NCLEX Renal and Urinary

The nurse is caring for a client receiving peritoneal dialysis and notes a brownish tinge to the dialysate output. The nurse should interpret this finding as a sign of which related complication?

Bowel perforation

The nurse should plan to teach a client diagnosed with chronic kidney disease (CKD) to contact the primary health care provider immediately if which complication develops? Select all that apply.

Confusion, Shortness of breath, Increasing sense of fatigue

The use of peritoneal dialysis for the treatment of chronic kidney disease would be contraindicated for a client diagnosed with which condition?

Severe emphysema

The nurse determines that a hemodialysis client with an arteriovenous (AV) fistula in the right arm is at risk for infection. The nurse determines that the client has best met the outcome criteria for this problem if which observation is made?

The client's white blood cell (WBC) count is 7500 mm3 (7.5 × 109/L)

The home care nurse has given instructions to a female client diagnosed with cystitis about measures to help prevent recurrence. Which statement made by the client indicates the need for further instructions?

"I should take bubble baths for more effective hygiene."

A client has had an arteriovenous (AV) graft created for hemodialysis. The client asks the nurse when the graft will be ready for use. The most appropriate response by the nurse is which time frame?

3 weeks

A client diagnosed with chronic kidney disease is requesting a cup of juice. The nurse should ask the unlicensed assistive personnel (UAP) to give the client a cup of which type of juice?

Grape

A client recovering from acute kidney injury needs to learn dietary modifications, which include limiting potassium in the diet. What should the nurse teach the client to do?

Limit meat intake to 6 oz per day.

A client diagnosed with prostatitis secondary to a kidney infection has received instructions on management of the condition at home and prevention of reoccurrence. The nurse determines that the client understood the instructions if the client verbalized that he would take which action?

Use warm sitz baths and analgesics to increase comfort.

The nurse is giving the client diagnosed with polycystic kidney disease instructions for replacing the elements that are lost in the urine as a result of impaired kidney function. The nurse instructs the client to increase the intake of which items in the diet? Select all that apply.

Water ; sodium

The nurse has instructed a client about the procedure for continuous ambulatory peritoneal dialysis (CAPD). The nurse determines that the client needs further teaching if the client indicates that she or he plans to take which action?

Perform 1 exchange per day.

A client is being discharged after undergoing a transurethral resection of the prostate (TURP). The nurse teaches the client to expect which variation in normal urine color for several days after the procedure?

Pink-tinged

The nurse caring for a client with a diagnosis of urolithiasis instructs the client that it is most important to perform which activity?

Strain all urine from each voiding.

A client diagnosed with nephrolithiasis arrives at a clinic for a follow-up visit. The laboratory analysis of the stone that the client passed 1 week ago indicates that the stone is composed of calcium oxalate. The nurse should encourage the client to avoid consuming which food item?

Strawberries

The nurse has taught a client who experienced an acute kidney injury to include dietary proteins that are considered high quality. The nurse determines that the client needs further teaching if the client selects which food?

Sweet potatoes

The nurse is teaching a client diagnosed with chronic kidney disease about daily fluid allotment. What comment by the client indicates the need for further teaching?

"I will take my daily fluid intake before supper so I won't be awakened at night."

A client who is newly diagnosed with chronic kidney disease is scheduled to begin hemodialysis. The nurse interprets which psychological finding exhibited by the client to be consistent with this disorder? Select all that apply.

2.Depression 3.Withdrawal 4.Labile emotions 5.Personality changes

Which client is the best candidate for peritoneal dialysis as a treatment option for renal failure?

A client with severe heart failure

A client diagnosed with chronic kidney disease (CKD) has been told that hemodialysis will be required. The client becomes angry and states, "I'll never be the same now." Based on this information, which should the nurse identify as the client's primary concern?

Altered body image because of the physical changes that may occur

A client undergoing long-term peritoneal dialysis is experiencing a problem with reduced outflow from the dialysis catheter. Which nursing interventions appropriately address the possible causes of this dysfunction? Select all that apply.

Assess catheter for possible obstruction. Determine when the client last had a bowel movement. Assess the client's temperature for signs of possible infection.

The nurse is reviewing the health care record of a client with a diagnosis of benign prostatic hyperplasia. The nurse notes that which sign exhibited by the client occurs late in the disorder?

Hematuria

The nurse has administered a dose of epoetin alfa to a client diagnosed with chronic kidney disease. Which hemodynamic effect should the nurse monitor the client for as a possible side effect of this medication?

Hypertension

A client is being discharged to home after prostatectomy for treatment of benign prostatic hyperplasia. Which point should the nurse plan to teach the client as part of the discharge teaching?

Notify the primary health care provider if fever, increased pain, or an inability to void occurs.

The nurse caring for a client undergoing peritoneal dialysis notes that the drainage from the outflow catheter is cloudy. Which action should the nurse take?

Obtain a culture and sensitivity of the drainage.

The nurse is admitting a client with an arteriovenous (AV) fistula in the right arm for hemodialysis. Which strategy should the nurse plan to implement to best prevent injury to the AV fistula site?

Placing an alert bracelet per agency procedure on the client's right arm

A client diagnosed with acute kidney injury has been treated with sodium polystyrene sulfonate by mouth. The nurse evaluates this therapy as effective if which values were noted on follow-up laboratory testing?

Potassium: 4.9 mEq/L (4.9 mmol/L)

The nurse has collected nutritional data from a client with a diagnosis of cystitis. The nurse should determine that which beverage needs to be eliminated from the client's diet to minimize the recurrence of cystitis?

Tea

A client has recently been diagnosed with polycystic kidney disease. The nurse has a series of discussions with the client that are intended to help the client adjust to the disorder. Which should the nurse plan to include as part of one of these discussions?

The need for genetic counseling

A client who had cardiac surgery complicated by acute kidney injury is hemodynamically unstable. The primary health care provider has told the family that the client will be treated with continuous arteriovenous hemofiltration (CAVH). Which information, if shared with the family by the nurse, will assist in allaying the family's anxieties regarding this procedure?

The procedure is safe because there is a low risk of dropping the client's blood pressure.

A client, being evaluated as a potential kidney donor for a family member, asks the nurse why different evaluation teams are needed for the donor and recipient. In formulating a response, the nurse understands that this is being done for which reason?

To avoid a conflict of interest by the team evaluating the recipient and the team evaluating the donor

A client has been diagnosed with uric acid calculi. Which statement by the client demonstrates an understanding of lifestyle changes required to prevent further development of this type of renal calculi?

"I will have to give up drinking red wines with my pasta."

The nurse is caring for a client who has been diagnosed with intrarenal failure. The nurse understands that which factor can cause intrarenal failure? Select all that apply.

1.Leukemia 2.Antibiotics 3.Lymphoma 4.Bacterial infection 6.Nonsteroidal anti-inflammatory drugs

The nurse has provided instructions to a client diagnosed with a nephrostomy tube regarding home care after hospital discharge. The nurse determines that the client understands the instructions if the client verbalizes to drink approximately how many 8-ounce glasses of water per day?

8

The nurse is creating a teaching plan for a client diagnosed with chronic kidney disease who has been started on hemodialysis. What information should the nurse plan to include in discussions with the client?

Daily medications should be taken after hemodialysis, not before.

What should the nurse do to enhance the client's comfort during the insertion of a peritoneal dialysis catheter?

Obtain a prescription for premedication.

The nurse caring for a client undergoing peritoneal dialysis notes drainage of cloudy dialysate. Which action should the nurse take first?

Obtain a sample of the dialysate output for laboratory testing.

A client with a diagnosis of urolithiasis is scheduled for extracorporeal shock wave lithotripsy. Which information should the nurse provide to ensure that the client understands the procedure?

The stone granules are passed in the urine within a few days after the procedure.

The client scheduled for a transurethral resection prostatectomy (TURP) asks the nurse to explain how the prostate is going to be removed. The nurse should tell the client that the prostate will be removed through which pathway?

The urethra

The nurse is creating a plan of care for a client diagnosed with nephrotic syndrome. The nurse documents that which important parameter needs to be assessed on a daily basis?

Weight

The nurse in the clinic provides home care instructions to the client regarding measures to treat the prostatitis. Which statement by the client indicates a need for further instructions regarding those measures?

"I need to avoid sexual activity for 1 week."

Which statement by the client diagnosed with prostatitis would indicate a need for further teaching?

"I need to avoid sexual activity for 2 weeks."

A client diagnosed with chronic kidney disease (CKD) has learned about managing diet and fluid restriction between dialysis treatments. The nurse determines that the client is compliant with the therapeutic regimen when the assessment demonstrates a weight gain of no more than how many kilograms between hemodialysis treatments?

1 to 1.5 kg

The nurse is obtaining a history from a client admitted with hydronephrosis. What are some of the questions the nurse should ask the client? Select all that apply.

2."Have you had any recent flank or abdominal pain?" 3."In the past, have you ever had a kidney or urological disorder?" 4."Do you have a history of any childhood urinary tract problems?" 6."What is your usual pattern of urinary elimination, especially amount, frequency, color, clarity, and odor?"

The nurse is admitting a client who is to undergo ureterolithotomy. Which should the nurse assess in order to determine if the client is ready for surgery? Select all that apply.

2.The knowledge of postoperative activities 3.An understanding of the surgical procedure 4.Expected outcomes of the surgical procedure 5.Feelings or anxieties about the surgical procedure

The client diagnosed with diabetes mellitus and receiving peritoneal dialysis asks the nurse why it is important to leave the dialysate infused only for a specific amount of time. The nurse responds that not adhering to the dwell time can increase the risk of which complication?

Hyperglycemia

When a client undergoing hemodialysis becomes hypotensive, what action should the nurse immediately prepare to take?

Administer a 250-mL normal saline bolus.

The nurse has given instructions to the client diagnosed with chronic kidney disease about reducing pruritus from uremia. The nurse determines that the client needs further teaching if the client states the intention to use which item for skin care?

Alcohol cleansing pads

The nurse has completed instructions regarding diet and fluid restriction for the client diagnosed with chronic kidney disease. The nurse determines that the client understands the information presented if the client selected which dessert from the dietary menu?

Angel food cake

The client arrives at the ambulatory care clinic reporting low abdominal pain but is afebrile. A routine urine specimen reveals hematuria. History of which condition should the nurse ask the client about next?

Blow or trauma to the bladder or abdomen

The nurse is preparing to care for a client postureterolithotomy who has a ureteral catheter in place. The nurse should plan to implement which action in the management of this catheter when the client arrives from the recovery room?

Check the drainage from the catheter.

Which intervention should the nurse include in the plan of care for a client diagnosed with polycystic kidney disease?

Consume adequate fluid and sodium intake.

A client who has calcium phosphate kidney stones tells the nurse, "Tell me what I can do so that I never have to have this pain again." What should the nurse plan to include in the teaching? Select all that apply.

Decrease sodium intake. Limit the intake of whole grains. Limit protein to 5 to 7 servings per week.

The client has been diagnosed with pyelonephritis. The nurse interprets that which health problem has placed the client at risk for this disorder?

Diabetes mellitus

The registered nurse determines that a new nurse needs further teaching if the new nurse takes which action in the management of a client with chronic kidney disease diagnosed with ascites?

Encourage regular exercise to prevent atelectasis.

The nurse is performing an assessment on a client diagnosed with epididymitis. Which signs/symptoms of this problem should the nurse expect to note?

Fever, nausea and vomiting, and painful scrotal edema

The nurse is conducting a prostate screening clinic. Which sign of prostatism should the nurse question each client about?

Hesitancy when initiating urinary stream

The nurse participating in a prostate screening clinic questions each client about the presence of which sign/symptom of benign prostatic hypertrophy (BPH)?

Hesitancy when initiating urinary stream

The nurse has completed teaching with a hemodialysis client regarding the self-monitoring of the fluid status between hemodialysis treatments. The nurse determines that the client understands the information given if the client states the need to record which item(s) on a daily basis?

Intake, output, and weight

A client has a history of urolithiasis related to hyperuricemia. To prevent the formation of future stones, the nurse instructs the client to avoid which food?

Liver

The nurse has given a client diagnosed with polycystic kidney disease information about management of the disorder and prevention and recognition of complications. The nurse determines that the client needs further teaching if the client states to report which sign/symptom?

Lowered blood pressure

The registered nurse (RN) is monitoring a new nurse caring for a client experiencing urinary incontinence. Which action by the new nurse should indicate to the RN that the new nurse needs additional teaching in the care of this client?

Maintains fluid restriction

The nurse is planning care for a client with a diagnosis of acute glomerulonephritis. Which action should the nurse instruct the unlicensed assistive personnel (UAP) to implement in the care of the client?

Remove the water pitcher from the bedside.

The nurse is analyzing the laboratory results of a client diagnosed with chronic kidney disease who is receiving epoetin alfa. The nurse interprets that the medication is having the expected effect if the results indicate an increase in which level?

Red blood cells

A client has had a neobladder constructed after cystectomy to treat bladder cancer. The nurse determines that the client understands how to initiate voiding when the client states that it is necessary to take what action?

Relax the external sphincter while performing the Valsalva maneuver.

The client diagnosed with chronic kidney disease is scheduled for hemodialysis. When should the nurse plan to administer the client's daily dose of enalapril to ensure its effectiveness?

Upon return from dialysis

The nurse is teaching a client about self-monitoring between hemodialysis treatments. What should the nurse tell the client to record on a daily basis? Select all that apply.

Weight ; Intake and output

The nurse is giving a client diagnosed with both polycystic kidney disease (PKD) and hypertension instructions in the self-management of these disorders. What monitoring should the nurse encourage the client to do daily? Select all that apply.

Weight, salt intake, Blood pressure (BP)

A client has been prescribed nitrofurantoin sodium therapy for the treatment of a urinary tract infection. The nurse determines that the therapy is effective when which client assessment is noted?

Absence of dysuria

A client was diagnosed with chronic kidney disease 4 years ago. Treatment has included dialysis and aluminum hydroxide as prescribed as part of the medication regimen. When the client develops confusion and dementia and reports experiencing bone pain, the nurse interprets that this client is at risk for developing which disorder?

Aluminum intoxication

The nurse manager is observing the interaction between a new staff nurse and a client currently receiving hemodialysis. Which intervention should the nurse manager implement when the nurse and client are both drinking coffee and discussing the client's feeling about the procedure?

Asking the staff nurse to refrain from eating and drinking in the hemodialysis area

A male client has a history of urinary tract infections caused by urinary retention. Which intervention should the nurse implement to decrease the risk of infection?

Assist the client to stand for voiding.

A client diagnosed with chronic kidney disease is being treated with continuous ambulatory peritoneal dialysis. The nurse notes that there is a decrease in the catheter outflow after the prescribed 6-hour dwell time. Which action would be appropriate?

Assisting the client when ambulating

A client diagnosed with chronic kidney disease has undergone insertion of an indwelling catheter in the abdomen for peritoneal dialysis. What should the nurse teach the client to do if the peritoneal catheter dressing gets wet?

Change the dressing.

A client with a diagnosis of chronic kidney disease has an indwelling peritoneal catheter in the abdomen for peritoneal dialysis. While bathing, the client spills water on the abdominal dressing. Which action should the nurse perform to best assure client safety?

Change the dressing.

The registered nurse is observing a new nurse begin hemodialysis on a client with chronic kidney disease. The registered nurse intervenes and determines that the new nurse needs further teaching when the new nurse indicates the need for which action?

Covering the connection site with a heavy blanket for vasodilation and warmth

The nurse manager of a hemodialysis unit observes a new nurse preparing hemodialysis on a client with a diagnosis of chronic kidney disease. The nurse manager should note that the new nurse needs further teaching and intervene if which action is carried out by the new nurse?

Covers the connection site with a bath blanket to enhance extremity warmth

The nurse is administering epoetin alfa to a client diagnosed with chronic kidney disease (CKD). For which adverse effect of this therapy should the nurse monitor the client for?

Hypertension

A client has been diagnosed with urolithiasis in the right ureter. How should the nurse expect the client to describe the pain?

Intermittent in the right lower abdominal quadrant, radiating to the groin

The nurse reviewing a urinalysis report for a client with the diagnosis of acute kidney injury notes that the results are highly positive for proteinuria. The nurse determines that this client has which type of renal failure?

Intrinsic renal failure

A client diagnosed with chronic kidney disease is prescribed epoetin alfa. When discussing measures needed to support this medication therapy, the nurse should include information regarding which supplement?

Iron

A client with a history of renal insufficiency is having captopril added to the medication regimen. Before administering the first dose of captopril, the nurse is particularly interested in reviewing the client's most current urinalysis for the presence of which component?

Protein

The nurse is reviewing the history and physical of a client diagnosed with acute poststreptococcal glomerulonephritis (APSGN). Which manifestations of the disorder would the nurse expect to note? Select all that apply.

Proteinuria. Rusty colored urine. Generalized body edema

A client has urinary calculi that are composed of uric acid, and the nurse teaches the client dietary measures to prevent the further development of the calculi. The nurse determines that the client understands the dietary measures if the client states that it is necessary to avoid consuming what food products?

Sardines, herring, and organ meats

The nurse is evaluating the effects of care for the client with nephrotic syndrome. Which diagnostic result demonstrates the least amount of improvement over 2 days of care?

Serum albumin 1.9 g/dL (19 g/L), up to 2.0 g/dL (20 g/L)

The nurse is teaching a client who is taking cyclosporine after renal transplant about medication information. The nurse should tell the client to be especially alert for which problem?

Signs of infection

A client who is admitted to the hospital for an unrelated medical problem is diagnosed with urethritis caused by chlamydial infection. The unlicensed assistive personnel (UAP) assigned to the client asks the nurse what measures are necessary to prevent contraction of the infection during care. The nurse tells the UAP that which intervention is needed for infection control?

Standard precautions are sufficient because the disease is transmitted sexually.

The client suddenly becomes short of breath and reports chest pain during hemodialysis. The nurse notes that the client is tachycardic, pale, and anxious. Which action should the nurse take? Select all that apply.

Stop the dialysis. Administer oxygen as needed. Notify the primary health care provider.

A client has been admitted with a diagnosis of acute glomerulonephritis. During history taking, the nurse should ask the client about a recent history of which event?

Streptococcal infection

A client diagnosed with chronic kidney disease has a new medication prescription for epoetin alfa. How should the nurse plan to give this medication?

Subcutaneously

The nurse has provided home care instructions to a client with prostate cancer who has been hospitalized for a transurethral resection of the prostate (TURP). Which statement by the client indicates the need for further teaching?

"I can't lift or push objects that weigh more than 30 pounds."

A client diagnosed with nephrotic syndrome needs dietary teaching about how the diet can help counteract the effects of altered renal function. Which statement should the nurse plan to include in instructions to the client?

"Increase your intake of fish, meat, and eggs."

A client diagnosed with polycystic kidney disease says to the nurse, "My father had this disease, and now me. I'm not sure about having children." Which response should the nurse make to the client?

"You are not sure about having children?"

A client diagnosed with hyperaldosteronism has developed kidney failure and states to the nurse, "This means that I will die very soon." Which is the most appropriate therapeutic response for the nurse to make to the client?

"You sound discouraged today."

The nurse is assessing a client who is diagnosed with cystitis. Which assessment findings are characteristic of this disorder? Select all that apply.

1.Fever 3.Hematuria 4.Low back pain 5.Burning on urination

A client diagnosed with acute kidney injury has an elevated blood urea nitrogen (BUN) and is experiencing difficulty remembering information. Which interventions should the nurse implement when communicating with this client? Select all that apply.

1.Give simple, clear directions. 2.Include the family in discussions related to care. 3.Explain treatments using nontechnical language.

The nurse has provided instructions to a female client diagnosed with cystitis about measures to prevent recurrence of the inflammation. Which action by the client indicates the understanding of instruction? Select all that apply.

2.Hydrates with 3 liters of water daily 3.Consumes an acid-ash diet 4.Drinks cranberry juice daily 5.Wears cotton underwear

The nurse is explaining the concept of fluid restriction to a client diagnosed with chronic kidney disease who has started hemodialysis. The nurse tells the client that the fluid restriction is planned by adding the amount of the daily urine output (if any) plus which value?

500 to 700 mL

A client returning from the postanesthesia care unit after transurethral resection of the prostate (TURP) has bladder irrigation running via a 3-way Foley catheter. The nurse should notify the primary health care provider if which color of urine is noted in the urinary drainage bag?

Bright red

The nurse notes that the client prescribed methenamine mandelate also takes an antacid containing magnesium. What instruction should the nurse provide to the client regarding the administration of these medications?

Avoid taking the antacid while taking methenamine mandelate.

The nurse is teaching a client with acute kidney injury to include proteins in the diet that are considered high quality or complete proteins. The nurse determines that the client needs further teaching if he indicates that which food item is considered high quality?

Broccoli

A client just been diagnosed with acute kidney injury has a serum potassium level of 6.1 mEq/L (6.1 mmol/L). Which action should the nurse take immediately?

Call the primary health care provider.

A client with the diagnosis of chronic kidney disease (CKD) has received dietary counseling about potassium restriction in the diet. The nurse determines that the client has learned the information correctly when the client states that he or she will do what when preparing vegetables?

Boil them and discard the water.

A client recovering from a diagnosed acute kidney injury has been given dietary instructions, including restriction of potassium in the diet. The nurse determines that the client understands if the client indicates that meal preparation should include which actions?

Boiling vegetables and discarding the water

A client diagnosed with chronic kidney disease is on fluid restriction and receives aluminum hydroxide gel as a phosphate binder. The nurse determines that the client is at risk for which problem because of these treatment measures?

Constipation

The nurse counseling a client who has developed kidney failure is attempting to explore the client's feelings about dialysis. After determining that the client is most upset about disruption in his or her daily routine, the nurse advises the client to explore which treatment option with the primary health care provider?

Continuous ambulatory peritoneal dialysis (CAPD)

The nurse is assigned to care for a client undergoing peritoneal dialysis. When the client reports shoulder pain, what should be the nurse's initial action?

Elevate the head of the bed.

A client with a diagnosis of nephrotic syndrome states to the nurse, "Why should I even bother trying to control my diet and the swelling? It doesn't really matter what I do if I can never get rid of this kidney problem anyway!" Which potential client problem should the nurse address based on the client's statement?

Feeling powerless

The nurse admitting a client diagnosed with chronic kidney disease assesses for which cardiovascular sign/symptom frequently associated with chronic kidney disease?

Hypertension

The nurse is caring for a client who has returned from the postanesthesia care unit (PACU) after prostatectomy. The client has a three-way Foley catheter with infusion of continuous bladder irrigation solution. Which description of the color of the urinary drainage should lead the nurse to determine that the flow rate is adequate?

Pale yellow or slightly pink

A client is diagnosed with urolithiasis, and laboratory analysis of the stone that the client passed indicates that it is of the uric acid type. The nurse gives the client dietary instructions and instructs the client to primarily avoid consuming which food or beverage?

Sardines

A client undergoes transurethral resection of the prostate (TURP). Which solution should the nurse have available postoperatively for continuous bladder irrigation (CBI)?

Sterile normal saline

The nurse collects a urine specimen for a urinalysis from a client recently diagnosed with polycystic kidney disease. The results of the urinalysis indicate a urine specific gravity of 1.000. Which determination should the nurse most likely make when analyzing this result?

This finding is lower than normal, indicating dilute urine.

The nurse is caring for a client who returned to the nursing unit after suprapubic prostatectomy. The nurse monitors the continuous bladder irrigation to detect which sign of catheter blockage?

Urine leakage around the three-way catheter at the meatus

Which important parameter should the nurse assess on a daily basis for a client diagnosed with nephrotic syndrome?

Weight

A client undergoing peritoneal dialysis has developed peritonitis. The nurse determines that the client is recovering adequately from the infection if which outcome is noted?

White blood cell (WBC) count is 8000 mm3 (8 × 109/L).

A client newly diagnosed with polycystic kidney disease asks the nurse to explain again what the most serious complication of the disorder might be. The nurse will provide the client with information concerning which condition?

End-stage renal disease (ESRD)

A client is scheduled for insertion of a soft peritoneal dialysis catheter. The client asks the nurse why the catheter must be tunneled under the skin. Which rationale should the nurse use to answer the client's question?

This stabilizes the catheter and reduces the risk of infection.