N321: Exam 2 - NCLEX-Style Questions (Renal/GU)

A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which intervention is important? - 1. Strain all urine - 2. Limit fluid intake - 3. Enforce strict bed rest. - 4. Encourage a high-calcium diet

- 1. Strain all urine R: Urine should be strained for calculi and sent to the laboratory for analysis. Fluid intake of 3 to 4 qt. 3 to 4 L/day is encouraged to flush the urinary tract and prevent further calculi formation. Ambulation is encouraged to help pass the calculi through gravity. A low-calcium formation of calcium calculi.

Which method should be used to collect a specimen for urine culture? - 1. Have the client void in a clean container. - 2. Clean the foreskin of the penis of uncircumcised men before specimen collection. - 3. Have the client void into a urinal, and then pour the urine into the specimen container. - 4. Have the client begin the stream of urine in the toilet and catch the urine in a sterile container midstream.

- 4. Have the client begin the stream of urine in the toilet and catch the urine in a sterile container midstream. R: Catching urine midstream reduces the amount of contamination by microorganisms at the meatus. Voiding in a clean container is done for a random specimen, not a clean-catch specimen for urine culture. When cleaning an uncircumcised male, the foreskin should be retracted and the glands penis should be cleaned to prevent specimen contamination. Voiding in a specimen because the urinal isn't sterile.

A client admitted for acute pyelonephritis is about to start antibiotic therapy. Which symptom would be expected in this client? 1) Hypertension 2) Flank pain on the affected side 3) Pain that radiates toward the unaffected side 4) No tenderness with deep palpation over the CVA

2) Flank pain on the affected side R: The client may complain of pain on the affected side because the kidney is enlarged and might have formed an abscess. Hypertension is associated with chronic pyelonephritis. Pain may radiate down the ureters or to the epigastrium. The client would have tenderness with deep palpation over the CVA.

The client with acute renal failure has a serum potassium of 6.0 mEq/L. The nurse would plan which of the following as a priority action? a) check the sodium level b) place the client on a cardiac monitor c) encourage increased vegetables in the diet d) allow an extra 500 ml of fluid intake to dilute the electrolyte concentration

b) place the client on a cardiac monitor

The nurse is assessing a patient who is receiving peritoneal dialysis with 2-L inflows. Which information should be reported immediately to the health care provider? a. The patient complains of feeling bloated after the inflow. b. The patient's peritoneal effluent appears cloudy. c. The patient has abdominal pain during the inflow phase. d. The patient has an outflow volume of 1600 ml.

b. The patient's peritoneal effluent appears cloudy. R: Cloudy-appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.

A patient complains of leg cramps during hemodialysis. The nurse should a. give acetaminophen (Tylenol). b. infuse a bolus of normal saline. c. massage the patient's legs. d. reposition the patient.

b. infuse a bolus of normal saline. R: Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? a) Acute glomerulonephritis b) Acute renal failure c) Nephrotic syndrome d) Chronic renal failure

a) Acute glomerulonephritis

Which type of medication may be used in the treatment of a patient with incontinence to inhibit contraction of the bladder? a) Anticholinergic agent b) Over-the-counter decongestant c) Tricyclic antidepressants d) Estrogen hormone

a) Anticholinergic agent R: Anticholinergic agents are considered first-line medications for urge incontinence.

When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? a) Check for thrill or bruit over the access site. b) Warm the solution to body temperature. c) Inspect the catheter insertion site for infection. d) Add the prescribed drug to the dialysate.

a) Check for thrill or bruit over the access site. R: Check for thrill or bruit over the access site. When preparing a client for hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency. Inspecting the catheter insertion site for infection, adding the prescribed drug to the dialysate, and warming the solution to body temperature would be necessary when preparing a client for peritoneal dialysis.

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? a) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. b) Administer furosemide (Lasix) 20 mg I.V. c) Encourage oral fluids. d) Start hemodialysis after a temporary access is obtained.

a) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. R: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a) Urine output of 250 ml/24 hours b) Temperature of 100.2° F (37.8° C) c) Serum creatinine level of 1.2 mg/dl d) Blood urea nitrogen (BUN) level of 22 mg/dl

a) Urine output of 250 ml/24 hours R: ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply. a) Vitamin D synthesis b) Secretion of prostaglandins c) Vitamin B production d) Secretion of insulin e) Regulation of blood pressure

a) Vitamin D synthesis b) Secretion of prostaglandins e) Regulation of blood pressure R: Functions of the kidney include secretion of prostaglandins, regulation of blood pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body does not produce Vitamin B.

A diabetic patient is admitted for evaluation of renal function because of recent fatigue, weakness, and elevated BUN and serum creatinine levels. While obtaining a nursing history, the nurse identifies an early symptom of renal insufficiency when the patient states, a. "I get up several times every night to urinate." b. "I wake up in the night feeling short of breath." c. "My memory is not as good as it used to be." d. "My mouth and throat are always dry and sore."

a. "I get up several times every night to urinate." R: Polyuria occurs early in chronic kidney disease (CKD) as a result of the inability of the kidneys to concentrate urine. The other symptoms would be expected later in the progression of CKD.

A patient is diagnosed with stage 3 CKD. The patient is treated with conservative management, including erythropoietin injections. After teaching the patient about management of CKD, the nurse determines teaching has been effective when the patient states, a. "I will measure my urinary output each day to help calculate the amount I can drink." b. "I need to take the erythropoietin to boost my immune system and help prevent infection." c. "I need to try to get more protein from dairy products." d. "I will try to increase my intake of fruits and vegetables."

a. "I will measure my urinary output each day to help calculate the amount I can drink." R: The patient with CKD who is not receiving dialysis is generally taught to restrict fluids. The patient would need to measure urine output and then add 600 ml for insensible losses to calculate an appropriate oral intake. Erythropoietin is given to increase red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.

The nurse has instructed a patient who is receiving hemodialysis about dietary management. Which diet choices by the patient indicate that the teaching has been successful? a. Scrambled eggs, English muffin, and apple juice b. Cheese sandwich, tomato soup, and cranberry juice c. Split-pea soup, whole-wheat toast, and nonfat milk d. Oatmeal with cream, half a banana, and herbal tea

a. Scrambled eggs, English muffin, and apple juice R: Scrambled eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.

In preparation for hemodialysis, a patient has an AV native fistula created in the left forearm. When caring for the fistula postoperatively, the nurse should a. check the fistula site for a bruit and thrill. b. assess the rate and quality of the left radial pulse. c. compare blood pressures in the left and right arms. d. irrigate the fistula site daily with low-dose heparin.

a. check the fistula site for a bruit and thrill. R: The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.

A patient with diabetes who has chronic kidney disease (CKD) is considering using continuous ambulatory peritoneal dialysis (CAPD). In discussing this treatment option with the patient, the nurse informs the patient that a. patients with diabetes who use CAPD have fewer dialysis-related complications than those on hemodialysis. b. home CAPD requires more extensive equipment than does home hemodialysis. c. CAPD is contraindicated for patients who might eventually want a kidney transplant. d. dietary restrictions are stricter for patients using CAPD than for those having hemodialysis.

a. patients with diabetes who use CAPD have fewer dialysis-related complications than those on hemodialysis. R: Patients with diabetes have better control of blood pressure, less hemodynamic instability, and fewer problems with retinal hemorrhages when using peritoneal dialysis than when using hemodialysis. CAPD is less expensive and has fewer dietary restrictions than hemodialysis. CAPD is not a contraindication for a kidney transplant.

In the immediate postoperative period, the nurse caring for a patient who is a recipient of a kidney transplant would expect that fluid therapy would involve administration of IV fluids a. to be determined hourly, based on every milliliter of urine output. b. at a minimum rate of 100 ml/hr to perfuse the kidney. c. titrated to keep blood pressure within a normal range. d. at a rate to keep urine clear and without blood clots.

a. to be determined hourly, based on every milliliter of urine output. R: Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a liter an hour. Fluid infusion rate is titrated rather than being at a set rate. Blood pressure and urine appearance are not the major parameters considered when titrating fluid infusion.

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? a) "Be aware that your urine will be cherry-red for 5 to 7 days." b) "Increase your fluid intake to 2 to 3 L per day." c) "Apply an antibacterial dressing to the incision daily." d) "Take your temperature every 4 hours."

b) "Increase your fluid intake to 2 to 3 L per day." R: Increase your fluid intake to 2 to 3 L per day The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.

Nursing management of the client with a urinary tract infection should include: a) Teaching the client to douche daily b) Discouraging caffeine intake c) Administering morphine sulfate d) Instructing the client to limit fluid intake

b) Discouraging caffeine intake R: Strategies for preventing urinary tract infection include proper perineal hygiene, increased fluid intake, avoiding urinary tract irritants (including caffeine), and establishing a frequent voiding regimen.

The client presents with nausea and vomiting, absent bowel sounds, and colicky flank pain. The nurse interprets these findings as consistent with: a) Urethritis b) Ureteral colic c) Interstitial cystitis d) Acute prostatitis

b) Ureteral colic

To determine glomerular filtration rate (GFR) for a patient with chronic kidney disease, the nurse will plan to a. schedule frequent blood urea nitrogen (BUN) tests. b. initiate a 24-hour collection of the patient's urine. c. check the specific gravity on serial urine specimens. d. use a bladder scanner to check for residual urine.

b. initiate a 24-hour collection of the patient's urine. R: Creatinine clearance testing, the most accurate way to assess GFR, requires a 24-hour urine collection. BUN levels may increase for other reasons, such as dehydration, and are not as accurate in determining glomerular filtration. Urine-specific gravity testing and monitoring residual urine would not be useful in determining the GFR.

A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in: a) 1 hour. b) 24 hours. c) 1 minute. d) 30 minutes.

c) 1 minute. R: The creatinine clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a) Impaired urinary elimination b) Toileting self-care deficit c) Risk for infection d) Activity intolerance

c) Risk for infection R: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: a) a decreased serum phosphate level secondary to kidney failure. b) an increased serum calcium level secondary to kidney failure. c) water and sodium retention secondary to a severe decrease in the glomerular filtration rate. d) metabolic alkalosis secondary to retention of hydrogen ions.

c) water and sodium retention secondary to a severe decrease in the glomerular filtration rate. R: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

Two hours after a kidney transplant, the nurse obtains all these data when assessing the patient. Which information is most important to communicate to the health care provider? a. The BUN and creatinine levels are elevated. b. The urine output is 900 to 1100 ml/hr. c. The patient's central venous pressure (CVP) is decreased. d. The patient has level 8 (on a 10-point scale) incision pain when coughing.

c. The patient's central venous pressure (CVP) is decreased. R: The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant.

A patient with CKD has a nursing diagnosis of disturbed sensory perception related to central nervous system changes induced by uremic toxins. An appropriate nursing intervention for this problem is to a. convey a caring attitude and foster the nurse-patient relationship. b. keep the patient on bed rest to avoid possible falls or other injuries. c. ensure restricted protein intake to prevent nitrogenous product accumulation. d. provide an opportunity for the patient to discuss concerns about the condition.

c. ensure restricted protein intake to prevent nitrogenous product accumulation. R: Uremia is caused by the products of protein breakdown, and protein restriction is used to decrease uremia. Because the primary cause of the patient's disturbed sensory perception is the uremia, conveying a caring attitude and providing opportunities for the patient to discuss concerns will not be as helpful as protein restriction. Although safety is a concern for the patient, bed rest is likely to promote weakness. The patient should be supervised when out of bed.

As the nurse reviews a diet plan with a patient with diabetes and renal insufficiency, the patient states that with diabetes and kidney failure there is nothing that is good to eat. The patient says, "I am going to eat what I want; I'm going to die anyway!" The best nursing diagnosis for this patient is a. imbalanced nutrition: more than required related to knowledge deficit about appropriate diet. b. risk for noncompliance related to feelings of anger. c. grieving related to actual and perceived losses. d. risk for ineffective health maintenance related to complexity of therapeutic regimen.

c. grieving related to actual and perceived losses. R: The patient's statements that there is nothing that is good to eat and that death is unavoidable indicate grieving about the losses being experienced as a result of the diabetes and chronic kidney disease (CKD). The patient data do not indicate knowledge deficit, anger, or the complexity of the therapeutic program as being issues for this patient.

A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it a. can accommodate larger needles. b. increases patient mobility. c. is much less likely to clot. d. can be used sooner after surgery.

c. is much less likely to clot. R: AV fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not impact on needle size or patient mobility.

A patient begins hemodialysis after having had conservative management of chronic kidney disease. The nurse explains that one dietary regulation that will be changed when hemodialysis is started is that a. unlimited fluids are allowed since retained fluid is removed during dialysis. b. increased calories are needed because glucose is lost during hemodialysis. c. more protein will be allowed because of the removal of urea and creatinine by dialysis. d. dietary sodium and potassium are unrestricted because these levels are normalized by dialysis.

c. more protein will be allowed because of the removal of urea and creatinine by dialysis. R: Once the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is allowed. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.

A patient with acute renal failure (ARF) requires hemodialysis and temporary vascular access is obtained by placing a catheter in the left femoral vein. The nurse will plan to a. restrict the patient's oral protein intake. b. discontinue the retention catheter. c. place the patient on bed rest. d. start continuous pulse oximetry.

c. place the patient on bed rest. R: The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.

Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess a. the BUN and creatinine. b. the blood glucose level. c. the patient's bowel sounds. d. the level of consciousness (LOC).

c. the patient's bowel sounds. R: Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not impact on the nurse's decision to give the medication.

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? a) Restricting fluid intake to reduce the need to void b) Establishing a predetermined fluid intake pattern for the client c) Encouraging the client to increase the time between voidings d) Assessing present voiding patterns

d) Assessing present voiding patterns R: The guidelines for initiating bladder retraining include assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? a) Therapeutic index b) GI absorption rate c) Liver function studies d) Creatinine clearance

d) Creatinine clearance R: The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the student have understood the material when they identify which of the following as a cause of stress incontinence? a) Obstruction due to fecal impaction or enlarged prostate b) Bladder irritation related to urinary tract infections c) Increased urine production due to metabolic conditions d) Decreased pelvic muscle tone due to multiple pregnancies

d) Decreased pelvic muscle tone due to multiple pregnancies R: Stress incontinence is due to decreased pelvic muscle tone, which is associated with multiple pregnancies, obstetric injuries, obesity, menopause, or pelvic disease.

Which of the following would be included in a teaching plan for a patient diagnosed with a urinary tract infection? a) Drink coffee or tea to increase diuresis b) Use tub baths as opposed to showers c) Void every 4 to 6 hours d) Drink liberal amount of fluids

d) Drink liberal amount of fluids R: Drink liberal amounts of fluids Patients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The patient should shower instead of bathe in a tub because bacteria in the bath water may enter the urethra.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a) Serum sodium level of 135 mEq/L b) Serum potassium level of 4.9 mEq/L c) Temperature of 99.2° F (37.3° C) d) Urine output of 20 ml/hour

d) Urine output of 20 ml/hour R: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.

A client is being admitted to the hospital with a diagnosis of urolithiasis and ureteral colic. The nurse assesses the client for pain that is: a) dull and aching in the costovetebal area b) aching and camplike thoughout the abdomen c) sharp and radiating posteriorly to the spinal column d) excruciating, wavelike, and radiating toward the genitalia

d) excruciating, wavelike, and radiating toward the genitalia