Renal and Urinary
A nurse is discussing hemodialysis with a newly licensed nurse. The nurse should identify that hemodialysis is contraindicated for which of the following clients? A. A client who cannot receive anticoagulants B. A client who is unable to ambulate C. A client who is immunocompromised D. A client who is allergic to iodine
A. A client who cannot receive anticoagulants A. Anticoagulants are required for clients receiving hemodialysis to prevent clot formation. Therefore, hemodialysis is contraindicated for a client who cannot receive anticoagulants. B. The client is not required to ambulate in order to receive hemodialysis. C. The client who is immunocompromised can receive hemodialysis. D. Hemodialysis does not require the use of iodine. Therefore, the client who is allergic to iodine can receive this treatment.
A nurse working in the emergency department is caring for a client who reports costovertebral angle tenderness, nausea, and vomiting. For which of the following laboratory values should the nurse notify the provider? A. WBC 15,000/mm3 B. BUN 15 mg/dL C. Urine specific gravity 1.020 D. Urine pH 5.5
A. WBC 15,000/mm3 A. The WBC count is above the expected reference range and indicates the presence of an infection. The nurse should report this laboratory value to the provider. B. A BUN level of 15 mg/dL is within the expected reference range. C. A urine specific gravity of 1.020 is within the expected reference range. D. A urine pH of 5.5 is within the expected reference range.
A nurse is performing an admission assessment of a client who has acute glomerulonephritis. The nurse should expect which of the following findings? A. Low blood pressure B. Polyuria C. Dark-colored urine D. Weight loss
C. Dark-colored urine A. The client who has acute glomerulonephritis usually experiences sodium and fluid retention, which leads to an elevated blood pressure. B. The client who has acute glomerulonephritis usually has a decreased urine output. C. The client who has acute glomerulonephritis usually has urine that is a dark, reddish-brown color. D. The client who has acute glomerulonephritis usually gains weight due to fluid retention.
A nurse is planning care for a group of clients. Which of the following clients should the nurse plan to monitor for signs of nephrotoxicity? A. A client who is receiving gentamicin for treatment of a wound infection B. A client who is receiving digoxin for treatment of heart failure C. A client who is receiving methylprednisolone for treatment of severe asthma D. A client who is receiving propranolol for treatment of hypertension
A. A client who is receiving gentamicin for treatment of a wound infection A. Aminoglycoside antibiotics can injure cells of the proximal renal tubules, causing acute tubular necrosis. The nurse should plan to monitor this client for nephrotoxicity and acute kidney injury. B. Providers use caution when prescribing digoxin for clients who have renal impairment, but its use does not cause nephrotoxicity. C. Methylprednisolone does not cause nephrotoxicity. D. Providers use caution when prescribing propranolol for clients who have renal impairment, but its use does not cause nephrotoxicity.
A nurse is reviewing the laboratory reports of a client who has acute kidney injury (AKI). Which of the following findings should the nurse expect? (Select all that apply.) A. BUN 30 mg/dL B. Urine output of 40 mL in past 3 hr C. Potassium 3.6 mEq/L D. Serum calcium 9.8 mg/dL E. Hematocrit 30%
A. BUN 30 mg/dL B. Urine output of 40 mL in past 3 hr E. Hematocrit 30% A. BUN 30 mg/dL is correct. This BUN level is elevated, which is an expected finding for a client who has AKI. B. Urine output of 40 mL in past 3 hr is correct. Oliguria with a urine output 100 to 400 mL per 24 hr is an expected finding for a client who has AKI. C. Potassium 3.6 mEq/L is incorrect. This potassium level is within the expected reference range. An elevated potassium level is an expected finding for a client who has AKI. D. Serum calcium 9.8 mg/dL is incorrect. This serum calcium level is within the expected reference range. A decreased serum calcium level is an expected finding for a client who has AKI. E. Hematocrit 30% is correct. This hematocrit level is decreased, which is an expected finding for a client who has AKI.
A nurse is caring for a client who has nephrotic syndrome and has been taking prednisone for 3 days. Which of the following adverse effects should the nurse monitor for and report to the provider? A. Sore throat B. Frequent stools C. Drowsiness D. Tremors
A. Sore throat A. Glucocorticoids depress the natural immune system and increase the client's risk for infection. A sore throat can indicate an infection. B. Frequent stools are not an adverse effect of prednisone therapy. The nurse should monitor for black, tarry stools. C. Insomnia is an adverse effect of prednisone therapy. D. Tremors are not an adverse reaction related to prednisone therapy. The nurse should monitor the client for psychological alterations
A nurse is performing an admission assessment on a client who has severe chronic kidney disease (CKD). Which of the following findings should the nurse expect for this client? A. Tachypnea B. Hypotension C. Exophthalmos D. Insomnia
A. Tachypnea A. The nurse should expect the client who has severe CKD to have tachypnea due to metabolic acidosis. B. The nurse should expect the client who has severe CKD to have hypertension due to fluid retention. C. Exophthalmos is not an expected finding for a client who has severe CKD. The nurse should expect the client who has hyperthyroidism to have exophthalmos. D. The nurse should expect the client who has severe CKD to have lethargy and drowsiness.
A nurse is planning care for a client who has acute glomerulonephritis. The nurse should plan to provide which of the following interventions? A. Weight the client daily B. Encourage the client to drink 2 to 3 L of fluid per day. C. Instruct the client to ambulate every 2 hr. D. Obtain the client's serum blood glucose.
A. Weight the client daily A. The nurse can monitor fluid retention by weighing the client daily. B. The nurse should calculate the daily fluid allowance by adding 500 to 600 mL to the client's previous 24-hr urine output. C. The nurse should promote the client's conservation of energy and should encourage the client to rest as much as possible. D. The nurse should obtain a serum blood glucose from a client who has diabetes mellitus.
A nurse is providing discharge teaching for a client who has chronic kidney disease (CKD). Which of the following statements by the client indicates an understanding of the teaching? A. "I will consume foods high in protein." B. "I will decrease my intake of foods high in phosphorus." C. "I will limit my intake of foods high in calcium." D. "I will add salt to the foods I consume."
B. "I will decrease my intake of foods high in phosphorus." A. Clients who have CKD should consume a diet low in protein because the phosphorus content of protein becomes elevated and can cause osteodystrophy. B. Clients who have CKD should limit the intake of foods high in phosphorus due to the decrease in the kidneys' ability to excrete it. C. Clients who have CKD often need supplemental calcium and vitamin D. D. Clients who have CKD retain sodium and fluid. They should consume foods low in sodium.
A nurse is providing education regarding cyclosporine for a client who had a kidney transplant 2 days ago. Which of the following statements by the nurse is appropriate? A. "You may experience hair loss due to the medication therapy you'll be taking." B. "You will need to continue taking this medication to protect your new kidneys." C. "Use an over-the-counter anti-inflammatory medication for aches and pains." D. "You will be at an increased risk for infection if you stop taking this medication."
B. "You will need to continue taking this medication to protect your new kidneys." A. One of the most common adverse effects of cyclosporine is hirsutism. B. Clients must take cyclosporine daily for the life of the transplanted organ. C. Renal damage can be intensified by using NSAIDs. D.Cyclosporine increases the risk of infection. Discontinuing cyclosporine places the client at risk for organ rejection.
A nurse is teaching a client who has a new diagnosis of acute pyelonephritis. Which of the following instructions should the nurse include in the teaching? A. Drink up to 1,500 mL of fluid per day. B. Avoid the use of NSAIDs for pain. C. Monitor peripheral blood glucose level twice per day. D. Increase dietary protein intake.
B. Avoid the use of NSAIDs for pain. A. The client should drink at least 2,000 mL of fluid per day to promote renal blood flow and urine production and to prevent dehydration. B. The nurse should instruct the client to avoid the use of NSAIDs for pain, which can further damage the kidney. C. There is no indication to monitor blood glucose levels during treatment for acute pyelonephritis. D. The client should follow a balanced diet for adequate healing. The provider may prescribe decreased protein intake if the client develops kidney impairment.
A nurse is reviewing the medical records of four clients. Which of the following conditions is a risk factor for chronic pyelonephritis? A. Parkinson's disease B. Diabetes mellitus C. Peptic ulcer disease D. Gallbladder disease
B. Diabetes mellitus A. Parkinson's disease is not related to the development of chronic pyelonephritis. B. A client who has a history of diabetes mellitus is at risk for the development of chronic pyelonephritis due to reduced bladder tone. C. A history of peptic ulcer disease is not related to the development of chronic pyelonephritis. D. A history of gallbladder disease is not related to the development of chronic pyelonephritis.
A nurse is obtaining a voided urine culture and sensitivity for a client who has manifestations of a urinary tract infection. Which of the following actions should the nurse take? A. Collect the client's urine in a clean specimen container. B. Instruct the client to initiate the flow of urine before collecting the specimen. C. Obtain the client's first morning voiding on the following day. D. Place the client's urine specimen in a container with a preservative.
B. Instruct the client to initiate the flow of urine before collecting the specimen A. The nurse should use a sterile specimen for a urine culture and sensitivity. B. The nurse should instruct the client to pass a sterile container into the urine stream after initiating the flow of urine. C. The nurse can collect a urine specimen for culture and sensitivity at any time during the day. D. The nurse does not need to place the urine specimen in a container with a preservative
A nurse working in a women's health clinic is caring for a client who reports urinary urgency and dysuria. Which of the following additional findings should the nurse identify as an indication of a urinary tract infection (UTI)? A. Vaginal discharge B. Pyuria C. Glucosuria D. Elevated creatine kinase-MB
B. Pyuria A. The nurse should identify vaginal discharge as an indication of vulvovaginitis rather than a UTI. B. The nurse should identify pyuria, which is white blood cells in the urine, as a common manifestation of a UTI. C. The nurse should identify glucosuria as an indication of hyperglycemia rather than a UTI. D. The nurse should identify an elevated creatine kinase-MB as an indication of cardiac involvement rather than a UTI.
A nurse is providing teaching for a client who has urge urinary incontinence. The nurse should include which of the following instructions? A. Sit on the toilet with water running every 4 hr. B. Set an interval for toileting based on previous voiding pattern. C. Respond immediately to the urge to void. D. Self-catheterize daily following a regular voiding.
B. Set an interval for toileting based on previous voiding pattern. A. The sound of running water is a sensory stimulus that promotes normal micturition, but does not help reduce urinary incontinence. B. When the client can maintain continence, the length of time between voids is gradually increased. The nurse should establish a toileting schedule to coincide with the client's voiding pattern. The nurse can gradually increase the length of time between voids as the client maintains continence. C. The nurse should teach the client to hold urine deliberately until the scheduled voiding time. By increasing the bladder's ability to hold and suppress urine, the client can develop continence. D. The nurse should recommend self-catheterization for a client who has functional urinary incontinence, not urge incontinence.
A nurse is providing teaching for a client who has chronic kidney disease (CKD). Which of the following client statements indicates an understanding of the teaching? A. "I will monitor my blood pressure on the same day each week." B. "I will take milk of magnesia if I'm constipated." C. "I will weigh myself each morning." D. "I will use a salt substitute in my diet."
C. "I will weigh myself each morning." A. A client who has CKD should monitor his blood pressure daily due to the risk for hypertension. B. A client who has CKD should not take milk of magnesia for constipation because of its magnesium and sodium content. C, The client who has CKD should monitor his weight every morning at the same time to provide an accurate assessment of fluid balance. D. A client who has CKD should avoid using a salt substitute because it contains potassium.
A nurse is caring for a client who has received hemodialysis. The nurse should identify that which of the following findings places the client at risk for seizures? A. Hypokalemia B. A rapid increase of catecholamines C. A rapid decrease in fluid D. Hypercalcemia
C. A rapid decrease in fluid A. Hypokalemia places the client at risk for hyporeflexia, rather than seizures. B. An increase of catecholamines places the client at risk for tachycardia, rather than seizures. C. A rapid decrease in fluid can result in cerebral edema and increased intracranial pressure, placing the client at risk for seizures. D. Hypercalcemia places the client at risk for muscle weakness, rather than seizures.
A nurse is caring for a client who has continuous bladder irrigation following a transurethral resection of the prostate. Upon detecting an output obstruction, which of the following actions should the nurse take first? A. Irrigate the catheter with normal saline. B. Notify the provider. C. Check the irrigation tubing for kinks. D. Provide PRN pain medication.
C. Check the irrigation tubing for kinks. A. The nurse should irrigate the catheter with normal saline to attempt to clear the obstruction, but this is not the first action the nurse should take. B. The nurse should notify the provider of the obstruction if not resolved by nursing interventions, but this is not the first action the nurse should take. C. The first action the nurse should take is to check the irrigation tubing for kinking or clots as these can prevent outflow of fluids. D. The nurse should provide PRN pain medication to promote client comfort, but this is not the first action the nurse should take.
A nurse is assessing a client who has chronic kidney disease and has completed her third peritoneal dialysis (PD) treatment. Which of the following findings should the nurse report to the provider? A. Greater outflow of dialysate than inflow B. Weight loss C. Cloudy dialysate effluent D. Report of pain during inflow
C. Cloudy dialysate effluent A. A greater outflow of dialysate fluid is expected. Dialysate fluid is hypertonic; therefore, fluid is drawn off the body. B. Dialysate fluid is hypertonic; therefore, fluid is drawn off the body. Each liter of fluid lost is equivalent to 1 kg. C. Cloudy or opaque drainage is an early manifestation of peritonitis. The nurse should notify the provider immediately because infection can be a life-threatening complication. D. Clients who undergo PD usually have pain at the beginning of each treatment, during the inflow of the dialysate. This pain usually resolves within 1 to 2 weeks of PD.
A nurse is caring for a client who has chronic kidney failure and the following laboratory results: BUN 196 mg/dL, sodium 152 mEq/L, and potassium 7.3 mEq/L. Which of the following interventions should the nurse implement? A. Initiate an IV infusion of 0.9% sodium chloride. B. Give oral spironolactone. C. Infuse regular insulin in dextrose 10% in water. D. Administer furosemide.
C. Infuse regular insulin in dextrose 10% in water. A. The client who has an elevated sodium level should not receive fluids that contain sodium chloride. B. The client who has chronic kidney failure will retain potassium at high levels. This client should not take spironolactone, a potassium-sparing diuretic. C. The client who has an elevated potassium level should receive regular insulin with dextrose 10% in water by continuous IV infusion to facilitate moving potassium out of the extracellular fluid into intracellular fluid. D. Diuretics, such as furosemide, are effective in the excretion of excessive potassium for clients who have unimpaired kidney function. For a client who has chronic kidney failure, diuretics are ineffective.
A newly licensed nurse and a nurse preceptor are caring for a client who has just had an arteriovenous shunt placed in her left arm. Which of the following actions by the newly licensed nurse requires intervention by the preceptor? A. Auscultating for bruits in the shunt every 4 hr while the client is awake B. Elevating the shunted arm on pillows postoperatively C. Measuring blood pressure in the shunted arm every 4 hr D. Palpating distal pulses of the shunted arm
C. Measuring blood pressure in the shunted arm every 4 hr A. Listening for bruits is indicated following shunt placement. B. Elevating the shunted arm is indicated postoperatively to reduce swelling and promote circulation. C. Measuring blood pressure in the shunted arm requires intervention by the preceptor. D. Palpating for distal pulses is indicated following shunt placement.
A nurse is caring for a client who has acute kidney injury. Which of the following laboratory findings should the nurse report to the provider? A. Serum potassium 5.0 mEq/L B. Serum calcium 9.0 mg/dL C. Serum creatinine 4.0 mg/dL D. Serum amylase 84 IU/L
C. Serum creatinine 4.0 mg/dL A. The client's serum potassium level is within the expected reference range. B. The client's serum calcium level is within the expected reference range. C. The nurse should report the client's serum creatinine level to the provider. This finding is outside of the expected reference range. D. The client's serum amylase level is within the expected reference range.
A nurse is preparing a teaching plan for a male client who has a continent internal ileal reservoir following surgery to treat bladder cancer. Which of the following statements should the nurse include in the teaching plan? A. "This should not affect your ability to have sexual intercourse." B. "You should empty your new bladder when it feels full." C. "You will need to avoid foods that produce intestinal gas." D. "You must insert a catheter through your stoma to drain the urine."
D. "You must insert a catheter through your stoma to drain the urine." A. Creation of a continent internal ileal reservoir can cause impotence in men. The nurse should use therapeutic communication to encourage the client and his partner to express their feelings and concerns. B. There is no sensation of bladder fullness in a continent internal ileal reservoir. The client must learn to void on a scheduled basis. C. There is no need to avoid certain foods. The continent internal ileal reservoir is not attached to the gastrointestinal tract. Ureterosigmoidostomy or conduit surgeries use the bowel for output. D. The client must use intermittent catheterization to drain urine from the continent internal ileal reservoir
A nurse is planning care for a client who is scheduled to undergo extracorporeal shock wave lithotripsy (ESWL) for urolithiasis. Which of the following actions should the nurse plan to take? A. Place the client in a semi-Fowler's position. B. Assist with the client's intubation. C. Begin a 24-hr urine specimen collection after the procedure. D. Apply electrodes for cardiac monitoring.
D. Apply electrodes for cardiac monitoring A. The nurse should position the client in supine position on a flat x-ray table for ESWL. B. The nurse should plan to assist with moderate (conscious) sedation. It is not necessary to intubate the client for ESWL. C. The nurse should plan to strain the urine following ESWL. D. The nurse should apply electrodes for continuous monitoring of the client's cardiac rhythm during ESWL. This monitoring allows the provider to deliver shock waves that are synchronized with the R wave.
A nurse is planning care for a client who is postoperative following a nephrectomy. Which of the following assessments is the priority for the nurse to evaluate? A. Bowel sounds B. WBC count C. Pain level D. Blood pressure
D. Blood Pressure A. The nurse should evaluate the client's bowel sounds to determine a return to baseline functioning following anesthesia, but another assessment is the priority. B. The nurse should evaluate the client's WBC count postoperatively to detect infection, but another assessment is the priority. C. The nurse should evaluate and treat the client's pain routinely to promote comfort, but another assessment is the priority. D. The greatest risk to the client is acute adrenal insufficiency. The adrenal gland can be removed or damaged during nephrectomy. The nurse should evaluate the client for hypotension, decreased urine output, and decreased level of consciousness.
A nurse is caring for a client the night before a scheduled intravenous urography. Which of the following is the nurse's priority intervention? A. Inform the client about dietary limitations. B. Place the informed consent document in the client's record. C. Administer a bowel preparation to the client. D. Determine if the client has an allergy to iodine or shellfish.
D. Determine if the client has an allergy to iodine or shellfish. A. The client may be NPO after midnight or on a liquid diet to promote kidney hydration. The nurse should inform the client of the prescribed dietary limitations to prevent injury, but another intervention is the priority. B. The nurse should place the informed consent document on the client's chart to ensure it is available for the procedure the next day, but another intervention is the priority. C. The nurse should administer the bowel preparation to promote accuracy of the procedure, but another intervention is the priority. D. The greatest risk to the client is injury or death from an allergic reaction to radiopaque contrast media. The nurse should determine if the client has an allergy to iodine or shellfish, which indicates the client is at high risk of having an allergic reaction to the contrast media
A nurse is providing instructions regarding reduced dietary intake of potassium for a client who has chronic kidney disease. Which of the following food selections is appropriate for the nurse to recommend to the client? A. 1 cup cubed cantaloupe B. 1 cup boiled spinach C. One baked potato D. One large apple
D. One large apple A. Cantaloupe is high in potassium, containing 427 mg per serving. B. Spinach is high in potassium, containing 839 mg per serving. C. Baked potatoes are high in potassium, containing 573 mg per serving. D. Of the listed foods, one large apple is the lowest in potassium, containing 239 mg per serving.
A nurse is caring for a client following extracorporeal shock wave lithotripsy (ESWL) for the treatment of calcium phosphate kidney stones. Which of the following actions is appropriate for the nurse to take? A. Monitor the client's urine for ketones. B. Provide the client with an increased animal protein diet. C. Limit the client's fluid intake to 1.5 L per day. D. Strain all of the client's urine.
D. Strain all of the client's urine. A. The nurse should monitor urine ketones for a client who has diabetic ketoacidosis. B. The nurse should decrease the client's intake of animal proteins to prevent further calcium phosphate stone formation. C. The nurse should encourage the client to drink at least 3 L per day to promote urine flow, decrease the risk of stone precipitation, and prevent dehydration. D. The nurse should strain all of the client's urine following ESWL to monitor for stone fragments as they leave the body.
A nurse is caring for a client immediately following a kidney transplant. The nurse should identify which of the following client findings as a possible indication of a delay in functioning of the transplanted kidney? A. Blood pressure 110/58 mm Hg B. Incisional tenderness C. Pink and bloody urine D. Urine output 30 mL/2 hr
D. Urine output 30 mL/2 hr A. This blood pressure reading is within the expected reference range following a kidney transplant. The nurse should monitor for an elevated blood pressure as an indication of rejection. B. Tenderness at the incision site is expected during the early postoperative period. The nurse should monitor for indications of wound infection. C. Pink and bloody urine is an expected finding immediately after surgery. The nurse should expect the urine to become clear yellow within several days. D. A minimum urine output of 30 mL/hr is expected following a renal transplant. The nurse should monitor for adequate output or a decrease in the hourly output.
A nurse is caring for a hospitalized client who received hemodialysis 1 hr ago. When evaluating the client's status after dialysis, which of the following information should the nurse assess for first? A. Serum potassium level B. Body weight C. Serum creatinine level D. Vital signs
D. Vital signs A. The nurse should check the client's potassium level following hemodialysis to ensure it is within the expected reference range. However, another assessment is the priority. B. The nurse should compare the client's body weight before and after dialysis to determine the amount of fluid loss. However, another assessment is the priority. C. The nurse should provide ongoing monitoring of the kidney function to track the progress of the client's kidney disease. However, another assessment is the priority. D. When using the airway, breathing, circulation approach to client care, the nurse should determine that the priority information to assess is the client's vital signs.