NCLEX Renal, Urinary and Reproductive systems

You're providing care to a patient with a uric acid kidney stone that is 2 mm in size per diagnostic imaging. The patient is having severe pain and rates their pain 10 on 1-10 scale. The physician has ordered a treatment plan to assist the patient in passing the kidney stone. What nursing intervention is PRIORITY for this patient based on the scenario? A. Administer pain medication B. Encourage fluid intake of 2-4 liters per day C. Massage the costovertebral area D. Implement a high protein diet

A. Administer pain medication

A nurse is caring for a client who recently had a kidney transplant. Which priority assessment finding requires follow up by the nurse? A. Fever B. Hematuria C. Moon facies D. Yellow sclera

A. Fever

You are providing pre-op teaching to a patient scheduled for a percutaneous nephrolithotomy. Which statement by the patient demonstrates the patient understood the pre-op teaching? A. "During the procedure the surgeon will move the stone down the ureter, so I can pass the stone in the urine. B. "I may have a nephrostomy tube after the procedure." C. "A scope is inserted through the urinary system from the urethra to the kidneys to assess the kidney stone." D. "This procedure is noninvasive and no incision is required."

B. "I may have a nephrostomy tube after the procedure."

A client seeks help for dealing with incontinence. A nursing intervention is to teach Kegel exercises. Which type of incontinence is the client most likely experiencing? A. Reflex incontinence B. Stress incontinence C. Overflow incontinence D. Functional incontinence

B. Stress incontinence

The nurse is caring for an older adult client. Which genitourinary factor that contributes to urinary incontinence in older adults should the nurse consider when planning care? A. Sensory deprivation B. Urinary tract infection C. Frequent use of diuretics D. Inaccessibility of a bathroom

B. Urinary tract infection

The nurse is caring for a client 4 days after the client had a cystectomy and formation of an ileal conduit. After observing mucous threads in the client's urine, what should the nurse do? A. Recognize that this is an expected response. B. Obtain a specimen for culture and sensitivity. C. Report this to the primary healthcare provider immediately. D. Increase the client's fluid intake for the next 12 hours.

A. Recognize that this is an expected response.

Which component of the client's nephron acts as a receptor site for the antidiuretic hormone and regulates water balance? A. Collecting ducts B. Bowman's capsule C. Distal convoluted tubule D. Proximal convoluted tubule

A. Collecting ducts

While reviewing the result of an intravenous pyelogram, the nurse discovers that the client has a shortened urethra. The client also complains of urinary incontinence. Which nursing intervention is beneficial for the client? A. Providing thorough perineal care after each voiding B. Encouraging the client to use the toilet or bedpan every 2 hours C. Responding quickly to the client's indication of the need to void D. Providing privacy, assistance, and voiding stimulants over the perineum

A. Providing thorough perineal care after each voiding

A nurse is evaluating a client's response to fluid replacement therapy. Which clinical finding indicates successful replacement? A. Urinary output of 30 mL in an hour B. Central venous pressure reading of 1.5 mm Hg C. Baseline pulse rate of 120 beats/min that decreases to 110 beats/min within a 15-minute period D. Baseline blood pressure of 50/30 mm Hg that increases to 70/40 mm Hg within a 30-minute period

A. Urinary output of 30 mL in an hour

The registered nurse (RN) is teaching a nursing student about the care given to a female client before a prostate antigen-specific test. Which statement of the nursing student indicates a need for further teaching? A. "I will observe breast changes in the client." B. "I will ask if the client is having her menstrual cycle." C. "I will observe the venipuncture site for hematoma." D. "I will ask the client to have nothing by mouth (NPO)."

D. "I will ask the client to have nothing by mouth (NPO)."

The client is scheduled for an abdominal hysterectomy with a bilateral oophorectomy. As the nurse prepares to have the client sign the informed consent, the client asks how long she should wait to become pregnant. Which action should the nurse take? A. Have the client sign the informed consent form. B. Ask the client if she understands what the surgery entails. C. Tell the client that she will not be able to get pregnant after the surgery. D. Call the primary healthcare provider immediately and hold preoperative medications.

D. Call the primary healthcare provider immediately and hold preoperative medications.

A client is admitted to the hospital with a tentative diagnosis of urinary retention related to benign prostatic hyperplasia. The primary healthcare provider notes a secondary diagnosis of delirium related to urosepsis and prescribes the insertion of an indwelling urinary retention catheter. Which nursing action is most important at this time? A. Secure a prescription for wrist restraints. B. Orient the client to time, place, and person. C. Involve family members in the client's care. D. Determine whether any unsafe behavior patterns exist.

D. Determine whether any unsafe behavior patterns exist.

A client has end-stage kidney disease and is admitted for a kidney transplant. Which information should the nurse share when teaching about the donor? A. Must have the same blood type B. Must be a member of the same family C. Must be approximately the same body size D. Must have matching leukocyte antigen complexes

D. Must have matching leukocyte antigen complexes

A client is diagnosed with pheochromocytoma. Which finding in the urinalysis report supports the diagnosis? A. Sodium - 200 mmol/24 hr B. Calcium - 5.6 mmol/24 hr C. Urea nitrogen - 0.5 mmol/24 hr D. Total catecholamines - 640 mmol/24 hr

D. Total catecholamines - 640 mmol/24 hr

A client who is suspected of having Cushing syndrome is admitted to the hospital. When checking the laboratory reports, which condition should the nurse expect? A. Hypokalemia B. Hypovolemia C. Hypocalcemia D. Hyponatremia

A. Hypokalemia

A client with an invasive carcinoma of the bladder is receiving radiation to the lower abdomen in an attempt to shrink the tumor before surgery. What should the nurse do, considering the side effects of radiation? A. Observe the feces for the presence of blood. B. Monitor the blood pressure for hypertension. C. Administer enemas to remove sloughing tissue. D. Provide a high-bulk diet to prevent constipation.

A. Observe the feces for the presence of blood.

What should the nurse monitor for when caring for a postoperative client who presents with 180 mL of urine in the urinary drainage bag from the past 8 hours? A. Renal failure B. Liver cirrhosis C. Diabetes mellitus D. Rheumatoid arthritis

A. Renal failure

After interacting with a client, a nurse finds that a 23-year-old client has never undergone a Papanicolaou (Pap) test. What should the nurse suggest to the client? A. Schedule a Pap test immediately B. Schedule a Pap test during menses C. Schedule a Pap test every five years D. Schedule a Pap test and human papillomavirus test

A. Schedule a Pap test immediately

A client reports to a health clinic because a sexual partner recently was diagnosed as having gonorrhea. The health history reveals that the client has engaged in receptive anal intercourse. What should the nurse assess for in this client? A. Melena B. Anal itching C. Constipation D. Ribbon-shaped stools

B. Anal itching

Your patient arrives back to their room after having extracoporeal shock wave lithotripsy (ESWL) for treatment of a kidney stone. What will be included in the patient's plan of care? SELECT-ALL-THAT-APPLY: A. Keep the patient in bed B. Encourage fluid intake of 3-4 liters per day C. Maintain nephrostomy tube D. Strain urine E. Keep dressing dry and intact

B. Encourage fluid intake of 3-4 liters per day D. Strain urine

A client with chronic kidney disease is receiving medication to manage anemia. Which primary goal should the nurse include in the care plan from this information? A. Prevention of uremic frost B. Prevention of chronic fatigue C. Prevention of tubular necrosis D. Prevention of dependent edema

B. Prevention of chronic fatigue

Which dietary suggestion should the nurse provide while teaching a group of geriatric female clients who have reduced amounts of circulating estrogen? A. "Include fish in your diet." B. "Include fruits in your diet." C. "Include yogurt in your diet." D. "Include legumes in your diet."

C. "Include yogurt in your diet."

Which patient below is at MOST risk for developing uric acid type kidney stones? A. A 53 year old female with recurrent urinary tract infections. B. A 6 year old male with cystinuria. C. A 63 year male with gout. D. A 25 year old female that follows a vegan diet and report eating high amounts of spinach and strawberries on a regular basis.

C. A 63 year male with gout.

During percussion of the client's bladder, the primary healthcare provider hears sounds as high up as the umbilicus. While caring for this client, the nurse provides privacy, assistance, and voiding stimulants as needed. What other action should the nurse perform while caring for this client? A. Administer potentially nephrotoxic agents B. Evaluate the client's history for steroid therapy C. Evaluate the client's history for anticholinergic therapy D. Administer nonsteroidal antiinflammatory drugs (NSAIDs)

C. Evaluate the client's history for anticholinergic therapy

A client with the diagnosis of chronic kidney disease develops hypocalcemia. Which clinical manifestations should the nurse expect the client with hypocalcemia to exhibit? Select all that apply. A. Acidosis B. Lethargy C. Fractures D. Osteomalacia E. Eye calcium deposits

C. Fractures D. Osteomalacia E. Eye calcium deposits

While reviewing the urinalysis reports of an elderly client, the nurse finds white blood cells (WBCs) in the urine. Which condition might the client have? A. Pyelonephritis B. Kidney trauma C. Kidney infection D. Acute tubular necrosis

C. Kidney infection

A client has undergone pelvic surgery and the nurse removes the catheter in a week according to instructions. In the follow up within several hours, which finding in the client indicates a need for reinsertion of catheter? A. Anuria B. Polyuria C. Retention D. Incontinence

C. Retention

A client with end-stage kidney disease is receiving continuous ambulatory peritoneal dialysis. The nurse should monitor the client for which peritoneal dialysis complications? Select all that apply. A. Pruritus B. Oliguria C. Tachycardia D. Cloudy outflow E. Abdominal pain

C. Tachycardia D. Cloudy outflow E. Abdominal pain

A client with chronic kidney disease is admitted to the hospital with severe infection and anemia. The client is depressed and irritable. The client's spouse asks the nurse about the anticipated plan of care. Which is an appropriate nursing response? A. "The staff will provide total care, because the infection causes severe fatigue." B. "Mood elevators will be prescribed to improve depression and irritability." C. "Vitamin B12 will be prescribed for the anemia, and the stools will be dark." D. "The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products."

D. "The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products."

A client is diagnosed with bladder cancer, and a cystectomy and creation of an ileal conduit are scheduled. What should the nurse plan to do preoperatively? A. Limit fluid intake for 24 hours. B. Teach range-of-motion and Kegel exercises. C. Explain the procedure for irrigating the ileal conduit. D. Administer cleansing enemas and laxatives as prescribed.

D. Administer cleansing enemas and laxatives as prescribed.

The nurse is providing education to a client with calculi in the calyces of the right kidney. The client is scheduled to have the calculi removed. Which information should the nurse include in the teaching? A. The calculi are too large for transurethral removal. B. During the surgery, the right ureter will be removed. C. After surgery, a suprapubic catheter will be in place. D. After surgery, there will be a small incision in the right flank area.

D. After surgery, there will be a small incision in the right flank area.

A nurse is caring for a client with diabetes insipidus. Which clinical manifestation should a nurse expect the client to exhibit? A. Increased blood glucose B. Decreased serum sodium C. Increased specific gravity D. Decreased urine osmolarity

D. Decreased urine osmolarity

A client with a left ureteral calculus is scheduled for a transurethral ureterolithotomy. During the preoperative assessment, how does the nurse expect the client to report pain? A. It is a boring-type pain that is located in the left flank. B. It is dull and constant and located in the costovertebral angle. C. It is located at the level of the kidneys and occurs with each urination. D. It is spasmodic and located in the left side and radiating to the suprapubic area.

D. It is spasmodic and located in the left side and radiating to the suprapubic area.

A client is admitted to the hospital with severe renal colic caused by a ureteral calculus. Later that evening the client's urinary output is much less than the intake. When it is confirmed that the bladder is not distended, what should the nurse suspect developed? A. Oliguria B. Hydroureter C. Renal shutdown D. Urethral obstruction

B. Hydroureter

A client develops acute glomerulonephritis after a recent streptococcal infection. The nurse should expect to find which clinical manifestation during the health history and physical examination? A. Nocturia B. Periorbital edema C. Increased appetite D. Recent weight loss

B. Periorbital edema

You're providing discharge teaching to a patient who was hospitalized for the treatment of a kidney stone. The type of kidney stone the patient experienced was a uric acid type stone. What type of foods will you educate the patient to avoid? A. Cabbage, spinach, tomatoes, strawberries B. Ice cream, milk, pork, cheese C. Beans, potatoes, corn, peas D. Liver, scallops, anchovies, sardines, pork

D. Liver, scallops, anchovies, sardines, pork

The nurse is assisting the primary healthcare provider during a renal ultrasonography. Arrange the steps involved in the procedure in correct sequence. 1. Apply gel over skin 2. Wipe cotton pad over gel 3. Move transducer across skin 4. Place client in prone position

4. Place client in prone position 1. Apply gel over skin 3. Move transducer across skin 2. Wipe cotton pad over gel

A nurse checking the perineum of a client with a radium implant for cervical cancer observes the packing protruding from the vagina. The nurse notifies the primary healthcare provider to have the packing removed. What is the primary reason that the packing needs to be removed immediately? A. The radioactive packing will injure healthy tissue. B. Removal of the packing will prevent excessive blood loss. C. The exposure of radium to the environment will diminish its effectiveness. D. Removal of the packing will minimize life-threatening contact with the radiation.

A. The radioactive packing will injure healthy tissue.

The nurse is reviewing a client's current medication therapy and suspects hematuria. Which medication is responsible for the client's condition? A. Warfarin B. Cimetidine C. Phenazopyridine D. Nitrofurantoin

A. Warfarin

A diet that contains restricted amounts of protein, sodium, and potassium has been prescribed for a client with end-stage renal disease who is receiving dialysis. The nurse is providing dietary instructions. Which statement by the client indicates teaching is effective? A. "I should avoid using salt substitutes." B. "I should exclude meat from my diet." C. "I may not add seasoning to my food." D. "I may eat low-sodium canned vegetables."

A. "I should avoid using salt substitutes."

You're developing a nursing care plan for a patient with a kidney stone. Which of the following nursing interventions will you include in the patient's plan of care? A. Restrict calcium intake B. Strain urine with every void C. Keep patient in supine position to alleviate pain D. Maintain fluid restriction of 1-2 Liter per day

B. Strain urine with every void

A patient with a kidney stone explains that the pain he is experiencing is intense, sharp, and wavelike that radiates to the scrotum. In addition, he explains it feels like he has to void but a small amount of urine is passed. Based on the patient's signs and symptoms, where may the kidney stone be located? A. Renal Calyx B. Renal Papilla C. Ureter D. Urethra

C. Ureter

The nurse is providing postoperative care 8 hours after a client had a total cystectomy and the formation of an ileal conduit. Which assessment finding should be reported immediately? A. Edematous stoma B. Dusky-colored stoma C. Absence of bowel sounds D. Pink-tinged urinary drainage

B. Dusky-colored stoma

The laboratory report of a client indicates that the urinary urea nitrogen levels are 9 g/24 hr. What does the nurse anticipate from this finding? A. Client has sepsis B. Client has dehydration C. Client has high-protein intake D. Client has potential kidney damage

D. Client has potential kidney damage

The registered nurse is instructing the student nurse regarding the gross anatomy and physiology of the kidneys prior to client examination. Which statement made by the student nurse indicates the nurse needs to intervene? A. "The right kidney is a little longer and narrower than the left kidney." B. "The existence of three kidneys with normal kidney function is normal." C. "The presence of a single kidney with normal kidney function is normal." D. "The urinary bladder lies directly behind the pubic bone."

A. "The right kidney is a little longer and narrower than the left kidney."

A client who is 5 feet, 8 inches tall (173 cm) and weighs 220 lb (99.8 kg) is admitted to the hospital with ureteral colic, blood in the urine, and a blood pressure of 150/90 mm Hg. Which is the priority objective of nursing care for this client? A. Decrease pain B. Decrease weight C. Decrease hematuria D. Decrease hypertension

A. Decrease pain

When receiving hemodialysis, the client may develop hyponatremia. For which clinical findings associated with hyponatremia should the nurse assess the client? Select all that apply. A. Diarrhea B. Seizures C. Chvostek sign D. Cardiac dysrhythmias E. Increased temperature

A. Diarrhea B. Seizures

A client with a renal disorder is scheduled for an intravenous pyelogram (IVP). Which interventions should the nurse undertake prior to the procedure? Select all that apply. A. Ensure that the consent form is signed B. Assess the client for iodine sensitivity C. Have the client remove all metal objects D. Administer an enema or cathartic to the client E. Instruct the client to lie still during the procedure

A. Ensure that the consent form is signed B. Assess the client for iodine sensitivity D. Administer an enema or cathartic to the client

A man with benign prostatic hyperplasia is scheduled for a transurethral incision of the prostate (TUIP). As he is being admitted to the surgical unit, he tells the nurse he is concerned that the operation will result in impotence. Which is the best response by the nurse? A. "It's understandable that you are worried; it is a very real possibility." B. "I can understand your concern, but this operation usually does not cause impotence." C. "Most men worry about their ability to function; you should speak with your primary healthcare provider." D. "You may be impotent for a while, but normal functioning probably will return within a few months."

B. "I can understand your concern, but this operation usually does not cause impotence."

The nurse is providing home-going instructions to a female client following a cervical biopsy. Which statement indicates the client understands the instructions? A. "I can use tampons when bleeding heavily." B. "I should use antiseptic solutions to clean the perineal region." C. "I can resume housework tomorrow morning." D. "I should douche before having intercourse."

B. "I should use antiseptic solutions to clean the perineal region."

A client who was admitted to the hospital with a diagnosis of a renal calculus is successful in passing the stone. The nurse is preparing the client for discharge and should include what in the client's instructions? A. "Strain all urine." B. "Increase fluid intake." C. "Limit dietary potassium." D. "Maintain bed rest for 24 hours."

B. "Increase fluid intake."

A client is admitted with a diagnosis of torsion of the testes. How should the nurse respond when the client asks, "Why do I have to have surgery right now?" A. "There's no other way to control the pain." B. "Irreversible damage occurs after a few hours." C. "The extreme swelling can cause the testicle to rupture." D. "The reduction in testicular blood flow leads to rapid death of sperm."

B. "Irreversible damage occurs after a few hours."

A client with acute kidney injury is to receive peritoneal dialysis and asks why the procedure is necessary. Which is the nurse's best response? A. "It prevents the development of serious heart problems." B. "It helps perform some of the work usually done by the kidneys." C. "It will keep your kidneys from getting worse and may 'restart' your kidneys to perform better than before." D. "It speeds recovery because the kidneys are not responding to regulating hormones."

B. "It helps perform some of the work usually done by the kidneys."

You're providing an in-service to a group of nurses about the different types of kidney stones. You explain to the attendees that the most common type of kidney stone is made up of: A. Cholesterol B. Calcium and oxalate C. Calcium and phosphate D. Uric acid

B. Calcium and oxalate

While caring for a client who sustained a severe head injury in a motor vehicle accident, the nurse observes that the client is constantly passing urine and is dehydrated. What does the nurse suspect as the cause for the client's condition? A. Decreased secretion of aldosterone B. Decreased secretion of antidiuretic hormone C. Decreased secretion of parathyroid hormone D. Decreased secretion of atrial natriuretic peptide

B. Decreased secretion of antidiuretic hormone

A client with acute kidney injury moves into the diuretic phase after 1 week of therapy. For which clinical indicators during this phase should the nurse assess the client? Select all that apply. A. Skin rash B. Dehydration C. Hypovolemia D. Hyperkalemia E. Metabolic acidosis

B. Dehydration C. Hypovolemia

A nurse is caring for a client during the early postoperative period after a prostatectomy. Which action is the priority? A. Have the client stand to void. B. Discourage straining for a bowel movement. C. Use a bulb syringe to aspirate urine from the retention catheter. D. Notify the primary healthcare provider if the client does not void by bedtime.

B. Discourage straining for a bowel movement.

A client with a history of chronic kidney disease is hospitalized. Which assessment findings will alert the nurse to kidney insufficiency? A. Facial flushing B. Edema and pruritus C. Dribbling after voiding and dysuria D. Diminished force and caliber of stream

B. Edema and pruritus

What are the general manifestations associated with clients who have urinary system disorders? Select all that apply. A. Facial edema B. Excessive thirst C. Stress incontinence D. Nausea and vomiting E. Elevated blood pressure

B. Excessive thirst D. Nausea and vomiting E. Elevated blood pressure

A nurse is providing dietary instructions to a client who is being treated with continuous ambulatory peritoneal dialysis (CAPD) for chronic glomerulonephritis. Which should the nurse include when discussing what the client needs? A. Low-calorie foods B. High-quality protein C. Increased fluid intake D. Foods rich in potassium

B. High-quality protein

The physician orders a 24-hour urine collection on a patient with recurrent kidney stones. As the nurse you know that the specimen should be? A. Kept at room temperature B. Kept on ice or refrigerated C. Sent to the lab every four hours D. Kept at a temperature between 98.6 'F to 99.3'F

B. Kept on ice or refrigerated

A nurse is providing preoperative teaching for a client who is scheduled for a transurethral resection of the prostate. To prepare the client what to expect postoperatively, which instructions should the nurse include in the teaching session? A. The urine will be bright red for 24 to 48 hours. B. Spasms of the bladder occur during the first 24 to 48 hours. C. To decrease bladder contractions, the Valsalva maneuver and Kegel exercises will be encouraged. D. To maintain proper fluid balance, oral fluids are restricted during continuous urinary bladder irrigations.

B. Spasms of the bladder occur during the first 24 to 48 hours.

A client is admitted to the hospital in the oliguric phase of acute kidney injury. The nurse estimates that the urine output for the last 12 hours is about 200 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. What does the nurse conclude about the amount of fluid prescribed? A. It equals the expected urinary output for the next 24 hours. B. It will prevent the development of pneumonia and a high fever. C. It will compensate for both insensible and expected output over the next 24 hours. D. It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias.

C. It will compensate for both insensible and expected output over the next 24 hours.

During an exacerbation of multiple sclerosis a client reports urinary urgency and frequency. What is the most appropriate initial nursing action? A. Begin teaching self-catheterization. B. Develop a plan to ensure high fluid intake. C. Palpate the suprapubic area of the abdomen. D. Initiate a regimen to monitor urinary output.

C. Palpate the suprapubic area of the abdomen.

A patient is scheduled for an intravenous pyelogram (IVP) to assess for kidneys stones. Which finding below requires the nurse to contact the physician? A. Patient reports flank pain that radiates downward B. Patient has hematuria C. Patient is allergic to shellfish D. Patient has cloudy urine

C. Patient is allergic to shellfish

A lithotripsy to break up renal calculi is unsuccessful, and a nephrolithotomy is performed. Which postoperative clinical indicator should the nurse report to the primary healthcare provider? A. Passage of pink-tinged urine B. Pink drainage on the dressing C. Intake of 1750 mL in 24 hours D. Urine output of 20 to 30 mL/hr

D. Urine output of 20 to 30 mL/hr