Urinary Exam 3 Medsurg2
A nurse is checking the laboratory values of a client who has chronic kidney disease. The nurse should expect elevations in which of the following values? a) Potassium and magnesium b) Calcium and bicarbonate c) Hemoglobin and hematocrit d) Arterial pH and PaCO2
A. Potassium and magnesium Clients who have chronic kidney disease have hyperkalemia, hyperphosphatemia, and hypermagnesemia as well as elevations in serum creatinine and blood urea nitrogen.
A nurse is reinforcing teaching with a client who has chronic renal failure. Which of the following food choices by the client indicates the teaching has been understood? A. Canned soup B. Grilled Fish C. Pastrami D. Peanut butter
ANSWER B. Protein such as fresh fish or poultry can minimize the risk of chronic renal failure worsening
A nurse is collecting data from a client who has acute kidney injury (AKI). According to the RIFLE classification system, which of the following findings should the nurse identify as an indication that the client has end-stage kidney disease? A. Less than 0.5 mL/kg of urine output for 12 hours B. No urine output for 12 hours C. No urine output without renal replacement therapy for 4 to 12 weeks D. No urine output without renal replacement therapy for more than 3 months
Answer: D Rationale: In the RIFLE classification, R is for Risk, I is for Injury, F is for Failure, L is for Loss, and E is for End-stage kidney disease. No urine output without renal
A nurse is checking urinalysis results for four clients . Which of the following urinalysis results indicate a urinary tract infection ? A. Positive for hyaline casts B. Positive for leukocytes esterase C. Positive for ketones D. Positive for crystals
B. Positive for leukocytes esterase
A nurse is reinforcing teaching with a client who has a history of urinary tract infection (UTIs). Which of the following client statements indicates the need for additional instruction? A. I will empty my bladder every 2 to 4hr B. I will drink 2 liters of fluids per day C. I will use a vaginal douche daily D. I will wear cotton underwear Answer
C. I will use a vaginal douche daily
A nurse is reinforcing teaching about urinary tract infections (UTIs) with a client. Which of the following manifestations should the nurse include? A. Weight gain B. Back pain C. Vaginal discharge D. Muscle cramps
Correct: B. Back pain Rationale: Back pain and flank pain are manifestations of a UTI. Other manifestations include frequency, urgency, and cloudy, foul smelling urine
A nurse is reinforcing teaching with a newly licensed nurse about caring for a client who has a new left arteriovenous fistula. Which of the following statements should the nurse make? A. "Check the fistula daily for a vibration." B. "Instruct the client to restrict movement of his left arm." C. "Avoid taking blood pressures on the client's left arm.' D. "Instruct the client to sleep on his left side."
Rationale: C. The nurse should avoid taking blood pressure measurements on the client's left arm, as this can decrease blood flow and cause clotting.
A nurse is caring for a client who has a diagnosis of renal calculi and reports severe flank pain. Which of the following is the priority nursing action? A. Relieve the client's pain B. Encourage the client to increase fluid intake C. Monitor the client's intake and output D. Strain the client's urine
A. Relieve the client's pain The nurse should apply the urgent versus non-urgent priority-setting framework when caring for the client. Using this framework, the nurse should prioritize urgent needs because they pose a greater threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which finding is the most urgent. The pain associated with renal calculi is severe and can lead to shock; therefore, this is the nurse's priority action.
A nurse is collecting data from a client who is receiving peritoneal dialysis. Which of the following findings should the RN report to the MD immediately? a.) Difficulty draining the effluent b.) Redness at the access site. c.) Fluid flowing from the catheter site. d.) Cloudy effluent.
A: d.) Cloudy effluent R: A cloudy or opaque effluent indicates the client is at greatest risk for peritonitis, a bacterial infection of the peritoneum. Therefore, this is the priority finding for the RN to report to the MD.
A nurse is contributing to the plan of care for a client who had a stroke. The client has hemiplegia and occasional urinary incontinence. Which of the following interventions should the nurse recommend? A. Offer the client a bedpan every 2 hours B. Limit the clients daily fluid intake until he is no longer incontinent C. Request a prescription for an indwelling catheter from the clients provider D. Ambulate the client to the bathroom every 30 minutes
ANSWER A. Following a stroke the client might have bladder incontinence due to confusion, impaired sensation, in response to bladder fullness, and decreased sphincter control. The nurse should encourage the client to void every 2 hours while awake to promote bladder control. By offering the bedpan the nurse promotes client safety.
A nurse is reinforcing teaching with a client who is preoperative prior to a transurethral resection of the prostate (TURP). Which of the following statements indicates an understanding of the information? A) "I will not need to have a urinary catheter following this procedure." B) "I will expect my urine to be cloudy after having this procedure.' C) "At least I won't have leakage of urine after this procedure." D) "I will feel the urge to urinate following this procedure."
ANSWER D. After a TURP, the client will feel the urge to urinate. The nurse should reassure him that he will receive analgesics to help relieve this discomfort
A nurse is caring for a client who is receiving peritoneal dialysis. The nurse monitors the client for which of the following adverse effects? A) Diarrhea B) Increased serum albumin C) Hypoglycemia D) Respiratory distress
ANSWER D. Respiratory distress can occur during peritoneal dialysis due to fluid overload
A nurse is collecting data from a client who has an injury to the lower abdomen following a motor-vehicle crash. The nurse should identify that which of the following findings is a manifestation of bladder trauma? a.) Stress incontinence b.) Hematuria c.) Pyuria d.) Fever
ANSWER: B Hematuria which is blood in the urine, is an early manifestation of bladder trauma. Blood in the meatus, pelvic pain, anuria, or the complete absence of urine are also other manifestations of bladder trauma.
A nurse is collecting data from a client who is receiving continuous ambulatory peritoneal dialysis. Which of the following findings should the nurse report to the provider? a.) WBC 6,000/mm^3 b.) Potassium 4.0 mEq/L c.) Cloudy, yellow drainage d.) Report of abdominal fullness
ANSWER: C An early sign of peritonitis is cloudy drainage which should be reported to the provider, alone with fever and abdominal tenderness
A nurse is caring for a client who has a urinary tract infection which of the following is a priority intervention by the nurse? A. Offer a warm sitz bath B. Recommend drinking cranberry juice C. Encourage increased fluids D. Administer an antibiotic
Answer : D the greatest risk to the client is injury to the renal system and sepsis from the uti .the priority intervention is to administer antibiotics
A nurse is collecting data from a client who is PostOperative following a transurethral resection of the prostate (TURP), After the nurse discontinues the client's Urinary Catheter, Which of the following findings should the nurse report to the provider? A.Decrease Urine output B.Report of burning upon urination C.stress incontinence D.pink-tinged urine
Answer A A decrease in urine output after a TURP indicates an obstruction to urine flow by a clot or residual prostatic tissue and Should be reported to the provider
A nurse is collecting data from a client who has urolithiasis and reports pain in his thigh. The nurse should identify that this finding indicates the stone is in which of the following structures? A. Ureter B. Bladder C. Renal pelvis D. Renal tubules
Answer A. ureter when stones are in the ureters, pain radiates to the genitalia and to the thighs.
A female client who has a recurrent cystitis asks the nurse about preventing future episodes . For which of the following statements should the nurse provide teaching reinforcement? A. I drink at least 2 L of fluid per day B. I prefer tub baths to showering C. I uriniate after sexual relations D. I wipe from front to back after urination
Answer B Cystitis is an inflammation of the bladder lining that commonly occurs with a UTI. Women who are at risk for UTIs should avoid tub baths because they can increase risk of infection
A nurse is reinforcing dietary teaching with a client who has late stage chronic kidney disease (CKD). Which of the following nutrients should the nurse instruct the client to increase in her diet A. Calcium B. Phosphorus C. Potassium D. Sodium
Answer C A client who has CKD can envelop hypocalcemia due to reduced production of active vitamin D, which is needed for calcium absorption. The client should supplement her diet with dietary calcium
A nurse is reinforcing teaching with a client who has a history of urinary tract infection (UTIs). Which of the following client statements indicates the need for additional instruction? A. I will empty my bladder every 2 to 4hr B. I will drink 2 liters of fluids per day C. I will use a vaginal douche daily D. I will wear cotton underwear
Answer C. "i will use a vaginal douche daily" - The client should avoid vaginal douches,bubble baths, and any substances that can increase the risk of UTIs. The client should use mild soap and water to wash the perineal area
A nurse is checking the Lab Values of a client who has chronic kidney disease. The nurse should expect evaluations in which of the following values? A. Calcium and bicarbonate B. Arterial pH and PaCO2 C. Hemoglobin and Hematocrit D. Potassium and Magnesium
Answer D Clients who have CKD have hyperkalemia. Hypophosphatemia, and hypermagnesemia as well as elevation in serum creatinine and blood urea nitrogen
A nurse is reinforcing teaching with a client who is preoperative prior to a transurethral resection of the prostate (TURP). Which of the following client statements indicates an understanding of the information? A. I will not need to have a urinary catheter following this procedure B. I will expect my urine to be cloudy after this procedure C. At least i won't have any urine leakage after this procedure D. I will feel the urge to urinate following this procedure
Answer D. i will feel the urge to urinate following this procedure - After TURP, the client will feel the urge to urinate. The nurse should reassure him that he will receive analgesics to help relieve this discomfort
A nurse is caring for a client who has a continuous bladder irrigation following a transurethral resection of the prostate (TURP). Which of the following actions should the nurse take? a. Irrigate the catheter with a sterile water b. Clamp the drainage catheter during ambulation c. Report viscous drainage with clots to the provider d. Remove the catheter if the client feels a strong urge to urinate
Answer and Rationale: C. Report viscous drainage with clots to the provider The nurse should report urine output that is bright red with clots or urine that resembles ketchup to the provider, as this is indication of hemorrhage
A nurse is reinforcing teaching about a prostate-specific antigen (PSA) test with a client. Which of the following statements should the nurse make? a. "You should not ejaculate for 24 hours after the PSA test." b. Annual PSA screening should begin at age 40.' c. You don't need to fast prior to the PSA test." d. Expected PSA values will decrease as you get older."
Answer and Rationale: C. "You don't need to fast prior to the PSA test". Fasting is not required for the PSA test. The client may eat or drink until the time of the test.
A nurse is caring for a client who is receiving peritoneal dialysis. The nurse notes that the dialysate output is less than the input and that the client's abdomen is distended. Which of the following actions should the nurse take A. insert indwelling urinary catheter B. change the clients position C. administer pain medication to the client D. place the drainage bad above the client's abdomen
Answer is B The client is retaining the dialysate solution after the dwelling time. The nurse should ensure that the clamp is open and the tubing is not kinked and repositioning the client to facilitate the drainage of the solution from the peritoneal cavity
A nurse is monitoring a client who has a kidney biopsy for postoperative complications. Which of the following complications should the nurse identify as causing the greatest risk to the client? A. infection B. hemorrhage C. hematuria D. pain
Answer-B Rationale- the greatest risk for a client following a kidney biopsy is hemorrhage due to lack due to lack of clotting at the puncture site. the nurse should report this finding to the provider immediately.
A nurse is teaching a client who will have an x-ray of the kidneys , ureters and bladder. Which of the following statements should the nurse include in the teaching? A. "you will receive a contrast dye during the procedure" B. " an enema is necessary before the procedure " C. "you will need to lie in a prone position during the procedure" D. "the procedure determines whether you have a kidney stone"
Answer-D Rationale- the nurse should explain to the client that a KUB can identify renal calculi, strictures, calcium deposits and obstructions of the urinary system.
A nurse is collecting data from a client who is postoperative following extracorporeal shockwave lithotripsy(ESWL). The nurse should identify which of the following findings is a priority? A. Report of palpitations B. Pink tinged urine C. Bruising on the flank area D. Stone fragments in the urine
Answer: A Rationale: The nurse should apply the ABC priority setting framework which emphasizes the core of human functioning.
A nurse is collecting data on a client who is 4 hours postoperative following a transurethral resection of the prostate and has an indwelling urinary catheter in place. Which of the following findings should the nurse expect? a) Blood-tinged urine in the drainage bad b) Catheter tubing coiled at the client's side c) Client report of severe bladder spasms d) Urinary output of 20 mL/hr
Answer: A Rationale: The nurse should identify that blood-tinged urine in the drainage bag is an expected finding for the first few days following surgery.
A nurse is reinforcing teaching with a client who has gout and urolithiasis. The client asks how to prevent future uric acid stones. Which of the following suggestions should the nurse provide? (SATA) A. Take allopurinol as prescribed B. Exercise several times a week C. Limit intake of foods high in purine D. Decrease daily fluid intake E. Avoid lemonade
Answer: A, B, C Rationale: The nurse should inform the client that allopurinol is an antigout medication that reduces the level of uric acid, which helps prevent uric acid stone formation. Immobility is a risk factor for urinary stasis and stone formation; therefore, the client should maintain a healthy lifestyle, including regular exercise, to help prevent stone formation. Purine increases the risk of uric acid stone formation. The nurse should identify that organ meats, poultry, fish, red wine, and gravies are high in purine.
A nurse is reinforcing teaching with a client who has chronic kidney disease. What should the nurse include: A. Limit fluid intake B. Limit calorie intake C. Eat a diet high in phosphorus D. Eat a diet high in protein
Answer: A. Limit fluid intake. A client who has CKD should limit fluid intake to prevent hypervolemia (excessive fluid overload).
A nurse is collecting data from a client who is 1 week postoperative following a living donor kidney transplant. Which of the following findings should indicate to the nurse that the client is experiencing acute kidney rejection? a) Creatinine 0.8 mg/dL b) Blood pressure 160/90 mmHg c) Sodium 137 mg/dL d) Urinary output 100 ml/hr
Answer: B Rationale: Due to the kidney's role in fluid and blood pressure regulation, a client who is experiencing rejection can have hypertension.
A nurse is preparing a client who is scheduled for an intravenous pyelogram (IVP) Which of the following findings should the nurse report to the provider? A) Allergy to egg products B) Vomiting and diarrhea for the last 6 hours C) Serum potassium of 3.6 mEq/L D) Serum creatinine of 1.2 mg/dL
Answer: B. Vomiting and diarrhea for the last 6 hours The nurse should identify that vomiting and diarrhea for 6 hours deplete the client's fluid volume, which results in dehydration that can cause renal failure following a procedure that uses contrast dye. Therefore, the nurse should notify the provider.
A nurse is caring for a client who has chronic glomerulonephritis with oliguria. For which of the following electrolyte imbalances should the nurse monitor? A. Hypercalcemia B. Hyperkalemia C. Hypomagnesemia D. Hypophosphatemia
Answer: B. Hyperkalemia Rationale: Oliguria resulting from chronic glomerulonephritis causes potassium retention, leading to levels above the expected reference range of 3.5 to 5 mEq to 5 mEq/L. Other electrolyte imbalances common with this disorder affect sodium and phosphorus levels. Chronic glomerulonephritis eventually leads to end-stage kidney disease.
A nurse is assisting with the preparation of an in-service program about the stages of acute kidney injury (AKI). Which of the following pieces of information should the nurse suggest about prerenal azotemia? A. Prerenal azotemia begins prior to the onset of symptoms B. Interference with renal perfusion causes prerenal azotemia C. Prerenal D. Infections and tumors cause prerenal azotemia
Answer: B. Interference with renal perfusion causes prerenal azotemia Rationale: Prerenal azotemia results from interference with renal perfusion (e.g. heart failure or hypovolemic shock).
A nurse is checking urinalysis results for four clients . Which of the following ur analysis results indicate a urinary tract infection? A. Positive for hyaline casts B. Positive for leukocytes esterase C. Positive for ketones D. Positive for crystals
Answer: B: a positive leukocyte esterase indicates a urinary tract infection
A nurse is reinforcing teaching with a client who has acute pyelonephritis. Which of the following instructions should the nurse include in the teaching? A. "You should avoid taking NSAIDs for pain." B. "You should maintain complete bed rest until the manifestations decrease." C. "You should drink 1,000ml of fluid per day." D. "You should complete the entire cycle of antibiotic therapy."
Answer: D Rationale: The client should complete the full prescription of the antibiotic therapy to decrease the chance of regrowth of the causative
A nurse is reinforcing teaching with a client prior to a cystoscopy. Which of the following statements should the nurse make? A. "You will need to keep the sutures clean after this procedure." B. "You will be placed on your left side for this procedure." C. "Expect to be on bed rest for 24 hours after this procedure." D. "Expect to have pink-tinged urine after this procedure."
Answer: D. Rationale: A cystoscopy is a procedure in which a scope is inserted into the urethra to diagnose or treat bladder problems. Following the procedure, the pink-tinged urine is expected.
A nurse is reviewing the laboratory findings of a client who has chronic kidney disease. The client reports significant, persistent nausea and muscle weakness. Which of the findings should the nurse expect? A. Hypernatremia B. Hypomagnesemia C. Hypercalcemia D. Hyperkalemia
Answer: D. Hyperkalemia Rational: A Client who has chronic kidney disease can have a hyperkalemia, which is a potassium level greater than 5.0mEq/L. The expected reference range for a potassium level is 3.5 to 5.0 mEq/L. Other manifestations of hyperkalemia can include palpitation, dysrhythmias, nausea, and muscle weakness.
A nurse is collecting data from a client who is postoperative following a transurethral resection of the Prostate (TURP) and has continuous bladder irrigation. The nurse notes no drainage in the client's urinary drainage bag over 1 hour. Which of the following actions should the nurse take? A) instruct the client to attempt to void around the indwelling urinary catheter. B) Increase the rate of irrigation fluid installation. C) Irrigate the indwelling urinary catheter with a syringe. D) prepare to administer a diuretic.
Answer:C. Irrigate the indwelling urinary catheter with a syringe to clear the obstruction and allow the urine and irrigation fluid to drain.
A nurse is caring for a client who has manifestations of acute tubular necrosis (ATN) following a kidney transplantation. Which of the following interventions should the nurse anticipate for this client? (Select all that apply.) A. Hemodialysis B. Biopsy C. Immunosuppression D. Balloon angioplasty E. Surgical repair
Correct Answers: A. Hemodialysis B. Biopsy C. Immunosuppression Clients who develop ATN after transplantation surgery might need dialysis until they have an adequate urine output and their BUN and creatinine levels stabilize. Because the development of ATN after transplantation surgery mimics the symptoms of rejection of the transplanted kidney, clients have to undergo a biopsy to determine the correct diagnosis. Immunosuppressive medication therapy is essential after kidney transplantation to protect the new kidney.
A nurse is caring for a client who is in the oliguric-anuric stage of acute kidney injury. The client reports diarrhea, a dull headache, palpitations, and muscle tingling and weakness, Which of the following actions should the nurse take first? A. Administer an analgesic to the client B. Check the client's electrolyte values C. Measure the client's weight D. Restrict the client's protein
Correct: B. Check the client's electrolyte values Rationale: The nurse should apply the urgent versus non-urgent priority-setting framework when caring for the client. Using this framework, the nurse should consider urgent needs to be the priority because they pose a greater threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which finding is the most urgent. The nurse should check the client's most recent potassium value because these findings are manifestations of hyperkalemia, which can lead to cardiac dysrhythmias.
A nurse is reinforcing teaching with a client who is preoperative prior to a transurethral resection of the prostate (TURP). Which of the following statements indicates an understanding of the information? A. "I will not need to have a urinary catheter following this procedure." B. "I will expect my urine to be cloudy after having this procedure.' C. "At least I won't have leakage of urine after this procedure." D. "I will feel the urge to urinate following this procedure."
D. "I will feel the urge to urinate following this procedure."
A nurse is assisting with the preparation of an in-service program about the stages of acute kidney injury (AKI). Which of the following pieces of information should the nurse suggest about prerenal azotemia? A. Prerenal azotemia begins prior to the onset of symptoms B. Prerenal ?????? C. Infections and tumors cause prerenal azotemia D. Interference with renal perfusion causes prerenal azotemia
D. Interference with renal perfusion causes prerenal azotemia
A nurse is reinforcing teaching about collecting a 24-hour specimen for creatinine clearance with newly licensed nurses. Which of the following instructions should the nurse include? A. Include the first voided specimen at the start of the collection period. B. Discard the last voided specimen at the end of the collection period C. Place signs in the bathroom as a reminder about the test in progress D. Instruct the client to increase exercise during the 24-hr period.
Rationale C. the nurse should place signs in the bathroom and alert family members of the test in progress so that everyone saves the specimens appropriately throughout the test.
A nurse is reinforcing teaching with a young adult client who has a history of calcium oxalate renal calculi. Which of the following instructions should the nurse include? A. "Drink fruit punch or juice with every meal." B. "Consume 1000 milligrams of dietary calcium daily." C. "Take 1 gram of a vitamin C supplement daily." D. "Increase your daily brain intake."
Rationale: B. Clients who are prone to the development of calcium oxalate stones should consume the recommended daily allowance (RDA) of calcium for their age. The RDA for calcium for adults 19 to 50 years old is 1,000 mg daily. Calcium should be obtained from dietary sources rather than supplements that can promote development of renal calculi.
A nurse is reinforcing teaching with a female client who has pyelonephritis about the disorder. Which of the following pieces of information should the nurse include to help the client prevent a recurrence? A. Douche after vaginal intercourse B. Wipe from front to back after defecation C. Avoid foods that are high in phosphate D. Add yogurt to your diet regularly
Rationale: B. Pyelonephritis is a bacterial infection of the kidney and renal pelvis. The nurse should instruct the client about the importance of wiping from front to back following fecal elimination to prevent introducing bacteria into the urinary tract, which can ultimately cause pyelonephritis.
A nurse is caring for a client who has just returned from the surgical suite following a right nephrectomy. Which of the following indicates that the client is meeting a successful short-term goal following this procedure? A. The client requests pain medication upon arrival from surgery B. A chest x-ray shows consolidation in the right lower lobe C. Urinary output is 35 to 50 mL/hr consistently D. The client has slight abdominal distention
Rationale: C. Following a nephrectomy, the client should have a urine output of at least 30 mL/hr consistently. Less than that indicates inadequate blood flow to the remaining kidney