Renal Questions

C D F Rationale: The bladder becomes less elastic over time and less urine is stored causing urgency in the client. Pain and burning are both associated with a urinary tract infection and should be assessed by the HCP if complaints are reported. Not all elderly clients will eventually become incontinent. Incontinency is a problem for any client, and interventions should take place to avoid skin breakdown and urinary tract infections.

1. A registered nurse has a new graduate nurse following her today. One of the clients is an elderly 78 year old woman with a urinary tract infection. If stated by the graduate nurse, would suggest that the registered nurse's teaching has been effective regarding normal urinary/renal system changes in elderly clients. A. "The bladder tissue becomes more elastic, allowing more urine to be stored." B. "Some pain and burning is okay with urination, as long as there is no fever." C. "The pelvic floor muscles tend to get weaker with aging, and even more so if the client has had children in the past." D. "The sensation of 'needing to urinate' is often delayed in elderly people, therefore urgency to void is normal." E. "All elderly clients will eventually be incontinent." F. "The kidneys ability to filter blood can be slower due to the blood vessels becoming hardened."

A C E F

1. Name three ways to treat hyperkalemia: A. Administration of Kayexalate B. Administraiton of potassium 40 mEq daily C. Dialysis D. Diet including orange juice, tomatoes, potatoes, bananas E. Administration of diuretics F. Administration of calcium gluconate

A D Rationale: An adequate fluid intake aids in the preventions of urinary calculi and infection. Odor-producing foods can produce offensive odors that may impact the client's lifestyle and relationships. Lack of any activity leads to urinary stasis, which promotes urinary calculi development and infection. Acidic urine helps prevent urinary tract infections. Tight clothing over the stoma obstructs blood circulation and urine flow.

A client had undergone a cystectomy and ileal conduit diversion. What should the nurse incorporate into the discharge instructions? Select all that apply. A. Drink at least 3,000 mL of fluid each day. B. Minimize daily activities. C. Keep urine alkaline to prevent urinary tract infections. D. Avoid odor-producing foods, such as onions, fish, eggs, and cheese. E. Wear snug clothing over the stoma to encourage urine flow into the drainage bag.

A B C D

A client has been admitted with acute renal failure. What should the nurse do? Select all that apply: A. Elevate the head of bed 30-45 degrees B. Take vital signs C. Establish an IV access site D. Call the ambulating physician for prescriptions E. Contact the hemodialysis unit

A B E

A client has been prescribed allopurinol (Zyloprim( for renal calculi that are caused by high uric acid levels. Which of the following indicate the client is experiencing adverse effect(s) of this drug? Select all that apply. A. Nausea B. Rash C. Constipation D. Flushed Skin E. Bone Marrow depression

B C F Rationale: A dusky appearance of the stoma indicates decreased blood supply to the stoma; a healthy stoma should appear beefy red. Protrusion indicates prolapse of the stoma, and sharp abdominal pain with rigidity suggests peritonitis. A urine output greater than 30 ml/hour is a sign of adequate renal perfusion and is a normal finding. Because mucous membranes are used to create the conduit, mucus in the urine is expected. Stomal edema is a normal finding during the first 24 hours after surgery.

A client with bladder cancer undergoes surgical removal of the bladder with construction of an ileal conduit. Which assessment findings indicate that the client is developing complications? Select all that apply. A. Urine output greater than 30 ml/hour. B. Dusky appearance of the stoma. C. Stoma protrusion from the skin. D. Mucus shreds in the urine collection bag. E. Edema of the stoma during the first 24 hours after surgery. F. Sharp abdominal pain with rigidity.

B D E

A client with chronic renal failure who receives hemodialysis three times a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? Select all that apply: A. Drink fluids before eating solid foods B. Have limited amounts of fluid only when thirsty C. Limit activity D. Keep all dialysis appointments E. Eat smaller, more frequent meals

B C D E F

A low purine diet is ordered for a client who has uric acid kidney stones. Which foods should the client avoid? (Select all that apply): A. Eggs B. Chicken C. Liver D. Oats E. Lentils F. Lobster

A B C E

A nurse is delegating to a nursing assistant (NA) about initiating a 24-hour urine collection for a client. Which statements demonstrate appropriate delegation? Select all that apply. a. "Put a container in the client's bathroom for collecting the urine." b. "Ensure that all urine is transferred to the container and kept on ice." c. "Remind the client to save all urine with each voiding." d. "Explain the purpose of the 24-hour urine collection to the client." e. "Record the amount the client voids on the intake and output record." f. "Document the color, odor, and whether or not there is sediment in the client's urine."

B D

A nurse understands that a patient may experience pain during peritoneal dialysis because of which of the following? Select all that apply: A. Warming the dialysate B. Too rapid instillation C. Infiltration of the solution into the bloodstream D. Accumulation of dialysate solution under the diaphragm E. Too rapid outflow of the dialysate

B D E Rationale: Sitting in warm water is beneficial in producing the urge for urination. Warm tea or coffee also helps in relieving urinary retention by producing the urge for urination. Drinking small quantities of water frequently keeps the patient well hydrated and also helps in passage of urine. Kegel exercises strengthen the pelvic floor muscles and are beneficial in decreasing urinary incontinence where there is no control or strength in the pelvic floor muscles. Taking a walk is good for general health but is not an immediate treatment for the relief of urinary retention.

A patient expresses to the nurse that he is unable to pass urine. What instructionsn should the nurse give this patient to relieve urinary retention? Select all that apply. A. Perform kegel exercises B. Sit in a tub of warm water C. Take a walk for 30 minutes every day D. Drink one cup of beverage like warm tea or coffee in a day. E. Drink small quantities of water frequently.

B C D E

A patient is to undergo their first dialysis treatment and is concerned about the possible complications that can occur while dialyzing. What should the nurse tell the patient to report immediately if these signs or symptoms were to occur? Select all that apply: A. Diarrhea B. Nausea and/or vomiting C. Blurred vision D. Headache E. Restlessness and agitation F. Shortness of breath

A D

A patient with chronic renal disease is being treated with continuous ambulatory peritoneal dialysis (CAPD). The nurse realizes this process: Select all that apply: A. Clears toxins over a 3-5 hour dwell time, during which time the patient can be mobile B. Exchanges and cleans bloody by correction of electrolytes and excretion of creatinine C. Provides continuous contact between the dialyzer and blood to clear toxins by ultrafiltration D. Uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion.

A B C

An adult male is admitted with urolithiasis. The nurse expects which orders for this client? (Select all that apply): A. Push/Force Fluids B. Strain all urine C. Medicate for Pain PRN D. Clean catch daily E. Daily catheterizations F. Clear liquid diet

A B D

As the perfusion of the kidneys declines below 80 mmHg, what effects ist hat patient most likely going to experience? Select all that apply. A. Increased sodium absorption B. Increased edema in legs C. Increased intake of calcium D. Blood pH increase E. Decrease output of <30 mL/hr F. Increase serum potassium

B C D

Atropine sulfate (Atropine) is contraindicated as a preoperative medication for which of the following clients? Select all that apply. a. A client with diabetes. b. A client with glaucoma. c. A client with urine retention. d. A client with bowel obstruction.

C D E

During the diuretic phase of acute renal failure, the nurse may see which of the following? Select all that apply. A. Decreased urinary output B. Functioning nephrons which results in concentrated urine. C. Increased urinary output D. Low urea concentration in urine E. Increased urinary output (1-3 or more liters/day)

B D E

High levels of magnesium is generally not a problem in renal failure unless the patient is ingesting. Magnesium is found in MOM, antacids, and magnesium citrate. In renal failure, signs of hypermagnesemia include: A. Hyperreflexia B. Decreased mental status C. Tachypnea D. Respiratory failure E. Absence of reflexes

B D

How does renin angiotensin aldosterone system cause hypertension? Select all that apply: A. Renin affects the adrenal system causing a dump of catacholumins which results in vasoconstriction. B. Angiotensin II has a direct vascular effect that results in vasoconstriction and can help cause hypertension if over stimulated. C. Renin causes the conversion of angiotensin I to angiotensin II which has a direct effect on venous constriction which can result in hypertension if over stimulated. D. Angiotensin II causes tissue growth that results in remodeling of vessel walls, which decreases compliance of vasculature.

B F

In caring for a patient with Nephrotic Syndrome, the nurse would expect which of the following? A. Dysphagia B. Edema C. Frequent UTI D. Hyperalbuminemia E. Polyphagia F. Protienuria

A C D

Mr. Johnson, your 64 year old patient, has just returned from his renal biopsy. What are the responsibilities of the nurse in the postoperative period? Select all that apply: A. Provide pressure to the biopsy site for 30 minutes B. Limit fluids for 4 hours following procedure C. Place the patient on bedrest of 2-6 hours following biopsy D. Monitor vital signs, especially for hypotension and tachycardia

A B C D Rationale: One of the National Patient Safety Goals (NPSG) is to identify safety risks including assessing which clients are most likely to commit suicide. Another NPSG is to maintain and communicate accurate client medication information. An action is to explain the importance of managing medication information to the client when he/she is discharged from the hospital or at the end of an outpatient encounter. Examples include: instructing the client to give a list to his/her primary care physician; to update the information when medications are discontinued, doses are changed, or new medications including over-the-counter products are added; and to carry medication information at all times in the event of emergency situations.

Prior to discharging a client with cancer of the bladder from the hospital, the nurse must do which of the following? Select all that apply.. A. Determine if the client is likely to become suicidal. B. Give a list of the client's medications to the client before discharge. C. Instruct the client to update information when medications are discontinued, doses are changed, or new medications are added. D. Explain the need to carry medication information with the client at all times. E. Instruct the client that the use of over-the-counter products need not to be reported to the health care provider.

B C F

Sally is ordered to start a 24-hour urine test in the morning, which of the following shows that she understands what to do for the test: A. Start first thing in the morning, being sure to collect the first urine. B. Begin test: discard 1st voiding, continue collecting for the next 24 hours. C. Starting time begins when the patient first voided D. Starting time begins after the first void is discarded, when the patient feels the urge to void. E. Special treatment of the collected urine is not important as long as all of the urine is in the container. F. Use appropriate container with appropriate preservative or refrigerate the specimen at all times.

A C

Taking into consideration the effects of the renal system on blood pressure. What factors can affect the blood pressure levels? Select all that apply. A. Hypoproteinemia B. Cholinergic stimulation C. Renin angiotensin Aldosterone system activation D. Increased serum phosphorous levels

A B C Answer/Rationale A- The health-care provider may order certain foods and meds when obtaining a 24 hour urine to evaluate for calcium or uric acid. B- When the collection begins, the client should completely empty the bladder and discard this urine. The test is started after the bladder is emptied. C- All urine for 24 hours should be saved and put in a container with a preservative, refrigerated, or placed on ice as indicated.

The client diagnosed with renal calculi scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply. A. Check the ordered diet and medication modifications B. Instruct the client to urinate and discard this urine when starting collection. C. Collect all urine during 24 hours and place in appropriate specimen container D. Insert an indwelling catheter in client after having the client empty the bladder. E. Instruct the UAP to notify the nurse when the client urinates

A B C Answer/Rationale: A. Renal failure affects almost every system in the body. Neurologically, the patient may have drowsiness, headache, muscle twitching, and seizures. In the recovery period, the client is alert and has no seizure activity. B. In renal failure, levels of erythropoietin are decreased, leading to anemia. An increased in H&H indicates recovery period C. Nausea, Vomiting, and diarrhea are common in the client with ARF; therefore, an absence of these indicates recovery.

The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the client is in the recovery period? Select all that apply. A. Increased alertness and no seizure activity B. Increase in hemoglobin and hematocrit C. Denial of nausea and vomiting D. Decreased urine specific gravity E. Increased serum creatinine level

A B D E

The client performs self-peritoneal dialysis. What should the nurse teach the client about preventing peritonitis? Select all that apply: A. Broad-spectrum antibiotics may be administered to prevent infection B. Antibiotics may be added to the dialysate to treat peritonitis C. Clean technique is permissible for prevention of peritonitis D. Peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort E. Peritonitis is the most common and severed complication of peritoneal dialysis

B D E F

The nurse collects a urine sample from a patient with pyelonephritis. After the l ab has completed the urinalysis, the nurse would expect which of the following abnormalities? A. Glucosuria B. Hematuria C. Ketonuria D. Leukocyturia E. Proteinuria F. Pyuria

C D E

The nurse is attending to a patient with obstructing urinary calculi. The patient is treated with Tamsulosin (Flomax) to help ease passage of the stones. In addition, opioids are administered to relieve colic pain. What actions should the nurse perform to ensure treatment effectiveness and patient safety? Select all that apply: A. Restrict fluid intake. B. Advise complete bed rest. C. Encourage the patient to move. D. Strain all urine voided by the patient. E. Avoid letting the patient ambulate unattended.

A C D

The nurse is caring for a patient with chronic renal failure. The nurse would recognize which of the following as common complications of the disease? A. Anemia B. Angina C. Fluid and Electrolyte abnormalities D. Hypertension E. Hypotension F. Tachycardia

C D Rationale: The client with an ileal conduit must learn self-care activities related to care of the stoma and ostomy appliances. The client should be taught to increase fluid intake to about 3,000 mL/day and should not limit intake. Adequate fluid intake helps to flush mucus from the ileal conduit. The ostomy appliances 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. An aspirin should not be used as a method of odor control because it can be an irritant to the stoma and lead to ulceration. The ostomy pouch should be emptied when it is one-third to one-half full to prevent the weight of the urine from pulling the appliance away from the skin.

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."

1 4 2 3 5

The nurse is inserting an indwelling catheter into a female client. What interventions should be implemented? Rank in order of performance 1. Explain the procedure to the client 2. Set up the sterile field 3. Inflate the catheter bulb 4. Place absorbent pads under the client 5. Clean the perineum from clean to dirty with Betadine

A B E F Rationale: A KUB is an x-ray of the kidneys, ureters and bladder. A KUB can look for kidney stones and you would wear a lead apron over exposed body parts to reduce the risk of radiation. The client is not put under sedation for this procedure and the client must remove any clothing that interferes with the test. No dye is to be injected into the client for the procedure so, also, the client will not need to alert the HCP or RN about their allergy to shellfish. (QUESTION BY ME)

The nurse is preparing a client to go downstairs and undergo a KUB. Which statements, if verbalized by the client, would demonstrate the client needs more teaching? A. "I am looking forward to the nap I will get while under sedation." B. "I can keep my clothes on for the procedure." C. "This will show that I could have kidney stones." D. "I have to wear a lead apron so the rest of my body is not exposed to the radiation." E. "I will need to drink plenty of fluids to flush out the dye after my procedure is over." F. "I am allergic to shellfish, so I will not be able to go through with my procedure."

A B E F

The nurse is speaking with a client who underwent a minimally invasive procedure treatment for recurrent urolithiasis. Which instructions are appropriate to reinforce in the teaching plan? Select all that apply. A. Client should drink at least 2-3L of fluid a day B. Client should strain all urine upon discharge C. Remain off all medications other than the ones for treatment until after stones are passed D. Increase calcium intake in the diet to ease passage of stones E. Contact your healthcare provider if hematuria or fever occur F. Continue to take antibiotics after the procedure

A B C

The nurse is teaching a group of men about prostate cancer. Which of the following points should be included in the instruction? Select all that apply. a. Prostate cancer is usually multifocal and slow growing. b. Most prostate cancers are adenocarcinoma. c. The incidence of prostate cancer is higher in men of African descent, and the onset is earlier. d. A prostate specific antigen (PSA) lab test greater than 4ng/mg will need to be monitored. e. Cancer cells are detectable in the urine.

A D F

The nurse is teaching a patient to recognize foods that are high in sodium. Which food item does the nurse use as an example? Select all that apply: A. Egg roll with soy sauce B. White rice C. Salad with oil and vinegar dressing D. Bacon and eggs E. Steak F. Soup with saltine crackers G. Steamed vegetables

A C E

The nurse should instruct the client who is being discharged to home 3 days after transurethral resection of the prostate (TURP) to do which of the following? Select all that apply. a. Drink at least 3000mL of water a day. b. Increase calorie intake by eating six small meals a day. c. Report bright red bleeding to the health care provider. d. Take deep breaths and cough every 2 hours. e. Report a temperature over 99˚F (37.2˚C).

C D E

The patient is being evaluated for Polycystic Kidney Disease. The nurse assesses the patient experiencing to note which common symptoms? A. Adrenal crisis B. Fever C. Frequent UTI D. Hematuria E. Lower back and flank pain that worsens with activity F. Nausea

E F

To assess the client's renal status, the nurse should monitor which of the following laboratory tests? Select all that apply: A. Serum sodium B. Potassium levels C. Arterial Blood Gases D. Hemoglobin E. Serum blood urea nitrogren (BUN) F. Creatinine levels G. Urinalysis

A B C D

What can contribute to the formation of renal calculi? A. Infection B. Prolonged acidic or alkaline urine C. Increased intake of calcium or oxalate-rich foods D. Decreased urine production E. Decreased intake of purines

C D

When a client is receiving hormone replacement for prostate cancer, the nurse should do which of the following? Select all that apply. a. Inform the client that increased libido is expected with hormone therapy. b. Reassure the client that erectile dysfunction will not occur as a consequence of hormone therapy. c. Provide the client the opportunity to communicate concerns and needs. d. Utilize communication strategies that enable the client to gain some feeling of control. e. Suggest that an appointment be made to see a psychiatrist.

A B C E

When caring for a client with a history of benign prostatic hypertrophy (BPH), the nurse should do which of the following? Select all that apply. (Billings, p.551) a. Provide privacy and time for the client to void. b. Monitor intake and output. c. Ask the client if he has urinary retention. d. Catheterize the client for post void residual urine. e. Test the urine for hematuria.

A D E

When observing your patient's nephrostomy tube, you could to the conclusion that your patient is actively bleeding. What findings support this? (Select all that apply): A. Decreased lab values B. Decreased pulse C. High blood pressure D. Abdominal pain and swelling E. Fatigue and Confusion

B C D

When providing teaching for the renal patient, the nurse must communication the importance of the patient reporting: Select all that apply: A. Pruritus B. Weight gain >4 lbs. C. Edema D. Confusion or lethargy

A C E Rationale: Practicing timed voiding, ideally every 2-3 hours during waking hours, can help in emptying the bladder, thereby reducing the chances of incontinence. Pelvic floor muscle training is important to strengthen the pelvic floor muscles that control the relaxation of the urinary sphincters, and improved muscle control can reduce the complaints of incontinence. Incontinence protective pads are urine-containing assistive devices that can help in cases of mild to moderate urine incontinence. Coffee is a bladder irritant and will increase the urge to urinate, thus increasing the likelihood of incontinence. Intermittent catheterization is advised in cases of urinary retention, not in urinary incontinence.

When teaching a patient about technique to manage urinary incontinence, which instructions should the nurse include as important? Select all that apply. A. Practice timed voiding B. Drink a cup of coffee C. Perform pelvic floor muscle training D. Perform intermittent catheterization E. Use incontinent protective pads

A C E

Which of the following are characteristics of the onset of acute renal failure? Select all that apply. A. Can be sudden B. Decreased BUN & Creatinine levels C. Increased or decreased urinary output D. Decreased serum potassium levels E. Can develop over hours or days

B C

While listening to a patient's breath sounds, who is a few days post-op from a subcutaneous nephrostomy, you hear crackles. Which of the following is most likely why you have these findings? (Select all that apply) A. Has taken too many pain meds B. Has not received enough pain meds & is too uncomfortable C. Has not properly coughed and deep breathed (q2h) D. Has had part of the diaphragm "nicked" in surgery and cannot breathe

B C D

While measuring urine output from a patient with bilateral nephrostomies, you would record: (Select all that apply): A. Total urine output together B. Any signs of blood clots C. Tea/pink urine D. Weigh patient daily

D E Rationale: Renal calculi have a sudden onset of pain that's described to some as excruciating and worst pain ever felt. The pain is felt in the kidney region referred to as the flank area closer to the back and around the lower ribs. Dark, scanty urine output related to obstruction and hematuria.

Your patient has complaints of severe sudden onset 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. What 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 E. Flank pain