so this patient's protein intake must be restricted. Eating animal protein may increase the chances of developing kidney stones. Although you may need to limit how much animal protein you eat each day, you still need to make sure you get enough protein. Consider replacing some of the meat and animal protein you would typically eat with beans, dried peas, and lentils, which are plant-based foods that are high in protein and low in oxalate.

A patient with diabetes has had many renal calculi over the past 20 years and now has chronic renal failure. Which substance must be reduced in this patient's diet? A. Carbohydrates B. Fats C. Protein D. Vitamin C

Correct Answer: B. Low-protein diet with a prescribed amount of water The patient should follow a low-protein diet with a prescribed amount of water. The patient requires some protein to meet metabolic needs. Protein can help keep healthy blood protein levels and improve health. Protein also helps keep the muscles strong, helps wounds heal faster, strengthens the immune system, and helps improve overall health.

A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments? A. Low-protein diet with unlimited amounts of water. B. Low-protein diet with a prescribed amount of water. C. No protein in the diet and use of a salt substitute D. No restrictions.

Correct Answer: A. Deficient fluid volume Deficient Fluid Volume is a priority diagnosis because the client needs to drink a large amount of fluid to keep the urine clear. The urine should be almost without color. About two (2) weeks after a TURP, when desiccated tissue is sloughed out, a secondary hemorrhage could occur. The client should be instructed to call the surgeon or go to the ED if at any time the urine turns bright red.

A priority nursing diagnosis for the client who is being discharged home 3 days after a TURP would be: A. Deficient fluid volume B. Imbalanced Nutrition: Less than Body Requirements C. Impaired Tissue Integrity D. Ineffective Airway Clearance

Correct Answer: A. Acute rejection Acute rejection most often occurs in the first two (2) weeks after transplant. Clinical manifestations include fever, malaise, elevated WBC count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. It is related to preexisting circulating antibodies in the recipient's blood against the donor antigen (usually ABO blood group or HLA antigen), which is present at the time of transplantation. These antibodies attack and destroy the transplanted organ as soon as or within a few hours after allograft is revascularized.

A week after kidney transplantation the client develops a temperature of 101, the blood pressure is elevated, and the kidney is tender. The X-ray results show the transplanted kidney is enlarged. Based on these assessment findings, the nurse would suspect which of the following? A. Acute rejection B. Chronic rejection C. Kidney infection D. Kidney obstruction

Correct Answer: D. Increased blood glucose levels and decreased wound healing. Steroid use tends to increase blood glucose levels, particularly in clients with diabetes and borderline diabetes. Steroids also contribute to poor wound healing and may cause acne, mood swings, and sodium and water retention. Adverse effects are common in patients receiving glucocorticoids in high doses or over a long period. Potential adverse effects include skin fragility, weight gain, increased risk of infections, and fractures. Significant cardiovascular and metabolic effects are hypertension, hyperglycemia, and dyslipidemia.

Adverse reactions of prednisone therapy include which of the following conditions? A. Acne and bleeding gums B. Sodium retention and constipation C. Mood swings and increased temperature D. Increased blood glucose levels and decreased wound healing.

Correct Answer: B. Thrombophlebitis After pelvic surgery, there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. The pathogenesis is thought to include injury to the intima of the pelvic vein caused by a spreading uterine infection, bacteremia, and endotoxins, which can also occur secondary to the trauma of delivery or surgery.

After surgery for an ileal conduit, the nurse should closely evaluate the client for the occurrence of which of the following complications related to pelvic surgery? A. Peritonitis B. Thrombophlebitis C. Ascites D. Inguinal hernia

Correct Answer: A. Disequilibrium syndrome Disequilibrium occurs when excess solutes are cleared from the blood more rapidly than they can diffuse from the body's cells into the vascular system. The dialysis disequilibrium syndrome is defined as a clinical syndrome of neurologic deterioration that is seen in patients who undergo hemodialysis. It is more likely to occur in patients during or immediately after their first treatment but can occur in any patient who receives hemodialysis.

After the first hemodialysis treatment, your patient develops a headache, hypertension, restlessness, mental confusion, nausea, and vomiting. Which condition is indicated? A. Disequilibrium syndrome B. Respiratory distress C. Hypervolemia D. Peritonitis

Correct Answer: B. Maculopapular rash Allopurinol is used to treat renal calculi composed of uric acid. Side effects of allopurinol include drowsiness, maculopapular rash, anemia, abdominal pain, nausea, vomiting, and bone marrow depression. Clients should be instructed to report skin rashes and any unusual bleeding or bruising.

Allopurinol (Zyloprim), 200 mg/day, is prescribed for the client with renal calculi to take home. The nurse should teach the client about which of the following side effects of this medication? A. Retinopathy B. Maculopapular rash C. Nasal congestion D. Dizziness

Correct Answer: C. To bind phosphorus in the intestine. A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body's calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion.

Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the purpose of giving this drug to a client with chronic renal failure? A. To relieve the pain of gastric hyperacidity. B. To prevent Curling's stress ulcers. C. To bind phosphorus in the intestine. D. To reverse metabolic acidosis.

Correct Answer: C. Recent sore throat The most common form of acute glomerulonephritis is caused by group A beta-hemolytic streptococcal infection elsewhere in the body. Poststreptococcal glomerulonephritis (PSGN) results from a bacterial infection that causes rapid deterioration of the kidney function due to an inflammatory response following streptococcal infection. PSGN most commonly presents in children 1 to 2 weeks after a streptococcal throat infection, or within 6 weeks following a streptococcal skin 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? A. Renal calculi B. Renal trauma C. Recent sore throat D. Family history of acute glomerulonephritis

Correct Answer: A. Milk, apples, tomatoes, and corn. Because a high-purine diet contributes to the formation of uric acid, a low-purine diet is advocated. An alkaline ash diet is also advocated because uric acid crystals are more likely to develop in acid urine. Foods that may be eaten as desired in a low-purine diet include milk, all fruits, tomatoes, cereals, and corn. Food allowed on an alkaline ash diet include milk, fruits (except cranberries, plums, and prunes), and vegetables (especially legumes and green vegetables). Gravy, chicken, and liver are high in purine.

Because a client's renal stone was found to be composed of uric acid, a low-purine, alkaline ash diet was ordered. Incorporation of which of the following food items into the home diet would indicate that the client understands the necessary diet modifications? A. Milk, apples, tomatoes, and corn. B. Eggs, spinach, dried peas, and gravy. C. Salmon, chicken, caviar, and asparagus D. Grapes, corn, cereals, and liver.

Correct Answer: C. Hematuria and proteinuria Hematuria and proteinuria indicate acute glomerulonephritis. These findings result from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis. The most common presenting symptom is gross hematuria as it occurs in 30 to 50% of cases with acute PSGN; patients often describe their urine as smoky, tea-colored, cola-colored, or rusty. The hematuria can be described as postpharyngitic (hematuria seen after weeks of infection).

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

Correct Answer: A. Osmosis and diffusion Osmosis allows for the removal of fluid from the blood by allowing it to pass through the semipermeable membrane to an area of high concentrate (dialysate), and diffusion allows for passage of particles (electrolytes, urea, and creatinine) from an area of higher concentration to an area of lower concentration.

Dialysis allows for the exchange of particles across a semipermeable membrane by which of the following actions? A. Osmosis and diffusion B. Passage of fluid toward a solution with a lower solute concentration C. Allowing the passage of blood cells and protein molecules through it. D. Passage of solute particles toward a solution with a higher concentration.

Correct Answer: C. Possible shock Rapid emptying of an overdistended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. Previously, removing no more than 1,000 ml at one time was the standard of practice, but this is no longer thought to be necessary as long as the over distended bladder is emptied slowly.

During a client's urinary bladder catheterization, the bladder is emptied gradually. The best rationale for the nurse's action is that completely emptying an overdistended bladder at one time tends to cause: A. Renal failure B. Abdominal cramping C. Possible shock D. Atrophy of bladder musculature

Correct Answer: B. Bleeding indicates abdominal blood vessel damage. Because the client has a permanent catheter in place, blood-tinged drainage should not occur. Persistent blood-tinged drainage could indicate damage to the abdominal vessels, and the physician should be notified. Catheter insertion, manipulation, and trauma/pulling of the external limb of the catheter can all cause local tissue damage at the peritoneal entry site, which could lead to blood staining.

During the client's dialysis, the nurse observes that the solution draining from the abdomen is consistently blood-tinged. The client has a permanent peritoneal catheter in place. Which interpretation of this observation would be correct? A. Bleeding is expected with a permanent peritoneal catheter. B. Bleeding indicates abdominal blood vessel damage. C. Bleeding can indicate kidney damage. D. Bleeding is caused by too-rapid infusion of the dialysate.

Correct Answer: D. Check the patient's latest potassium level The patient with ESRD may develop arrhythmias caused by hypokalemia. The incidence of PVCs, as well as complex PVCs in patients with ESRD, was comparable to that of the patients who had had myocardial infarction but was significantly higher than that found in low-risk subjects. The high incidence of complex PVCs in patients with ESRD may predispose them to increased cardiovascular death, and further investigation of this finding is indicated.

Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal disease. The priority intervention is: A. Call the doctor immediately. B. Give the patient IV lidocaine (Xylocaine). C. Prepare to defibrillate the patient. D. Check the patient's latest potassium level.

Correct Answer: B. Serum acid phosphatase level The most specific examination to determine whether a malignancy extends outside of the prostatic capsule is a study of the serum acid phosphatase level. The level increases when a malignancy has metastasized. The prostate-specific antigen (PSA) determination and a digital rectal examination are done when screening for prostate cancer.

If a client's prostate enlargement is caused by a malignancy, which of the following blood examinations should the nurse anticipate to assess whether metastasis has occurred? A. Serum creatinine level B. Serum acid phosphatase level C. Total nonprotein nitrogen level D. Endogenous creatinine clearance time

Correct Answer: B. Hemorrhage Hemorrhage is a potential complication. Postoperative hemorrhage is a rare but severe complication in LRP. Bleeding generally originates from injured venous vessels in the prostatectomy area, which is always self-limiting due to tissue compression in the pelvic space. However, it is not easy for slightly larger arteries to stop bleeding automatically.

Immediately post-op after a prostatectomy, which complications require priority assessment of your patient? A. Pneumonia B. Hemorrhage C. Urine retention D. Deep vein thrombosis

Correct Answer: A. For life. After an organ transplant, the client will need to take immunosuppressant (anti-rejection) drugs. These drugs help prevent the immune system from attacking ("rejecting") the donor organ. Typically, they must be taken for the lifetime of the transplanted organ. Organ rejection is a constant threat. Keeping the immune system from attacking the transplanted organ requires constant vigilance. So, it's likely that the transplant team will make adjustments to the anti-rejection drug regimen.

Immunosuppression following kidney transplantation is continued: A. For life B. 24 hours after transplantation C. A week after transplantation D. Until the kidney is not anymore rejected

Correct Answer: D. Diarrhea In renal failure, calcium absorption from the intestine declines, leading to increased smooth muscle contractions, causing diarrhea. The presence of chronic diarrhea or intestinal disease (e.g, Crohn's disease, sprue, chronic pancreatitis) suggests the possibility of hypocalcemia due to malabsorption of calcium and/or vitamin D.

In a client with renal failure, which assessment finding may indicate hypocalcemia? A. Headache B. Serum calcium level of 5 mEq/L C. Increased blood coagulation D. Diarrhea

Correct Answer: B. Validating frequently the client's understanding of the material. Uremia can cause decreased alertness, so the nurse needs to validate the client's comprehension frequently. Assess the extent of impairment in thinking ability, memory, and orientation. Note attention span. Uremic syndrome's effect can begin with minor confusion, irritability, and progress to altered personality or inability to assimilate information and participate in care. Awareness of changes provides opportunity for evaluation and intervention.

In planning teaching strategies for the client with chronic renal failure, the nurse must keep in mind the neurologic impact of uremia. Which teaching strategy would be most appropriate? A. Providing all needed teaching in one extended session. B. Validating frequently the client's understanding of the material. C. Conducting a one-on-one session with the client. D. Using videotapes to reinforce the material as needed.

Correct Answer: D. Elevated BUN and Creatinine. After a few days or weeks of successful transplantation surgery, the patient complains about tenderness at the site of the graft, pyrexia, and abnormal function of the organ or tissue graft, for example, in renal transplantation appears anuria, an increasing serum creatinine levels, and metabolic problems including hyperkalemia.

Mr. Roberto was readmitted to the hospital with acute graft rejection. Which of the following assessment findings would be expected? A. Hypotension B. Normal Body Temperature C. Decreased WBC D. Elevated BUN and Creatinine

Correct Answer: C. Exchange potassium for sodium. In renal failure, patients become hyperkalemic because they can't excrete potassium in the urine. Polystyrene sulfonate acts to excrete potassium by pulling potassium into the bowels and exchanging it for sodium. Sodium polystyrene sulfonate helps by removing extra potassium from the body. Due to its slow onset of action, it is a second-line agent in emergent situations. Data on the non-FDA approved use of this drug is limited. This drug can also help to remove excess calcium, sodium from solutions in technical applications.

Polystyrene sulfonate (Kayexalate) is used in renal failure to: A. Correct acidosis. B. Reduce serum phosphate levels. C. Exchange potassium for sodium. D. Prevent constipation from sorbitol use.

Correct Answer: D. Increased Blood Glucose Level In the past, people with kidney transplants usually have taken steroids (such as prednisone) as one of their immunosuppressive medications to prevent rejection. But steroids may cause weight gain, diabetes, high blood pressure, heart and blood vessel disease (cardiovascular disease), osteoporosis, and other problems.

Steroids, if used following kidney transplantation would cause which of the following side effects? A. Alopecia B. Increase Cholesterol Level C. Orthostatic Hypotension D. Increase Blood Glucose Level

Correct Answer: B. Discontinue dialysis and notify the physician If the client experiences air embolism during hemodialysis, the nurse should terminate dialysis immediately, notify the physician, and administer oxygen as needed. This maximizes oxygen for vascular uptake, preventing or lessening hypoxia. Elevate the head of bed or have a patient sit up in a chair. Promote deep-breathing exercises and coughing.

The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air embolism. The nurse should: A. Continue the dialysis at a slower rate after checking the lines for air. B. Discontinue dialysis and notify the physician. C. Monitor vital signs every 15 minutes for the next hour. D. Bolus the client with 500 ml of normal saline to break up the air embolism.

Correct Answer: A. Tender, indurated, and warm to the touch The client with prostatitis has a prostate gland that is swollen and tender, but that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection (which often accompany the disorder).

The client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse would look at the results of the prostate examination, which should reveal that the prostate gland is: A. Tender, indurated, and warm to the touch B. Soft and swollen C. Tender and edematous with ecchymosis D. Reddened, swollen, and boggy

Correct Answer: D. Decreased serum uric acid level By inhibiting uric acid synthesis, allopurinol decreases its excretion. The drug's effectiveness is assessed by evaluating for a decreased serum uric acid concentration. Allopurinol undergoes metabolism in the liver, where it transforms into its pharmacologically active metabolite, oxypurinol. The half-life of allopurinol is 1 to 2 hours, and oxypurinol is about 15 hours.

The client has a clinic appointment scheduled 10 days after discharge. Which laboratory finding at that time would indicate that allopurinol (Zyloprim) has had a therapeutic effect? A. Decreased urinary alkaline phosphatase level B. Increased urinary calcium excretion C. Increased serum calcium level D. Decreased serum uric acid level

Correct Answer: A. Shoulder Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders. Bladder injury pain does not radiate to the umbilicus, CV angle, or hip. Aside from iatrogenic injuries, patients with signs and symptoms of bladder injury will likely relay a history typical for pelvic trauma.

The client is admitted to the ER following a MVA. The client was wearing a lap seat belt when the accident occurred. The client has hematuria and lower abdominal pain. To determine further whether the pain is due to bladder trauma, the nurse asks the client if the pain is referred to which of the following areas? A. Shoulder B. Umbilicus C. Costovertebral angle D. Hip

Correct Answer: C. Blood pressure of 100/50 and pulse 130. A rapid pulse with low blood pressure is a potential sign of excessive blood loss. The physician should be notified. Class III of hemorrhagic shock includes a volume loss from 30% to 40% of total blood volume, from 1500 mL to 2000 mL. A significant drop in blood pressure and changes in mental status occurs. Heart rate and respiratory rate are significantly elevated (more than 120 BPM). Urine output declines. Capillary refill is delayed.

The client is admitted to the hospital with BPH, and a transurethral resection of the prostate is performed. Four hours after surgery the nurse takes the client's VS and empties the urinary drainage bag. Which of the following assessment findings would indicate the need to notify the physician? A. Red bloody urine B. Urinary output of 200 ml greater than intake C. Blood pressure of 100/50 and pulse 130. D. Pain related to bladder spasms.

Correct Answer: D. Client's support system and understanding of lifestyle changes. The client undergoing renal transplantation will need vigilant follow-up care and must adhere to the medical regimen. For many people, getting a kidney transplant can feel like getting another chance at life. There are many great things that come with getting a kidney transplant, like having more time in the day and more freedom. There are also many things the client should consider in the life after transplant that involve taking care of the new kidney.

The client is to undergo kidney transplantation with a living donor. Which of the following preoperative assessments is important? A. Urine output B. Signs of graft rejection C. Signs and symptoms of infection D. Client's support system and understanding of lifestyle changes.

Correct Answer: D. Headache, deteriorating level of consciousness, and twitching. Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, and vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by the rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and the onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for: A. Hypertension, tachycardia, and fever. B. Hypotension, bradycardia, and hypothermia. C. Restlessness, irritability, and generalized weakness. D. Headache, deteriorating level of consciousness, and twitching.

Correct Answer: C. Avoid green, leafy vegetables such as spinach. Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. The more oxalate that is absorbed from the digestive tract, the more oxalate in the urine. Often a combination of calcium from foods or beverages with meals and fewer high-oxalate foods is required.

The client passes a urinary stone, and lab analysis of the stone indicates that it is composed of calcium oxalate. Based on this analysis, which of the following would the nurse specifically include in the dietary instructions? A. Increase intake of meat, fish, plums, and cranberries. B. Avoid citrus fruits and citrus juices. C. Avoid green, leafy vegetables such as spinach. D. Increase intake of dairy products.

Correct Answer: B. Frequent dressing changes around the Penrose drain. Frequent dressing changes around the Penrose drain is required to protect the skin against breakdown from urinary drainage. If urinary drainage is excessive, an ostomy pouch may be placed over the drain to protect the skin. Change the dressing 2 times every day and anytime it's wet or loose. It's best to change it around the same time every day.

The client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. A Penrose drain is in place. Which of the following would the nurse include in the client's postoperative care? A. Sterile irrigation of the Penrose drain. B. Frequent dressing changes around the Penrose drain. C. Weighing the dressings. D. Maintaining the client's position on the affected side.

Correct Answer: D. Decongestants In the client with BPH, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about the use of these medications if the client has urinary retention. Retention can also be precipitated by other factors, such as alcoholic beverages, infection, bedrest, and becoming chilled.

The client who has a cold is seen in the emergency room with inability to void. Because the client has a history of BPH, the nurse determines that the client should be questioned about the use of which of the following medications? A. Diuretics B. Antibiotics C. Antitussives D. Decongestants

Correct Answer: A. Bradycardia and confusion Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.

The client with BPH undergoes a transurethral resection of the prostate. Postoperatively, the client is receiving continuous bladder irrigations. The nurse assesses the client for signs of transurethral resection syndrome. Which of the following assessment data would indicate the onset of this syndrome? A. Bradycardia and confusion B. Tachycardia and diarrhea C. Decreased urinary output and bladder spasms D. Increased urinary output and anemia

Correct Answer: C. Place the client on a cardiac monitor. The client with hyperkalemia is at risk for developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. Observe ECG or telemetry for changes in rhythm. Changes in electromechanical function may become evident in response to progressing renal failure and accumulation of toxins and electrolyte imbalance. Peaked T wave, wide QRS, prolonged PR interval is usually associated with hyperkalemia.

The client with acute renal failure has a serum potassium level of 5.8 mEq/L. The nurse would plan which of the following as a priority action? A. Allow an extra 500 ml of fluid intake to dilute the electrolyte concentration. B. Encourage increased vegetables in the diet. C. Place the client on a cardiac monitor. D. Check the sodium level.

Correct Answer: D. Ensure that small clamps are attached to the AV shunt dressing. An AV shunt is a less common form of access site but carries a risk of bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein and the ends of the cannula are joined. If accidental connection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site to use if needed.

The client with an arteriovenous shunt in place for hemodialysis is at risk for bleeding. The nurse would do which of the following as a priority action to prevent this complication from occurring? A. Check the results of the PT time as they are ordered. B. Observe the site once per shift. C. Check the shunt for the presence of a bruit and thrill. D. Ensure that small clamps are attached to the AV shunt dressing.

Correct Answer: B. Soap A reusable appliance should be routinely cleaned with soap and water. Clean with warm water and pat dry. Use soap only if the area is covered with sticky stool. If the paste has collected on the skin, let it dry, then peel it off. Maintaining a clean and dry area helps prevent skin breakdown.

The client with an ileal conduit will be using a reusable appliance at home. The nurse should teach the client to clean the appliance routinely with what product? A. Baking soda B. Soap C. Hydrogen peroxide D. Alcohol

Correct Answer: B. Change the dressing. Clients with peritoneal dialysis catheters are at high risk for infection. A dressing that is wet is a conduit for bacteria to reach the catheter insertion site. The nurse assures that the dressing is kept dry at all times. A moist environment promotes bacterial growth. Purulent drainage at the insertion site suggests the presence of local infection.

The client with chronic renal failure has an indwelling catheter for peritoneal dialysis in the abdomen. The client spills water on the catheter dressing while bathing. The nurse should immediately: A. Reinforce the dressing. B. Change the dressing. C. Flush the peritoneal dialysis catheter. D. Scrub the catheter with povidone-iodine.

Correct Answer: B. calcium carbonate (Tums) Phosphate binding agents that contain aluminum include Alu-caps, Basaljel, and Amphojel. These products are made from aluminum hydroxide. Tums are made from calcium carbonate and also bind phosphorus. Tums are prescribed to avoid the occurrence of dementia-related to a high intake of aluminum. Phosphate binding agents are needed by the client in renal failure because the kidneys cannot eliminate phosphorus.

The client with chronic renal failure is at risk of developing dementia-related to excessive absorption of aluminum. The nurse teaches that this is the reason that the client is being prescribed which of the following phosphate binding agents? A. aluminum hydroxide (Alu-cap) B. calcium carbonate (Tums) C. aluminum hydroxide (Amphojel) D. aluminum hydroxide (Basaljel)

Correct Answer: D. Continue to monitor vital signs. The client may have an elevated temperature following dialysis because the dialysis machine warms the blood slightly. If the temperature is elevated excessively and remains elevated, sepsis would be suspected, and a blood sample would be obtained as prescribed for culture and sensitivity purposes.

The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment the nurse notes that the client's temperature is 100.2. Which of the following is the most appropriate nursing action? A. Encourage fluids. B. Notify the physician. C. Monitor the site of the shunt for infection. D. Continue to monitor vital signs.

Correct Answer: A. MOM can cause magnesium toxicity. Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems. The kidney has a vital role in magnesium homeostasis and, although the renal handling of magnesium is highly adaptable, this ability deteriorates when renal function declines significantly. In moderate chronic kidney disease (CKD), increases in the fractional excretion of magnesium largely compensate for the loss of glomerular filtration rate to maintain normal serum magnesium levels.

The client with chronic renal failure tells the nurse he takes magnesium hydroxide (milk of magnesia) at home for constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because: A. MOM can cause magnesium toxicity. B. MOM is too harsh on the bowel. C. Metamucil is more palatable. D. MOM is high in sodium.

Correct Answer: C. On return from dialysis Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and also from having the medication removed from the bloodstream by dialysis.

The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication: A. Just before dialysis. B. During dialysis. C. On return from dialysis. D. The day after dialysis.

Correct Answer: C. Struvite Struvite stones commonly are referred to as infection stones because they form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Struvite stones are also known as triple-phosphate (3 cations associated with 1 anion), infection (or infection-induced), phosphatic, and urease stones.

The client with urolithiasis has a history of chronic urinary tract infections. The nurse concludes that this client most likely has which of the following types of urinary stones? A. Calcium oxalate B. Uric acid C. Struvite D. Cystine

Correct Answer: A. Encourage the removal of serum urea. The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance. Warm dialysate to body temperature before infusing. Warming the solution increases the rate of urea removal by dilating peritoneal vessels. Cold dialysate causes vasoconstriction, which can cause discomfort and excessively lower the core body temperature, precipitating cardiac arrest.

The dialysis solution is warmed before use in peritoneal dialysis primarily to: A. Encourage the removal of serum urea. B. Force potassium back into the cells. C. Add extra warmth into the body. D. Promote abdominal muscle relaxation.

Correct Answer: B. Pallor, diminished pulse, and pain in the left hand. Steal syndrome results from vascular insufficiency after the creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, which is due to tissue ischemia. Ischemic steal syndrome (ISS) is a complication that can occur after the construction of a vascular access for hemodialysis. It is characterized by ischemia of the hand caused by marked reduction or reversal of flow through the arterial segment distal to the arteriovenous fistula (AVF).

The hemodialysis client with a left-arm fistula is at risk for steal syndrome. The nurse assesses this client for which of the following clinical manifestations? A. Warmth, redness, and pain in the left hand. B. Pallor, diminished pulse, and pain in the left hand. C. Edema and reddish discoloration of the left arm. D. Aching pain, pallor, and edema in the left arm.

Correct Answer: B. Elevated BUN level Increased BUN is usually an early indicator of decreased renal function. Although, immediately after a renal insult, blood urea nitrogen (BUN) or creatinine levels may be within the normal range. The only sign of the acute kidney injury may be a decline in urine output. AKI can lead to the accumulation of water, sodium, and other metabolic products. It can also result in several electrolyte disturbances.

The most common early sign of kidney disease is: A. Sodium retention B. Elevated BUN level C. Development of metabolic acidosis D. Inability to dilute or concentrate urine

Correct Answer: D. Prostate-specific antigen An elevated prostate-specific antigen level indicates prostate cancer, but it can be falsely elevated if done after the prostate gland is manipulated. Elevated Prostate Specific Antigen (PSA) levels (usually greater than 4 ng/ml) in the blood is how 80% of prostate cancers initially present even though elevated PSA levels alone correctly identify prostate cancer only about 25% to 30% of the time. We recommend at least 2 abnormal PSA levels or the presence of a palpable nodule on DRE to justify a biopsy and further investigation.

The most indicative test for prostate cancer is: A. A thorough digital rectal examination B. Magnetic resonance imaging (MRI) C. Excretory urography D. Prostate-specific antigen

Correct Answer: A. Excess fluid volume related to the kidney's inability to maintain fluid balance. Crackles in the lungs, weight gain, and elevated blood pressure are indicators of excess fluid volume, a common complication in chronic renal failure. The client's fluid status should be monitored carefully for imbalances on an ongoing basis. Renal disorder impairs glomerular filtration that results in fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces.

The nurse assesses the client who has chronic renal failure and notes the following: crackles in the lung bases, elevated blood pressure, and weight gain of 2 pounds in one day. Based on these data, which of the following nursing diagnoses is appropriate? A. Excess fluid volume related to the kidney's inability to maintain fluid balance. B. Increased cardiac output related to fluid overload. C. Ineffective tissue perfusion related to interrupted arterial blood flow. D. Ineffective Therapeutic Regimen Management related to lack of knowledge about therapy.

Correct Answer: B. Intake, output, and weight The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording intake and output and measuring weight daily. Ideally, the hemodialysis client should not gain more than 0.5 kg of weight per day. Measure all sources of I&O. Weigh routinely. Aids in evaluating fluid status, especially when compared with weight. Weight gain between treatments should not exceed 0.5 kg/day.

The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the client best understands the information given if the client states to record the daily: A. Pulse and respiratory rate B. Intake, output, and weight C. BUN and creatinine levels D. Activity log

Correct Answer: C. Low protein, low sodium, low potassium Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. Reducing sodium in the diet helps to control high blood pressure. It also keeps one from being thirsty and prevents the body from holding onto extra fluid.

The nurse helps the client with chronic renal failure develop a home diet plan with the goal of helping the client maintain adequate nutritional intake. Which of the following diets would be most appropriate for a client with chronic renal failure? A. High carbohydrate, high protein B. High calcium, high potassium, high protein C. Low protein, low sodium, low potassium D. Low protein, high potassium

Correct Answer: D. Encourage a high fluid intake. Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Monitor intake and output (I&O) carefully, measure liquid stool. Weigh regularly. Provides direct indicators of fluid balance. Greatest fluid losses occur with an ileostomy, but they generally do not exceed 500-800 mL/day.

The nurse is assessing the urine of a client who has had an ileal conduit and notes that the urine is yellow with a moderate amount of mucus. Based on the assessment data, which of the following nursing interventions would be most appropriate at this time? A. Change the appliance bag. B. Notify the physician. C. Obtain a urine specimen for culture. D. Encourage a high fluid intake.

Correct Answer: C. Lima beans Lima beans (1/3 c) averages three (3) mEq per serving. Each serving of lima beans provides nearly 11 grams of protein—slightly more than other types of beans. Lima beans have a glycemic index (GI) of about 46. (Foods with a GI of 55 or below are considered low glycemic foods.) The glycemic load of a 100-gram serving of lima beans is about 7.

The nurse is assisting a client on a low-potassium diet to select food items from the menu. Which of the following food items, if selected by the client, would indicate an understanding of this dietary restriction? A. Cantaloupe B. Spinach C. Lima beans D. Strawberries

Correct Answer: B. Administration of diuretics To increase urinary output, diuretics and osmotic agents are considered. The client should be monitored closely because fluid overload can cause hypertension, congestive heart failure, and pulmonary edema. Given early in the oliguric phase of ARF in an effort to convert to non-oliguric phase, flush the tubular lumen of debris, reduce hyperkalemia, and promote adequate urine volume.

The nurse is caring for a client following a kidney transplant. The client develops oliguria. Which of the following would the nurse anticipate to be prescribed as the treatment of oliguria? A. Encourage fluid intake B. Administration of diuretics C. Irrigation of Foley catheter D. Restricting fluids

Correct Answer: A, B, & C. Appropriate nursing diagnoses for clients with chronic renal failure include excess fluid volume related to fluid and sodium retention; imbalanced nutrition, less than body requirements related to anorexia, nausea, and vomiting; and activity intolerance related to fatigue.

The nurse is caring for a hospitalized client who has chronic renal failure. Which of the following nursing diagnoses are most appropriate for this client? Select all that apply. A. Excess Fluid Volume B. Imbalanced Nutrition; Less than Body Requirements C. Activity Intolerance D. Impaired Gas Exchange E. Pain

Correct Answer: B. Urine output, 20 ml/hour. The decrease in urinary output may indicate inadequate renal perfusion and should be reported immediately. Urine output of 30 ml/hour or greater is considered acceptable. There is a possibility that the kidney could become damaged during the surgical procedure. Every attempt will be made to minimize this risk.

The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. Which of the following findings would be most important for the nurse to report to the physician? A. Temperature, 99.8°F B. Urine output, 20 ml/hour C. Absence of bowel sounds D. A 2×2 inch area of serosanguineous drainage on the flank dressing.

Correct Answer: B. Avoid caffeine and alcohol. Client's with stress incontinence are encouraged to avoid substances such as caffeine and alcohol which are bladder irritants. Regardless of whether the patient desires any of the three options, all patients should receive counseling on lifestyle modifications. Bladder irritants to avoid include caffeinated beverages (coffee, tea, sodas) alcohol, citrus fruits, chocolate, tomato, spicy foods, and tobacco.

The nurse is developing a teaching plan for a client with stress incontinence. Which of the following instructions should be included? A. Avoid activities that are stressful and upsetting. B. Avoid caffeine and alcohol. C. Do not wear a girdle. D. Limit physical exertion.

Correct Answer: C & D The client with an ileal conduit must learn self-care activities related to the care of the stoma and ostomy appliances. The client should be taught to increase fluid intake to about 3,000 ml per day and should not limit intake. The ostomy appliance should be changed approximately every 3 to 7 days and whenever a leak develops. A skin barrier is essential to protecting the skin from the irritation of the urine.

The nurse is evaluating the discharge teaching for a client who has an ileal conduit. Which of the following statements indicates that the client has correctly understood the teaching? Select all that apply. A. "If I limit my fluid intake I will not have to empty my ostomy pouch as often." B. "I can place an aspirin tablet in my pouch to decrease odor." C. "I can usually keep my ostomy pouch on for 3 to 7 days before changing it." D. "I must use a skin barrier to protect my skin from urine." E. "I should empty my ostomy pouch of urine when it is full."

Correct Answer: B. Hyperglycemia An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis. Hypertonicity in these hyperglycemic episodes is almost always due exclusively to glucose gain. A rare manifestation of severe hyperglycemia in subjects on dialysis is the development of pulmonary edema, which is corrected after correction of hyperglycemia with insulin.

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the dwell time for the dialysis at the prescribed time because of the risk of: A. Infection B. Hyperglycemia C. Fluid overload D. Disequilibrium syndrome

Correct Answers: A, B, D, & E. Maintain a record of inflow and outflow volumes and cumulative fluid balance. In most cases, the amount drained should equal or exceed the amount instilled. A positive balance indicates a need of further evaluation.

The nurse is monitoring a client receiving peritoneal dialysis and the nurse notes that a client's outflow is less than the inflow. Which of the following actions will the nurse take. Select all that apply. A. Place the client in good body alignment. B. Check the level of the drainage bag. C. Contact the physician. D. Check the peritoneal dialysis system for kinks. E. Reposition the client to his or her side.

Correct Answer: A. Notify the physician Disequilibrium syndrome may be due to the rapid decrease in BUN levels during dialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments with anticonvulsant medications and barbiturates may be necessary to prevent a life-threatening situation. The physician must be notified.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of a headache and nausea and is extremely restless. Which of the following is the most appropriate nursing action? A. Notify the physician. B. Monitor the client. C. Elevate the head of the bed. D. Medicate the client for nausea.

Correct Answer: B. Maintain strict aseptic technique. The major complication of peritoneal dialysis is peritonitis. A strict aseptic technique is required in caring for the client receiving this treatment. Observe meticulous aseptic techniques and wear masks during catheter insertion, dressing changes, and whenever the system is opened. Change tubings per protocol. Prevents the introduction of organisms and airborne contamination that may cause infection.

The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? A. Monitor the client's level of consciousness. B. Maintain strict aseptic technique. C. Add heparin to the dialysate solution. D. Change the catheter site dressing daily.

Correct Answer: D. No special precautions except to wear gloves if in contact with the client's urine. No specific precautions are necessary following a renal scan. The nurse wears gloves to maintain body secretion precautions. The client should tell his doctor about any prescription or over-the-counter medications he is taking. Discuss how to use them before and during the test.

The nurse is preparing to care for the client following a renal scan. Which of the following would the nurse include in the plan of care? A. Place the client on radiation precautions for 18 hours. B. Save all urine in a radiation safe container for 18 hours. C. Limit contact with the client to 20 minutes per hour. D. No special precautions except to wear gloves if in contact with the client's urine.

Correct Answer: C. Nephrostomy tube A nephrostomy tube is put in place after percutaneous ultrasonic lithotripsy to treat calculuses in the renal pelvis. The client may also have a Foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect the elimination of the calculus fragments.

The nurse is receiving in transfer from the postanesthesia care unit a client who has had percutaneous ultrasonic lithotripsy for calculuses in the renal pelvis. The nurse anticipates that the client's care will involve monitoring which of the following? A. Suprapubic tube B. Urethral stent C. Nephrostomy tube D. Jackson-Pratt drain

Correct Answer: D. Increases osmotic pressure to produce ultrafiltration. Increasing the glucose concentration makes the solution increasingly more hypertonic. The more hypertonic the solution, the greater the osmotic pressure for ultrafiltration and thus the greater amount of fluid removed from the client during an exchange.

The nurse is reviewing a list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response knowing that the glucose: A. Prevents excess glucose from being removed from the client. B. Decreases risk of peritonitis. C. Prevents disequilibrium syndrome. D. Increased osmotic pressure to produce ultrafiltration.

Correct Answer: C. inhaled ipratropium (Atrovent) Atrovent is a bronchodilator, and its anticholinergic effects can aggravate urinary retention. Caution is necessary for the use of intranasal/inhaled ipratropium in patients with hypertrophic prostate. Ipratropium is an acetylcholine antagonist via blockade of muscarinic cholinergic receptors. Blocking cholinergic receptors decreases the production of cyclic guanosine monophosphate (cGMP). This decrease in the lung airways will lead to decreased contraction of the smooth muscles.

The nurse is reviewing a medication history of a client with BPH. Which medication should be recognized as likely to aggravate BPH? A. metformin (Glucophage) B. buspirone (BuSpar) C. inhaled ipratropium (Atrovent) D. ophthalmic timolol (Timoptic)

Correct Answer: C. Decreased force in the stream of urine Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur. Men with BPH are likely to report predominant symptoms of nocturia, poor stream, hesitancy, or prolonged micturition.

The nurse is taking the history of a client who has had benign prostatic hyperplasia in the past. To determine whether the client currently is experiencing difficulty, the nurse asks the client about the presence of which of the following early symptoms? A. Urge incontinence B. Nocturia C. Decreased force in the stream of urine D. Urinary retention

Correct Answer: C. Normal to low urine specific gravity Water diuresis causes low urine specific gravity, low urine osmolarity, and a normal to elevated serum sodium level. Water diuresis was accompanied by (i) a rapid increase in urea excretion during the phase of increasing urine flow, followed by a fall in later periods to values similar to those in non-diuresis, (ii) a slower increase in sodium output, continuing after the establishment of the constant water load, (iii) unchanged potassium excretion, but slightly increased ammonium outputs.

The nurse suspects that a client with polyuria is experiencing water diuresis. Which laboratory value suggests water diuresis? A. High urine specific gravity B. High urine osmolarity C. Normal to low urine specific gravity D. Elevated urine pH

Correct Answer: A. Urine reflux into the stoma. The most important reason for attaching the appliance to a standard urine collection bag at night is to prevent reflux into the stoma and ureters, which can result in infection. Unlike the Indiana pouch, the ileal conduit is not continent because of its small size. Urine is not collected and held in the pouch but continuously flows out of the stoma. An ileal conduit requires you to wear an external urostomy bag that adheres to the skin around the stoma and collects urine.

The nurse teaches the client with a urinary diversion to attach the appliance to a standard urine collection bag at night. The most important reason for doing this is to prevent: A. Urine reflux into the stoma. B. Appliance separation C. Urine leakage D. The need to restrict fluids.

Correct Answer: B. Maintain a daily fluid intake of 2,000 to 3,000 ml. Maintaining a fluid intake of 2,000 to 3,000 ml/day is likely to be effective in preventing UTI. A high fluid intake results in high urine output, which prevents urinary stasis and bacterial growth. Infections can occur when urine is not drained frequently or completely. They can also occur when the catheter is contaminated by the user's hands. Watch out for foul-smelling, cloudy, or dark urine as this is a common symptom.

The nurse teaches the client with an ileal conduit measure to prevent a UTI. Which of the following measures would be most effective? A. Avoid people with respiratory tract infections. B. Maintain a daily fluid intake of 2,000 to 3,000 ml. C. Use sterile technique to change the appliance. D. Irrigate the stoma daily.

Correct Answer: D. "I'll take it with meals and bedtime snacks." Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. Aluminum hydroxide when used as an antacid is to be delivered orally. Shake the aluminum hydroxide suspension well before use. It should be taken 5 to 6 times daily after meals and at bedtime, not to exceed 3.84 g per 24 hours. The patient should follow the dose with water intake.

The nurse teaches the client with chronic renal failure when to take the aluminum hydroxide gel. Which of the following statements would indicate that the client understands the teaching? A. "I'll take it every four (4) hours around the clock." B. "I'll take it between meals and at bedtime." C. "I'll take it when I have a sour stomach." D. "I'll take it with meals and bedtime snacks."

Correct Answer: C. To produce a secretion that aids in the nourishment and passage of sperm. The prostate gland is located below the bladder and surrounds the urethra. It serves one primary purpose: to produce a secretion that aids in the nourishment and passage of sperm. The prostate gland is situated in the true pelvis and plays a supportive role in the male reproductive system. Its principal purpose is to secrete an alkaline solution protective for sperm in the acidic environment of the vagina.

The primary function of the prostate gland is: A. To store underdeveloped sperm before ejaculation. B. To regulate the acidity and alkalinity of the environment for proper sperm development. C. To produce a secretion that aids in the nourishment and passage of sperm. D. To secrete a hormone that stimulates the production and maturation of sperm.

Correct Answer: A. Eliminate pressure at the penoscrotal angle The primary reason for taping an indwelling catheter to a male client is so the penis is held in a lateral position to prevent pressure at the penoscrotal angle. Prolonged pressure at the penoscrotal angle can cause a urethrocutaneous fistula.

The primary reason for taping an indwelling catheter laterally to the thigh of a male client is to: A. Eliminate pressure at the penoscrotal angle. B. Prevent the catheter from kinking in the urethra. C. Prevent accidental catheter removal. D. Allow the client to turn without kinking the catheter.

Correct Answer: A. 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. Albumin is a protein that acts like a sponge, drawing extra fluid from the body into the bloodstream where it remains until removed by the kidneys. When albumin leaks into the urine, the blood loses its capacity to absorb extra fluid from the body, causing edema.

What change indicates recovery in a patient with nephrotic syndrome? A. Disappearance of protein from the urine. B. Decrease in blood pressure to normal. C. Increase in serum lipid levels. D. Gain in body weight.

Correct Answer: A. 15 minutes Dialysate should be infused quickly. The dialysate should be infused over 15 minutes or less when performing peritoneal dialysis. The fluid exchange takes place over a period ranging from 30 minutes to several hours. Each exchange takes about 30 to 40 minutes. During an exchange, yothe client can read, talk, watch television, or sleep. With CAPD, the client can keep the solution in the belly for 4 to 6 hours or more. The time that the dialysis solution is in the belly is called the dwell time. Usually, the client changes the solution at least four times a day and sleep with solution in the belly at night

What is the appropriate infusion time for the dialysate in your 38 y.o. patient with chronic renal failure undergoing peritoneal dialysis? A. 15 minutes B. 30 minutes C. 1 hour D. 2 to 3 hours

Correct Answer: D. Palpate the fistula throughout its length to assess for a thrill. The vibration or thrill felt during palpation ensures that the fistula has the desired turbulent blood flow. Assess for patency at least every 8 hours. Palpate the vascular access to feel for a thrill or vibration that indicates arterial and venous blood flow and patency. Auscultate the vascular access with a stethoscope to detect a bruit or "swishing" sound that indicates patency.

What is the best way to check for patency of the arteriovenous fistula for hemodialysis? A. Pinch the fistula and note the speed of filling on release. B. Use a needle and syringe to aspirate blood from the fistula. C. Check for capillary refill of the nail beds on that extremity. D. Palpate the fistula throughout its length to assess for a thrill.

Correct Answer: B. Fluid volume excess Kidneys are unable to rid the body of excess fluids which results in fluid volume excess during ESRD. Renal disorder impairs glomerular filtration that results in fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces. Since fluids are not reabsorbed at the venous end, fluid volume overloads the lymph system and stays in the interstitial spaces.

What is the most important nursing diagnosis for a patient in end-stage renal disease? A. Risk for injury B. Fluid volume excess C. Altered nutrition: less than body requirements D. Activity intolerance

Correct Answer: C. It is a time-consuming method of treatment. The disadvantages of peritoneal dialysis in the long-term management of chronic renal failure are that it requires large blocks of time. With CCPD, which may also be called automated peritoneal dialysis (APD), a machine called an automated cycler performs three to five exchanges at night while the patient sleeps. This gives patients more flexibility during the day, but they must remain attached to the machine for 10 to 12 hours at night. In the morning, they begin one exchange with a dwell time that lasts the entire day.

What is the primary disadvantage of using peritoneal dialysis for long-term management of chronic renal failure? A. The danger of hemorrhage is high. B. It cannot correct severe imbalances. C. It is a time-consuming method of treatment. D. The risk of contracting hepatitis is high.

Correct Answer: B. Fluid volume excess Fluid volume excess because the kidneys aren't removing fluid and wastes. The other diagnoses may apply, but they don't take priority. Renal disorder impairs glomerular filtration that results in fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces.

What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease? A. Activity intolerance B. Fluid volume excess C. Knowledge deficit D. Pain

Correct Answer: C. Activities that increase abdominal pressure Stress incontinence is the involuntary loss of urine during such activities as coughing, sneezing, laughing, or physical exertion. These activities increase abdominal and detrusor pressure. Precipitating activities include coughing, laughing, sneezing, straining, or exercising. The patient may initially present with urinary complaints of dysuria, frequency, and urgency.

When developing a plan of care for the client with stress incontinence, the nurse should take into consideration that stress incontinence is best defined as the involuntary loss of urine associated with: A. A strong urge to urinate. B. Overdistention of the bladder. C. Activities that increase abdominal pressure. D. Obstruction of the urethra.

Correct Answer: D. High-purine To control uric acid calculi, the client should follow a low-purine diet, which excludes high-purine foods such as organ meats. To prevent uric acid stones, cut down on high-purine foods such as red meat, organ meats, and shellfish, and follow a healthy diet that contains mostly vegetables and fruits, whole grains, and low-fat dairy products.

When providing discharge teaching for a client with uric acid calculi, the nurse should make an instruction to avoid which type of diet? A. Low-calcium B. Low-oxalate C. High-oxalate D. High-purine

Correct Answer: D. Separation of the appliance from the skin If the appliance becomes too full, it is likely to pull away from the skin completely or to leak urine onto the skin. Empty, irrigate, and cleanse ostomy pouch on a routine basis, using appropriate equipment. Frequent pouch changes are irritating to the skin and should be avoided. Emptying and rinsing the pouch with the proper solution not only removes bacteria and odor-causing stool and flatus but also deodorizes the pouch.

When teaching the client to care for an ileal conduit, the nurse instructs the client to empty the appliance frequently, primarily to prevent which of the following problems? A. Rupture of the ileal conduit. B. Interruption of urine production. C. Development of odor. D. Separation of the appliance from the skin.

Correct Answer: B. Set up specific times to empty the bladder. Instruct the patient with a neurogenic bladder to write down his voiding pattern and empty the bladder at the same times each day. Offer an opportunity to void every 1 to 2 hours, even if the urge to void is not felt. Intervals may be based on a shorter time than exist in continent voiding.

Which action is most important during bladder training in a patient with a neurogenic bladder? A. Encourage the use of an indwelling urinary catheter. B. Set up specific times to empty the bladder. C. Encourage Kegel exercises. D. Force fluids.

Correct Answer: B. Hypervolemia Acute renal failure causes hypervolemia as a result of overexpansion of extracellular fluid and plasma volume with the hypersecretion of renin. Therefore, hypervolemia causes hypertension. Fluid overload leads to endothelial dysfunction due to inflammation and ischemia-reperfusion injury, causing damage to glycocalyx and capillary leakage. Capillary leakage leads to interstitial edema and at the same time, due to significant loss of volume to the interstitial compartment, there is reduction in circulating intravascular volume. This may then lead to reduction in renal perfusion pressure and subsequently to AKI.

Which cause of hypertension is the most common in acute renal failure? A. Pulmonary edema B. Hypervolemia C. Hypovolemia D. Anemia

Correct Answer: A. The patient must be hemodynamically stable. Hemodynamic stability must be established before continuous peritoneal dialysis can be started. Starting dialysis with a PDC is preferable to an HDC in terms of patient morbidity, mortality, and cost. It has also been shown in large observational retrospective studies that there is a survival advantage for PD over HD in the first 1 to 3 years of dialysis.

Which criterion is required before a patient can be considered for continuous peritoneal dialysis? A. The patient must be hemodynamically stable. B. The vascular access must have healed. C. The patient must be in a home setting. D. Hemodialysis must have failed.

Correct Answer: A. Narcotic analgesics Narcotic analgesics are usually needed to relieve the severe pain of renal calculi. Narcotic analgesics act at the central nervous system (CNS) mu receptors and are commonly used in the treatment of renal colic. They are inexpensive and proven effective. Disadvantages include sedation, respiratory depression, smooth muscle spasm, and potential for abuse and addiction.

Which drug is indicated for pain related to acute renal calculi? A. Narcotic analgesics B. Nonsteroidal anti-inflammatory drugs (NSAIDS) C. Muscle relaxants D. Salicylates

Correct Answer: C. Hypertension, oliguria, and fatigue Mild to moderate HTN may result from sodium or water retention and inappropriate renin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia. The term "glomerulonephritis" encompasses a subset of renal diseases characterized by immune-mediated damage to the basement membrane, mesangium, or the capillary endothelium, leading to hematuria, proteinuria, and azotemia.

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

Correct Answer: D. After painful urination is relieved, stop taking phenazopyridine. Pyridium is taken to relieve dysuria because it provides an analgesic and anesthetic effect on the urinary tract mucosa. The patient can stop taking it after the dysuria is relieved. Symptomatic treatment with analgesics may be used in patients who present with severe dysuria. Phenazopyridine is a urinary analgesic used in short-term treatment of urinary dysuria or discomfort.

Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium)? A. If the urine turns orange-red, call the doctor. B. Take phenazopyridine just before urination to relieve pain. C. Once painful urination is relieved, discontinue prescribed antibiotics. D. After painful urination is relieved, stop taking phenazopyridine.

Correct Answer: D. 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. Strain all urine. Document any stones expelled and sent to the laboratory for analysis. Retrieval of calculi allows identification of the type of stone and influences choice of therapy.

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

Correct Answer: B. The client's history of three full-term pregnancies The history of three pregnancies is most likely the cause of the client's current episodes of stress incontinence. The client's fluid intake, age, or history of swimming would not create an increase in intra-abdominal pressure. Stress urinary incontinence affects 15.7% of adult women; 77.5% of women report the symptoms to be bothersome and 28.8% report the symptoms to be moderate to severe.

Which of the following assessment data would most likely be related to a client's current complaint of stress incontinence? A. The client's intake of 2 to 3 L of fluid per day. B. The client's history of three full-term pregnancies. C. The client's age of 45 years. D. The client's history of competitive swimming.

Correct Answer: C. 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. A major risk factor for UTI is the use of a catheter. In addition, manipulation of the urethra is also a risk factor. UTI is very common after a kidney transplant; the two triggers include the use of immunosuppressive drugs and vesicoureteral reflux. Other risk factors include the use of antibiotics and diabetes mellitus.

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

Correct Answer: D. A client with diabetes who has a heart catheterization Clients with diabetes are prone to renal insufficiency and renal failure. The contrast used for heart catheterization must be eliminated by the kidneys, which further stresses them and may produce acute renal failure. The development of Acute Kidney Injury (AKI) following cardiac catheterization or Percutaneous Coronary Interventions (PCI) is a serious complication. Around 10% to 15% of patients develop AKI after coronary interventions.

Which of the following clients is at greatest risk for developing acute renal failure? A. A dialysis client who gets influenza. B. A teenager who has an appendectomy. C. A pregnant woman who has a fractured femur. D. A client with diabetes who has a heart catheterization.

Correct Answer: D. Accumulation of waste products Although clients with renal failure can develop stress ulcers, the nausea is usually related to the poisons of metabolic wastes that accumulate when the kidneys are unable to eliminate them. Nausea and vomiting are very common in kidney patients and have many causes. These causes include the build-up of uremic toxins, medications, gastroparesis, ulcers, gastroesophageal reflux disease, gallbladder disease, and many many more.

Which of the following factors causes the nausea associated with renal failure? A. Oliguria B. Gastric ulcers C. Electrolyte imbalances D. Accumulation of waste products

Correct Answer: A. Encourage the client to ambulate every two (2) to four (4) hours. Ambulation stimulates peristalsis. A client with paralytic ileus is kept NPO until peristalsis returns. Encouraging ambulation very early in the postoperative period is a simple but very important prevention and treatment measure. Regular and serial clinical assessments should be exerted with open eyes and mind for worsening complications or a missed diagnosis.

Which of the following interventions would be most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery? A. Encourage the client to ambulate every 2 to 4 hours. B. Offer 3 to 4 ounces of a carbonated beverage periodically. C. Encourage use of a stool softener. D. Continue intravenous fluid therapy.

Correct Answer: B. Monitor the client's blood pressure. Because hypotension is a complication of peritoneal dialysis, the nurse records intake, and output, monitors VS, and observes the client's behavior. Monitor BP (lying and sitting) and pulse. Note level of jugular pulsation. Decreased BP, postural hypotension, and tachycardia are early signs of hypovolemia

Which of the following nursing interventions should be included in the client's care plan during dialysis therapy? A. Limit the client's visitors. B. Monitor the client's blood pressure. C. Pad the side rails of the bed. D. Keep the client NPO.

Correct Answer: B. Costovertebral angle tenderness and chills Costovertebral angle tenderness, flank pain, and chills are symptoms of acute pyelonephritis. Acute pyelonephritis is a bacterial infection causing inflammation of the kidneys. Pyelonephritis occurs as a complication of an ascending urinary tract infection which spreads from the bladder to the kidneys. Symptoms usually include fever, flank pain, nausea, vomiting, burning with urination, increased frequency, and urgency.

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

Correct Answer: C. Weight gain, pain at graft site Pain at the graft site and weight gain indicates the transplanted kidney isn't functioning and possibly is being rejected. In general, when transplanting tissue or cells from a genetically different donor to the graft recipient, the alloantigen of the donor induces an immune response in the recipient against the graft. This response can destroy the graft if not controlled. The whole process is called allograft rejection.

Which of the following symptoms indicate acute rejection of a transplanted kidney? A. Edema, Nausea B. Fever, Anorexia C. Weight gain, pain at graft site D. Increased WBC count, pain with voiding

Correct Answer: C. Painless hematuria Painless hematuria is the most common clinical finding in bladder cancer. Other symptoms include frequency, dysuria, and urgency, but these are not as common as the hematuria. Bladder carcinoma (BC) is the most common neoplasm of the urinary system. Urothelial carcinoma (UC) is the most common histologic type of BC (approximately 90%). The definition of UC is the invasion of the basement membrane or lamina propria or deeper by neoplastic cells of urothelial origin.

Which of the following symptoms is the most common clinical finding associated with bladder cancer? A. Suprapubic pain B. Dysuria C. Painless hematuria D. Urinary retention

Correct Answer: C. A 50 y.o. postmenopausal woman Women are more prone to UTIs after menopause due to reduced estrogen levels. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli bacteria, which protect against infection. Premenopausal women have large concentrations of lactobacilli in the vagina and prevent the colonization of uropathogens. However, the use of antibiotics can erase this protective effect.

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

Correct Answer: A. Daily doubling of urine output (4 to 5 L/day). Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (diuresis) of acute renal failure. The GFR is stable albeit at a level determined by the severity of the initial event. This cellular repair and reorganization phase results in slowly improving cellular function and sets the stage for improvement in organ function.

Which sign indicates the second phase of acute renal failure? A. Daily doubling of urine output (4 to 5 L/day). B. Urine output less than 400 ml/day. C. Urine output less than 100 ml/day. D. Stabilization of renal function.

Correct Answer: C. With prerenal failure, an IV isotonic saline infusion increases urine output. Prerenal failure is caused by such conditions as hypovolemia that impairs kidney perfusion; giving isotonic fluids improves urine output. Vasoactive substances can increase blood pressure in both conditions. The cells in the macula densa are sensitive to the increased delivery of NaCl and activate Type 2 adenosine receptors resulting in vasoconstriction of the glomerular arterioles and retraction of glomerular tufts. As a consequence urine output is decreased and urinary excretion of sodium is reduced providing a diagnostic flag of the tubular ischemic process.

Which statement correctly distinguishes renal failure from prerenal failure? A. With prerenal failure, vasoactive substances such as dopamine (Intropin) increase blood pressure. B. With prerenal failure, there is less response to such diuretics as furosemide (Lasix). C. With prerenal failure, an IV isotonic saline infusion increases urine output. D. With prerenal failure, hemodialysis reduces the BUN level.

Correct Answer: B. 400ml Oliguria is defined as urine output of less than 400ml/24hours. Renal causes of oliguria arise as a result of tubular damage. As a result of the tubular damage, the kidney loses its normal function i.e., production of urine while excreting the waste metabolites. In addition to this, direct damage to the renal tubules leads to a back leak of filtered uremic metabolites from the tubular lumen into the bloodstream. Hence, in these cases, decreased production of urine leads to oliguria.

You expect a patient in the oliguric phase of renal failure to have a 24 hour urine output less than: A. 200ml B. 400ml C. 800ml D. 1000ml

Correct Answer: A. 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. Renal stone disease is a common problem in patients with spinal cord injury. The factors responsible are thought to include hypercalciuria and chronic urinary infection. The urine of all stone patients was oversaturated with calcium phosphate for part of each day. Urinary calcium was elevated in 16% and plasma urate in 30% of the paraplegics studied.

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

Correct Answer: A. Check for kinks in the outflow tubing. Tubing problems are a common cause of outflow difficulties, check the tubing for kinks and ensure that all clamps are open. Other measures include having the patient change positions (moving side to side or sitting up), applying gentle pressure over the abdomen, or having a bowel movement. Assess the patency of catheter, noting difficulty in draining. Note the presence of fibrin strings and plugs. Slowing of flow rate and presence of fibrin suggests partial catheter occlusion requiring further evaluation and intervention.

You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining? A. Check for kinks in the outflow tubing. B. Raise the drainage bag above the level of the abdomen. C. Place the patient in a reverse Trendelenburg position. D. Ask the patient to cough.

Correct Answer: B. "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. Symptoms of uncomplicated UTI are pain on urination (dysuria), frequent urination (frequency), inability to start the urine stream (hesitation), sudden onset of the need to urinate (urgency), and blood in the urine (hematuria). Usually, patients with uncomplicated UTI do not have fever, chills, nausea, vomiting, or back pain, which are signs of kidney involvement or upper tract disease/pyelonephritis.

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

Correct Answer: C. Fever, weight gain, and diminished urine output. Symptoms of rejection include fever, rapid weight gain, hypertension, pain over the graft site, peripheral edema, and diminished urine output. Kidney transplantation is the treatment of choice in patients with end-stage renal disease or severe chronic kidney disease as it improves the quality of life and has better survival advantages compared to dialysis. Various factors merit consideration to match the donor kidney with the recipient, as the donor kidney acts as an alloantigen.

You suspect kidney transplant rejection when the patient shows which symptoms? A. Pain in the incision, general malaise, and hypotension. B. Pain in the incision, general malaise, and depression. C. Fever, weight gain, and diminished urine output. D. Diminished urine output and hypotension.

Correct Answer: A. Remain afebrile and have negative cultures. The immunosuppressive activity of cyclosporine places the patient at risk for infection, and steroids can mask the signs of infection. The patient's BUN creatinine ratio, magnesium levels, and blood pressure require monitoring while on therapy. Uric acid monitoring is debatable. Therapeutic monitoring of cyclosporine in transplant patients is a valuable tool in adjusting drug dosage to prevent acute rejection, nephrotoxicity, and predictable dose-dependent adverse reactions.

You're developing a care plan with the nursing diagnosis risk for infection for your patient that received a kidney transplant. A goal for this patient is to: A. Remain afebrile and have negative cultures. B. Resume normal fluid intake within 2 to 3 days. C. Resume the patient's normal job within 2 to 3 weeks. D. Try to discontinue cyclosporine (Neoral) as quickly as possible.

Correct Answer: C. "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 will most likely darken the color of the urine to an orange or red color. This is a normal effect and is not harmful. Darkened urine may also cause stains to the underwear that may be permanent.

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

Correct Answer: D. Delay catheterization and notify the doctor. Bleeding at the urethral meatus is evidence that the urethra is injured. Because catheterization can cause further harm, consult with the doctor. Urethral trauma can occur due to pelvic and perineal injuries or iatrogenic trauma to the urethra. Urethral bleeding as one of the complications of urethral trauma is not usually life-threatening, nevertheless it can be very embarrassing.

You're preparing for urinary catheterization of a trauma patient and you observe bleeding at the urethral meatus. Which action has priority? A. Irrigate and clean the meatus before catheterization. B. Check the discharge for occult blood before catheterization. C. Heavily lubricate the catheter before insertion. D. Delay catheterization and notify the doctor.

Correct Answer: B. Fluid volume deficit related to inability to conserve water Monitor and document vital signs especially BP and HR. Decrease in circulating blood volume can cause hypotension and tachycardia. Alteration in HR is a compensatory mechanism to maintain cardiac output. Usually, the pulse is weak and may be irregular if electrolyte imbalance also occurs. Hypotension is evident in hypovolemia.

Your 60 y.o. patient with pyelonephritis and possible septicemia has had five UTIs over the past two years. She is fatigued from lack of sleep, has lost weight, and urinates frequently even in the night. Her labs show: sodium, 154 mEq/L; osmolarity 340 mOsm/L; glucose, 127 mg/dl; and potassium, 3.9 mEq/L. Which nursing diagnosis is a priority? A. Fluid volume deficit related to osmotic diuresis induced by hyponatremia B. Fluid volume deficit related to inability to conserve water C. Altered nutrition: Less than body requirements related to hypermetabolic state D. Altered nutrition: Less than body requirements related to catabolic effects of insulin deficiency

Correct Answer: B. Disequilibrium syndrome Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the blood. This can lead to cerebral edema and increased intracranial pressure (ICP). Signs and symptoms include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.

Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect? A. Infection B. Disequilibrium syndrome C. Air embolism D. Acute hemolysis

Correct Answer: D. Taking a blood pressure reading on the affected arm can cause clotting of the fistula. Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking blood pressure on the affected arm. For the most effective hemodialysis, the patient needs good vascular access with an arteriovenous (AV) fistula or an AV graft that provides adequate blood flow. To prevent injuries, place an armband on the patient or a sign over the bed that says no BP measurements, venipunctures, or injections on the affected side. When blood flow through the vascular access is reduced, it can clot.

Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is important for providing care for the patient? A. The patient shouldn't feel pain during the initiation of dialysis. B. The patient feels best immediately after the dialysis treatment. C. Using a stethoscope for auscultating the fistula is contraindicated. D. Taking a blood pressure reading on the affected arm can cause clotting of the fistula.

Correct Answer: A. Pain radiating to the right upper quadrant. Patients with renal calculi will most likely report acute, severe flank pain that will often radiate to the abdomen and especially to the groin, testicle, and labia. It is often sharp and severe in nature. It may also be colicky. The pain is often associated with nausea and vomiting which is due to the embryological origins of the urogenital tract.

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? A. Pain radiating to the right upper quadrant. B. History of mild flu symptoms last week. C. Dark-colored coffee-ground emesis. D. Dark, scanty urine output.

Correct Answer: B. Infuse normal saline solution Treatment includes administering normal saline or hypertonic normal saline solution because muscle cramps can occur when the sodium and water are removed too quickly during dialysis. Saline and/or dextrose solutions, electrolytes, and NaHCO3 may be infused in the venous side of continuous arteriovenous (CAV) hemofilter when high ultrafiltration rates are used for removal of extracellular fluid and toxic solutes. Volume expanders may be required during or following hemodialysis if sudden or marked hypotension occurs.

Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps? A. Increase the rate of dialysis. B. Infuse normal saline solution. C. Administer a 5% dextrose solution. D. Encourage active ROM exercises.

Correct Answer: C. Oliguria Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal failure. In patients with acute oliguria, one of the most common functional derangements that are observed is the sudden fall in the GRF, leading to acute renal failure. It results in rapid increment in plasma urea and creatinine levels, metabolic acidosis with hyperkalemia, other electrolyte abnormalities, and volume overload.

Your patient returns from the operating room after abdominal aortic aneurysm repair. Which symptom is a sign of acute renal failure? A. Anuria B. Diarrhea C. Oliguria D. Vomiting

Correct Answer: D. Keep fingernails short and clean. Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation and breaks in the skin that increase the patient's risk of infection. Keeping fingernails short and clean helps reduce the risk of infection. Although dialysis has largely eliminated skin problems associated with uremic frost, itching can occur because the skin is an excretory route for waste products such as phosphate crystals (associated with hyperparathyroidism in ESRD).

Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient's teaching plan? A. Rub the skin vigorously with a towel. B. Take frequent baths. C. Apply alcohol-based emollients to the skin. D. Keep fingernails short and clean.