Chapter 36, 37

1. Increase fluid intake.

The nurse is contributing to the plan of care for a patient with glomerulonephritis. Which of the following interventions would the nurse recommend be included in the patient's plan of care? 1. Increase fluid intake. 2. Decrease sodium intake. 3. Increase potassium intake. 4. Decrease carbohydrate intake.

1. Micturition

The formation of urine is a critical physiological function. The nurse is aware that multiple processes are involved. Which process does the nurse recognize as not part of the formation of urine? 1.Micturition 2.Glomerular filtration 3.Tubular excretion 4.Tubular reabsorption

4. Suprapubic catheter

What type of urinary catheter is inserted through an incision in the lower abdomen and into the bladder? 1. Condom catheter 2. Indwelling urethral catheter 3. Straight urethral catheter 4. Suprapubic catheter

1. Tobacco use

The nurse is obtaining a history on a patient with a diagnosis of bladder cancer. Which of the following would the nurse expect to find in the patient's history? 1. Tobacco use 2. Vegetarian diet 3. Caffeine use 4. Alcohol use

912 mL

The nurse is documenting the patient's shift output. What is the patient's total output as recorded during 0700 to 1500? 1. 0800 voided 165 mL 2. 1130 voided 450 mL 3. 1300 emesis 42 mL 4. 1500 voided 255 mL Answer: ______________ mL

1. 25 mL

The nurse is catheterizing a patient after voiding to determine the amount of residual urine in the bladder. What should the nurse consider as being the normal amount of urine within the bladder after urination? 1. .25 mL 2. .75 mL 3. .100 mL 4. .150 mL

1. Monitor vital signs. 2. Observe for bleeding. 3. Monitor biopsy site. 4. Monitor urine output.

Which of the following are postprocedure care for a renal biopsy? Select all that apply. 1. Monitor vital signs. 2. Observe for bleeding. 3. Monitor biopsy site. 4. Monitor urine output. 5. Maintain nothing by mouth (N P O).

1. Listen for a bruit at the access. 2. Palpate the thrill at the access

Which of these is the nurse's priority during data collection for a patient with a vascular access? Select all that apply. 1. Listen for a bruit at the access. 2. Palpate the thrill at the access. 3. Document location of access. 4. Observe bruising at site. 5. Note tenderness at site.

3. Flank edema and bloody urine

The nurse is collecting data on a patient who experienced a sport injury to the lower back area. Which finding will cause the nurse greatest concern? 1.Report of nausea and anxiety 2.Ecchymosis and pain in area of injury 3.Flank edema and bloody urine 4.Pain in the lower abdomen

1. Dysuria 2. Urgency 3. Frequency

The nurse is collecting data on a patient who has presented to the health care provider's office with a fever. Which of these findings are signs or symptoms of a U T I? (Select all that apply.) 1. Dysuria 2. Urgency 3. Frequency 4. Amber urine 5. Ammonia-smelling urine

3. Bladder continence will develop after healing

. The nurse is providing postoperative care for a patient with a newly formed ileal conduit for a diagnosis of cancer. Which factor regarding the patient's surgery does the nurse identify as incorrect? 1.The nurse can expect the urine to contain mucus 2.Urine will drain continuously from the reservoir 3.Bladder continence will develop after healing 4.The surgery includes the formation of an ileostomy

4. The patient has a history of renal dysfunction

. The nurse is providing care for a patient scheduled for diagnostic studies of the gastrointestinal system using contrast medium. Which finding in the patient's medical history warrants the nurse contacting the HCP? 1.The patient reports an allergy to shellfish 2.The patient recently had pneumonia 3.The patient had food intake 12 hours previous 4.The patient has a history of renal dysfunction

4. ."Have you had any type of strep infection recently?

A 19-year-old patient reports flank pain and scanty urination. The nurse notices periorbital edema, and the urinalysis reveals white blood cells, red blood cells, albumin, and casts. Which question will provide important information for the nurse to include in data collection? 1."Have you noticed changes in your vision? 2."Have you ever had unprotected sex? 3."Have you had any gastrointestinal problems lately? 4."Have you had any type of strep infection recently?

2. Gelatin dessert 3. Clear carbonated beverage 4. Cranberry juice

A patient with chronic kidney disease who is on hemodialysis asks for a snack in the afternoon. The patient's potassium level is 6.0 mEq/L. Which of the following foods can the nurse offer? (Select all that apply.) 1. Banana 2. Gelatin dessert 3. Clear carbonated beverage 4. Cranberry juice 5. Nectarine 6. French fries

3. Decreased bladder size and muscle tone

. The nurse is collecting information from an older adult patient in the health care provider's (HCP) office. The patient reports frequent urination. Which effect of aging does the nurse recognize? 1.A decrease in glomerular filtration 2.The presence of an early bladder infection 3.Decreased bladder size and muscle tone 4.General decrease in renal functioning

3.Irreparable kidney damage

. The nurse is providing care for a patient who is diagnosed with urinary obstruction from a blockage of the urethra. An emergency surgery is scheduled. The nurse is aware of which complication occurring without resolution of the condition? 1.Bilateral hydronephrosis 2.Urinary bladder rupture 3.Irreparable kidney damage 4.Dilation of the ureters

3. Intrarenal

. The nurse is providing care for a patient with glomerulonephritis. Which form of kidney injury should the nurse realize has occurred with this patient? 1.Prerenal 2.Postrenal 3.Intrarenal 4.Suprabladder

4. A 50-year-old male with a 20-year history of smoking and works in a chemical laboratory

. Which patient will the nurse consider to be at greatest risk for cancer of the kidney? 1.A 30-year-old male who smokes a pack a day and is treated for hypertension 2.A 46-year-old female who is obese and works full time as an x-ray technician 3.A 55-year-old female who has undergone dialysis for 6 years for renal disease 4.A 50-year-old male with a 20-year history of smoking and works in a chemical laboratory

2. Encourage an appointment with a urologist

5. An older male patient expresses frustration at need to urinate often, dribbling of urine, and feelings of inability to empty his bladder. Which suggestion by the nurse is most helpful to the patient? 1.Obtain and wear incontinence pads 2.Encourage an appointment with a urologist 3.Review medications with the primary HCP 4.Set up a schedule for regular voiding

4.Complicated pyelonephritis

A female patient with a history of diabetes mellitus presents at the health care provider's (HCP) office with chills, a high fever, and flank pain. The nurse notes that a collected urine specimen appears cloudy. Which condition does the nurse expect? 1.Diabetic related sepsis 2.Infection from hepatitis 3.Urethritis and bladder infection 4.Complicated pyelonephritis

3.Provide a nightlight in the bathroom.

A home health nurse visits a patient who is 82 years old, uses a cane, and is continent. Which of the following interventions should be included in the plan of care, based on normal age-related changes of the urinary system, to promote patient safety? 1. Encourage fluids after 6 p.m. 2.Limit fluids to 1,000 mL per day. 3.Provide a nightlight in the bathroom. 4.Provide adult briefs to absorb dribbling.

3. Apply pressure to access site.

A patient has completed a dialysis session. The nurse notes bleeding from the patient's vascular access in the left arm. Which of the following is the nurse's first action? 1. Call the physician. 2. Notify the dialysis nurse. 3. Apply pressure to access site. 4. Take patient's blood pressure.

4. "Empty bladder then tighten the pelvic floor muscles for 8 seconds, then relax 10 seconds."

A patient is experiencing stress incontinence with frequent involuntary loss of urine. Which of the following directions would be most appropriate when teaching the patient how to perform Kegel exercises? 1. "Tighten your rectum at frequent intervals throughout the day." 2. "Keep your abdominal muscles tightened; do this every time you stand up." 3. "Do 20 sit-ups per day." 4. "Empty bladder then tighten the pelvic floor muscles for 8 seconds, then relax 10 seconds."

4 tablets

A patient is to receive 1,600 mg of sevelamer (Renagel) orally with meals. Renagel 400-mg tablets are available. How many tablets should the nurse give? Answer: ______________ tablets

2. Providing caring support to the patient

A patient shares a long-standing problem of urinary incontinence with the nurse. Which intervention does the nurse recognize as taking priority? 1.Referring the patient to a urologist 2.Providing caring support to the patient 3.Recommending a continence clinic 4.Keeping a voiding diary for evaluation

1. The patient is dehydrated

A patient with pneumonia has a blood urea nitrogen (BUN) of 32 mg/dL and creatinine of 0.8 mg/dL. What should the nurse realize is the most probable explanation for this finding? 1.The patient is dehydrated 2.The patient has septicemia 3.The patient is malnourished 4.The patient has kidney damage

2. Urinary tract infection

A patient's urinalysis results are white blood cells (WBCs) 100+/hpf; red blood cells (RBC) 4/hpf; bacteria, moderate amount; nitrite, positive; specific gravity, 1.025; and urine, cloudy. What should the nurse recognize these findings indicate? 1.Dehydration 2.Urinary tract infection 3.Contamination from menstruation 4.Presence of bacteria from the perineum

3. The patient is unable to detect the need to urinate

The nurse is providing care for a patient with a thoracic spinal cord injury. For which reason does the nurse understand the presence of a suprapubic catheter? 1.The patient is unable to stand to void 2.The patient is less likely to have bladder infections 3.The patient is unable to detect the need to urinate 4.The patient is at risk for skin breakdown from incontinence

1. Refrains from drawing blood or placing IV lines in the nondominate arm

The nurse is providing care for a patient who is scheduled for the formation of access for hemodialysis. Which important action does the nurse take with this patient? 1. Refrains from drawing blood or placing IV lines in the nondominate arm 2. Prepares the patient for permanent placement of a central venous catheter 3. Instructs the patient about the need for showering with antimicrobial soap 4. Reviews the type of underclothing that will be worn to protect the access

2. Obtain daily weight.

The nurse is caring for a patient with acute kidney injury. Which of the following actions should the nurse take to obtain the most accurate assessment of fluid balance for the patient? 1. Document voiding pattern. 2. Obtain daily weight. 3. Review creatinine levels. 4. Observe skin turgor.

2. The kidneys are unable to excrete hydrogen ions

The nurse is providing care for a patient with a diagnosis of kidney disease. The patient's last laboratory result indicates metabolic acidosis. Which kidney activity does the nurse recognize for the condition? 1.The kidneys are absorbing more bicarbonate 2.The kidneys are unable to excrete hydrogen ions 3.The kidneys are compensating for respiratory function 4.The kidneys are responding to vomiting related to disease

2. Encourage fluids. 4. Measure urine output.

The nurse is caring for a patient who has had a pyelogram with intravenous contrast. Which of the following care should the nurse provide? (Select all that apply.) 1. Maintain nothing by mouth. 2. Encourage fluids. 3. Check gag reflex. 4. Measure urine output. 5. Position patient prone. 6. Maintain bedrest for 24 hours.

4. Women should keep the labia separated while voiding.

The nurse is caring for a patient who is to have a urine culture and sensitivity done. Which of the following should be included in patient teaching for collecting a midstream clean-catch urine specimen for culture and sensitivity? 1. A second voided specimen is preferred. 2. A 24-hour urine specimen is needed. 3. As soon as the urine starts to flow, it should be collected in a sterile container. 4. Women should keep the labia separated while voiding.

3. Maintain a closed catheter system.

The nurse is caring for a patient with a urinary catheter. Which of the following is the most important nursing action for the nurse to take to prevent urinary tract infection in this patient? 1. Encourage fluids to 4,000 mL every 24 hours. 2. Empty the Foley bag every 4 hours around the clock. 3. Maintain a closed catheter system. 4. Wash the perineum every 8 hours.

4. Serum creatinine 2.2 mg/dL

The nurse is caring for a postoperative patient who is receiving 0.9% normal saline intravenously at 125 mL/hour, morphine intravenously for pain control, and gentamicin (Garamycin) intravenously every 8 hours for 24 hours. The patient is allergic to iodine. Morning labs are white blood cell 8,500, hemoglobin 12.4 g/dL, and serum creatinine 2.2 mg/dL. Which of these findings is a priority for the licensed vocational nurse to report to the registered nurse? 1. White blood cell 8,500 2. Intravenous rate 125 mL/hour 3. Allergy to iodine 4. Serum creatinine 2.2 mg/dL

1. Auscultate bruit over the right arm fistula. 6. Palpate for thrill over the right arm fistula.

The nurse is checking patency of a new right arm arteriovenous fistula. What action does the nurse use to do this? (Select all that apply.) 1. Auscultate bruit over the right arm fistula. 2. Auscultate the right brachial pulse. 3. Auscultate the right radial pulse. 4. Measure blood pressure in the right arm. 5. Palpate the right radial pulse. 6. Palpate for thrill over the right arm fistula.

2. Urine test for telomerase

The nurse is collecting data from a male patient who reports hematuria and bladder cramping. The patient's history indicates a 20-year history of smoking and long-term employment in a tool factory. Which specific test does the nurse expect the HCP to order? 1.Complete blood count 2.Urine test for telomerase 3.Urinalysis for bladder infection 4.Urine culture for presence of bacteria

2. Medications for chronic joint pain and hypertension

The nurse is collecting data on a patient admitted for symptoms of renal insufficiency. Which factor will cause the nurse to suspect prerenal injury? 1.A family history of polycystic kidney disease (PKD) 2.Medications for chronic joint pain and hypertension 3.Laboratory results indicating a high level of an aminoglycoside 4.A tumor obstruction diagnosed as being present in the right ureter

1.Patient wearing sweat pants

The nurse is making a visit to the home of a patient with functional incontinence. Which observation indicates that teaching about the disorder has been effective? 1. Patient wearing sweat pants 2.Patient drinking a cup of coffee 3.Patient sitting with the legs elevated 4.Patient restricting fluid intake after 6 p.m

1. Void frequently. 3. Avoid bubble baths. 5. Void after sexual intercourse. 6. Drink cranberry juice

The nurse is planning a patient teaching session on preventing urinary tract infections. Which of the following information should the nurse include in the teaching plan? Select all that apply. 1. Void frequently. 2. Drink large amounts of citrus juices. 3. Avoid bubble baths. 4. Wash the perineum every 8 hours. 5. Void after sexual intercourse. 6. Drink cranberry juice

3. Obtain daily weights

The nurse is planning care for a patient diagnosed with chronic renal failure. The nurse notes that the patient's output is 620 mL for the last 24 hours. The patient has periorbital edema and crackles in all lung fields upon auscultation. Which intervention is most important for the nurse to implement during care of this patient? 1.Administer oxygen therapy 2.Measure abdominal girth 3.Obtain daily weights 4.Maintain fluid restrictions

2. Strain all urine. 5. Teach to increase fluid intake. 6. Give analgesics as ordered.

The nurse is planning care for a patient with a diagnosis of a kidney stone. Which of the following interventions would the nurse implement? Select all that apply. 1. Restrict fluids. 2. Strain all urine. 3. Increase calcium intake. 4. Maintain bedrest. 5. Teach to increase fluid intake. 6. Give analgesics as ordered.

1. Convenience for the patient

The nurse is preparing a patient for a cystectomy and the creation of a continent urinary diversion. For which reason does the nurse identify creation of this type of diversion? 1.Convenience for the patient 2.Extensive bladder destruction exists 3.Prevention of skin breakdown 4.Failed previous incontinent diversion

2. Grape-like cysts will replace normal, functioning structures. 3. Initial symptoms are dull heaviness in the flank area and hematuria. 4. Patients are at risk for brain aneurysms and diverticulosis in the colon. 5. Disease is likely to require additional treatment for hypertension and UTIs.

The nurse is preparing to reinforce teaching to a patient newly diagnosed with PKD. Which information does the nurse include? (Select all that apply.) 1. Typically, first signs of the disease appear during late childhood. 2. Grape-like cysts will replace normal, functioning structures. 3. Initial symptoms are dull heaviness in the flank area and hematuria. 4. Patients are at risk for brain aneurysms and diverticulosis in the colon. 5. Disease is likely to require additional treatment for hypertension and UTIs.

2. Bilateral flanks

The nurse is providing care for a patient admitted for a suspected kidney infection. Which area of the body does the nurse expect the patient to identify as a source of pain? 1.Lower abdomen 2.Bilateral flanks 3.Midepigastric 4.Pelvic floor

4. Strain urinary output and observe for stones

The nurse is providing care for a patient admitted with severe flank pain identified as renal colic. Urinalysis is positive for microscopic hematuria. Which nursing intervention is most important for the nurse to implement? 1.Administer prescribed narcotic medication 2.Maintain IV fluids and encourage oral fluids 3.Promote assisted ambulation as tolerated 4.Strain urinary output and observe for stones

3. How to perform catheterization

The nurse is providing care for a patient scheduled for surgery for the formation of an orthotopic bladder substitution. Which patient teaching is important for the nurse to review during the patient's recovery? 1.How to monitor the stoma 2.How to prevent skin injury 3.How to perform catheterization 4.How to apply an ostomy appliance

3. Change the catheter with sterile technique daily

The nurse is providing care for a patient who has undergone placement of a suprapubic catheter. Which postprocedure nursing care is avoided? 1.Change the surgical dressing as needed 2.Tape the catheter in place to avoid tension 3.Change the catheter with sterile technique daily 4.Apply a skin barrier to prevent skin breakdown

1. Mashed potatoes and creamed corn

The nurse is providing care for a patient who is on fluid restrictions due to renal failure. The patient's intake & output (I&O) should be carefully measured. Which substance does the nurse exclude from the intake total? 1.Mashed potatoes and creamed corn 2.All oral and IV fluids 3.Water, coffee, juices, and gelatin 4.Any tube feeding administered

3. The patient who has an indwelling catheter for a urinary tract infection (UTI)

The nurse is providing care for older adult clients in an extended care facility. Which patient will the nurse monitor most closely for symptoms of urosepsis? 1.The patient with continuous urinary incontinence 2.The patient who is unable to obtain fluids independently 3.The patient who has an indwelling catheter for a urinary tract infection (UTI) 4.The patient who has surgery for placement of an ileostomy

3. Cardiac arrhythmias and angina from fluid loss

The nurse is providing support for a client who just finished a hemodialysis session. Which patient symptom is considered to be a complication of hemodialysis? 1.Headache from a drop-in blood pressure 2.Increased clotting time from dialysate 3.Cardiac arrhythmias and angina from fluid loss 4.High energy level related to loss of toxins

1. Peritonitis

The nurse is reinforcing teaching about the most serious side effect of peritoneal dialysis with a patient scheduled for the first treatment. Which side effect stated by the patient indicates correct understanding? 1.Peritonitis 2.Paralytic ileus 3.Respiratory distress 4.Cramps in the abdomen

1. Do not sleep on my arm 4. Wear loose clothing on my left arm 5. Avoid carrying heavy things with my left arm

The nurse is reinforcing teaching provided to a patient about caring for a new arteriovenous (AV) fistula in the left arm for dialysis. Which patient statements indicate correct understanding? (Select all that apply.) 1. Do not sleep on my arm 2. Keep my arm elevated at all times 3. Keep a firm bandage on my arm 4. Wear loose clothing on my left arm 5. Avoid carrying heavy things with my left arm

2. Cocoa 4. Spinach 5. Instant coffee

The nurse is reinforcing teaching provided to a patient with a history of calcium oxalate kidney stones. The nurse recognizes that teaching has been effective if the patient avoids which foods? (Select all that apply.) 1. Bread 2. Cocoa 3. Lettuce 4. Spinach 5. Instant coffee

4. Wear a urinary incontinence pad if away from home

The nurse is reinforcing teaching to a client who is preparing to perform intermittent self-catheterization at home. Which information by the nurse is inappropriate? 1.The bladder should be emptied every 3 hours 2.An overfilled bladder can be a source of infection 3.Catheters can be washed and reused repeatedly 4.Wear a urinary incontinence pad if away from home

4. "How much do you exercise?

The nurse is reviewing the laboratory results for a patient. Which question does the nurse ask the patient if the creatinine level is elevated? 1."Have you been sick lately? 2."Are you lactose intolerant? 3."Do you have flank pain? 4."How much do you exercise?

3. Protein 4. RBCs

The nurse is reviewing the results of a patient's urinalysis. Which components does the nurse identify as being abnormal in urine? (Select all that apply.) 1.Urea 2.Hormones 3.Protein 4.RBCs 5.Water

1. Blood 7/hpf 4.White blood cells 11/hpf 5. Nitrites positive 6. pH 9.0

The nurse is reviewing the urinalysis of a patient. Which of the following are abnormal findings to report to the health care provider? Select all that apply. 1. Blood 7/hpf 2. Glucose none 3. Protein 4 mg/dL 4.White blood cells 11/hpf 5. Nitrites positive 6. pH 9.0

2. Are you following a vegetarian diet?

The nurse is testing the urine pH for a patient in the HCP's office. The test indicates a pH of 7.0. Which question does the nurse ask the client? 1."Do you have pain when you urinate? 2."Are you following a vegetarian diet? 3."How much aspirin do you take daily? 4."Is there a family history of renal disease?

2. After collecting the urine specimen

The nurse is to administer an antibiotic and collect a urine for culture and sensitivity. When should the nurse administer the antibiotic? 1. Before collecting the urine specimen 2. After collecting the urine specimen 3. After obtaining the culture results 4. After reviewing the sensitivity report

2. The patient verbally expresses symptoms to report to the HCP

The nurse is visiting a patient who performs peritoneal dialysis at home. The nurse is evaluating the patient's technique and environment. Which situation is least likely to cause the nurse concern? 1. The patient has several pets who roam around the house 2. The patient verbally expresses symptoms to report to the HCP 3. The patient uses clean technique when instilling the dialysate 4. The patient voices the reasons for limiting dietary protein intake

1. Regulate blood pressure through the conservation of fluids

The nurse understands that a major function of the kidneys is to remove potentially toxic waste products from the blood. Which function is inaccurate? 1. Regulate blood pressure through the conservation of fluids 2. Regulate minerals to maintain electrolyte balance 3. Manage hydrogen or bicarbonate for acid-base balance 4. Manage erythrocyte production in the bone marrow

1. Check glomerular filtration rate (G F R) and creatinine prior to contrast media or nephrotoxic medications.

When the nurse is caring for a patient, what is the priority action to prevent acute kidney injury? 1. Check glomerular filtration rate (G F R) and creatinine prior to contrast media or nephrotoxic medications. 2. Read protocols to prevent contrast-induced nephropathy. 3. Hydrate before/after contrast media. 4. Monitor nephrotoxic drugs trough levels.

2. Strain all urine. 5. Provide pain relief. 6. Maintain I V hydration.

Which actions are essential for the nurse to take when providing care to a patient with a renal calculi? Select all that apply. 1. Limit fluids. 2. Strain all urine. 3. Maintain bedrest. 4. Restrict dairy products. 5. Provide pain relief. 6. Maintain I V hydration.

3. Involuntary urine loss from increasing abdominal pressure

Which of the following defines stress incontinence? 1. Occurs from impairment of physical/mental function 2. Involuntary loss of urine associated with bladder overdistention 3. Involuntary urine loss from increasing abdominal pressure 4. Involuntary urine loss with abrupt/strong desire to void

1. Control blood glucose. 2. Control blood pressure. 4. Restrict protein in diet.

Which of these actions should the nurse include in a teaching plan to help prevent or slow progression of diabetic nephropathy? Select all that apply. 1. Control blood glucose. 2. Control blood pressure. 3. Limit fluids. 4. Restrict protein in diet. 5. Increase insulin dose.

2. Urinary tract obstruction 3. Neurogenic bladder 4. Urinary incontinence

Which of these are justifiable reasons for urinary catheterization? Select all that apply. 1. Shock 2. Urinary tract obstruction 3. Neurogenic bladder 4. Urinary incontinence 5. Immobility

2. Continue changing the pouch.

While changing the pouch at the stoma site of an ileal conduit, the nurse notes the stoma is constantly spilling urine. Which of the following actions should the nurse take? 1. Notify the physician of the constant spillage. 2. Continue changing the pouch. 3. Remove the overflow of urine with a straight catheter. 4. Irrigate the stoma with a sterile solution of normal saline.