Urinary NCLEX QUESTIONS

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Which of the following statements indicates an understanding of the necessary dietary modifications of a client diagnosed with chronic renal failure? Select all that apply.

2. "I should avoid eggs, and a bagel is preferable." 5. "I should consume approximately 40 g of protein daily.

A client who suffered a crush injury to the leg has a highly positive urine myoglobin level. The nurse plans to monitor this particular client carefully for signs of:

2. Acute tubular necrosis

A client has just undergone renal biopsy. In planning care for this client, the nurse would avoid which intervention?

2. Ambulate in the room and hall for short distances.

A female client has a prescription for a clean-catch urine culture. After providing a sterile specimen cup to the client, the nurse would give which instruction so that the specimen is collected properly?

2. Cleanse the labia using cleansing towels, begin to void into toilet, and then collect the specimen.

A client with new-onset renal failure is having a first hemodialysis treatment. The nurse is especially careful to monitor the client for which of the following on return from the dialysis treatment?

2. Headache, decreasing level of consciousness, and seizures

Which of the following conditions places the client at risk for developing acute postrenal failure?

2. Hydronephrosis

A nurse is inserting an indwelling urinary catheter into a male client. As the catheter is inserted into the urethra, urine begins to flow into the tubing. At this point, the nurse:

2. Inserts the catheter 2.5 to 5 cm and inflates the balloon

A client with a suspected diagnosis of renal cancer is ordered to undergo a renal biopsy to confirm the diagnosis. The client informs a nurse that she will not sign the informed consent form. Which action should the nurse take?

Notify a physician that the client refuses to give consent.

female client is admitted to the emergency department following a fall from a horse. The health care provider (HCP) prescribes the insertion of an indwelling urinary catheter. The nurse notes blood at the urinary meatus while preparing for the procedure. The nurse should:

2. Notify the health care provider.

A long-term care nurse notes that a female client has leaking of urine when sneezing, coughing, or laughing. The nurse reports that this client has which of the following types of incontinence?

2. Stress incontinence

The use of peritoneal dialysis for the treatment of chronic renal failure would be contraindicated for which of the following clients?

2. The client with severe emphysema

nurse is monitoring an older client suspected of having a urinary tract infection (UTI) for signs of the infection. The nurse would be alert to the presence of:

3. Confusion

A client is scheduled for intravenous pyelography (IVP). Before the test, the priority nursing action would be to:

3. Determine a history of allergies.

A male client has a tentative diagnosis of urethritis. The nurse collects data from the client, knowing that which of the following are manifestations of the disorder?

3. Dysuria and penile discharge

A nurse is caring for a client with epididymitis. The nurse anticipates noting which of the following findings on data collection?

3. Fever, nausea and vomiting, and painful scrotal edema

A nurse is caring for the client with epididymitis. The nurse understands that which treatment modality could increase swelling in the affected area?

3. Heating pad

A nurse is collecting data on a newly admitted client with a diagnosis of bladder cancer. While collecting data on this client the nurse would most likely expect to note:

3. Hematuria

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the dwell time for the dialysis at the prescribed time because of the risk of:

3. Hyperglycemia

A nurse is providing dietary instructions to a client with renal calculi, and the laboratory analysis has revealed that the calculus is composed of uric acid. The nurse tells the client that it would be helpful to

3. Increase intake of legumes in the diet.

A nurse is urging a client to cough and deep breathe after a nephrectomy. The client tells the nurse, "That's easy for you to say! You don't have to do this." The nurse interprets that the client's statement is likely a result of:

3. Pain that is intensified because the location of the incision is near the diaphragm

A nurse is teaching a client regarding types of fluids that assist in prevention and treatment of urinary tract infections (UTIs). The nurse tells the client to consume which of the following fluids? Select all that apply.

3. Prune juice 4. Tomato juice 5. Cranberry juice

A nurse is assigned to care for a client who has just returned to the nursing unit following a renal biopsy. The nurse plans to do which of the following to properly care for this client for the remainder of the shift?

3. Test the urine for occult blood.

The nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point would the nurse want to include?

Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.

When performing a scrotal examination, the nurse finds a nodule. What should the nurse do next?

Notify the physician.

A client with chronic renal failure has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now has mental cloudiness, dementia, and complaints of bone pain. The nurse interprets that these data are compatible with:

4. Aluminum intoxication

A nurse is preparing the client who is scheduled for an intravenous pyelogram (IVP). The nurse would take which most important action before the test?

4. Ask about allergies to iodine or shellfish.

A client arrives at the ambulatory care clinic with low abdominal pain. A routine urine specimen reveals hematuria. The client does not have a fever. The nurse should next ask the client about a history of which of the following?

4. Blow or trauma to the bladder or abdomen

A nurse is collecting data from a male client with epididymitis. The nurse would expect to note which of the following signs and symptoms of this problem?

4. Fever, nausea and vomiting, and painful scrotal edema

A client newly diagnosed with chronic renal failure has recently begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse monitors the client during dialysis for:

4. Headache, deteriorating level of consciousness, and twitching

The nurse has given dietary instructions to a client diagnosed with acute glomerulonephritis. The nurse determines that the client understands the information presented if the client states the intention to do which of the following?

4. Limit protein intake.

A nurse is admitting a client to the nursing unit who has returned from the post-anesthesia care unit following prostatectomy. The client has a three-way Foley catheter with continuous bladder irrigation. The nurse would maintain the flow rate of the continuous bladder infusion to maintain a urine output that is:

4. Pale yellow or slightly pink

The nurse is completing an intake and output record for a client who is receiving continuous bladder irrigation after transurethral resection of the prostate. How many milliliters of urine should the nurse record as output for her shift if the client received 1,800 ml of normal saline irrigating solution and the output in the urine drainage bag is 2,400 ml?

600

The physician prescribes norfloxacin (Noroxin), 400 mg by mouth twice daily, for a client with a urinary tract infection (UTI). The client asks the nurse how long to continue taking the drug. For an uncomplicated UTI, the usual duration of norfloxacin therapy is:

7 to 10 days.

The nurse just received the shift report on her group of clients. Based on the information she received, which client should she assess first?

A client who underwent a right nephrectomy yesterday and is complaining of pain

The nurse correctly identifies a urine sample with a pH of 5.2 as being which type of solution?

Acidic

A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign highest priority to which nursing diagnosis?

Acute pain

A nurse's neighbor complains of severe right flank pain. She explains that it began during the night, but she was able to take acetaminophen (Tylenol) and return to bed. When she awoke, the pain increased in intensity. How should the nurse intervene?

Advise the neighbor to seek medical attention.

Which factor can lead to the formation of renal calculi?

Alkaline urine

A client with chronic renal failure must restrict her fluid intake to 500 ml daily. Despite having reached the limit, the client is insisting that she have more fluid. Which intervention by a nurse is appropriate?

Allow her to have a piece of hard candy.

A client is frustrated and embarrassed by urinary incontinence. Which of the following measures should the nurse include in a bladder retraining program?

Assessing present elimination patterns

A client with acute pyelonephritis is prescribed co-trimoxazole (Septra). Which finding best demonstrates that the client has followed the prescribed regimen?

Bacteria are absent on urine culture.

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?

Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl

A client requires hemodialysis. Which of the following drugs should be withheld before this procedure?

Cardiac glycosides

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first?

Cardiac rhythm

A client who returns to the surgical floor after undergoing transurethral resection of the prostate complains of pain. Which action should the nurse take first?

Check the client's medical record for postoperative orders.

A 25-year-old client comes to the emergency department with her clothes torn. She has visible cuts, bruises, and profuse vaginal bleeding. A nurse suspects that this client has been raped. What should the nurse do?

Collect forensic evidence.

A nurse-manager on the urology unit tells the staff that supplies have been disappearing at an alarming rate. A staff nurse has been assigned to monitor supply use. Which method can best help the nurse monitor supply use?

Compare charge slips for supplies used against the inventory left in the supply room every 24 hours.

A client tells a nurse that her ileoconduit appliance won't adhere to her skin. The nurse inspects the site and notes that the area around the stoma is red, moist, and tender to touch. How should the nurse intervene?

Consult the wound-ostomy nurse.

A client reports experiencing vulvar pruritus. Which finding may indicate that the client has an infection caused by Candida albicans?

Cottage cheese-like discharge

Which laboratory test is the most accurate indicator of a client's renal function?

Creatinine clearance

To treat a urinary tract infection (UTI), a client is prescribed sulfamethoxazole (Gantanol), 2 g by mouth initially, and then 1 g by mouth three times daily. The nurse should teach the client that sulfamethoxazole is most likely to cause which adverse effect?

Diarrhea

Four days after undergoing a right nephrectomy, a client develops a methicillin-resistant Staphylococcus aureus infection in the surgical incision. A physician orders contact isolation and dressing changes 3 times daily. How should the soiled dressing be handled during dressing changes?

Discard the dressing in a biohazard bag located in the designated receptacle inside the client's room.

A physician informs a client that her renal calculus is small enough that she should be able to pass it without surgical intervention. Which action should the nurse take to help the client pass the renal calculus?

Encourage the client to consume 3 to 4 liters of fluid a day.

The nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence?

Encouraging intake of at least 2 L of fluid daily

A client diagnosed with a sexually transmitted disease has been feeling poorly. A friend of the client's who is employed by the hospital asks a nurse why her friend is hospitalized. How should the nurse respond?

Explain that although she is a friend of the client, the nurse can't violate client confidentiality.

Which intervention might safely prevent constipation in a client who has end-stage ovarian cancer and requires high doses of opioids to control pain?

Explaining the importance of increasing the intake of fiber and fluids

The nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way?

Fluid intake should be approximately equal to the urine output.

The nurse is collecting data on a male client diagnosed with gonorrhea. Which symptom likely prompted the client to seek medical attention?

Foul-smelling discharge from the penis

When caring for a client with acute renal failure (ARF), the nurse expects the physician to adjust the dosage or dosing schedule of certain drugs. Which drug would require such adjustment?

Gentamicin sulfate (Garamycin)

A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders diagnostic tests of the vaginal discharge. Which STD must be reported to the public health department?

Gonorrhea

The nurse is caring for a client with acute pyelonephritis. Which nursing intervention is most important?

Increasing fluid intake to 3 L/day

A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region, which radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site?

Kidney

A client with a urinary tract infection is prescribed co-trimoxazole (trimethoprim-sulfamethoxazole). The nurse should provide which medication instruction?

"Drink at least eight 8-oz glasses of fluid daily."

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important?

Limiting fluid intake

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?

"Increase your fluid intake to 2 to 3 L per day."

A client with renal cancer who has not yet been informed of his diagnosis asks the nurse what his test results showed. How should the nurse respond?

"It must be difficult for you not to know the results of your test."

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?

"Make sure to include carbohydrates in your diet."

The nurse is monitoring the fluid intake and output of a female client recovering from an exploratory laparotomy. Which nursing intervention would help the client avoid a urinary tract infection (UTI)?

Maintaining a closed indwelling urinary catheter system and securing the catheter to the leg

(SELECT ALL THAT APPLY) The nurse is collecting data on a client who has a urinary tract infection (UTI). Which statements should the nurse expect the client to make?

(2) "I need to urinate frequently.", (3) "It burns when I urinate.", (5) "I need to urinate urgently."

The nurse is caring for a patient with acute renal failure. Rank in chronological order the phases of acute renal failure. Use all the options.

(2) Initial insult, (3) Oliguric Phase, (4) Diuretic Phase, (1) recovery phase

(SELECT ALL THAT APPLY) The nurse is teaching a client how to collect a 24-hour urine specimen for creatinine clearance. Which of the following directions should the nurse give the client?

(2), "Discard the first voiding and record the time.", (4) "Refrigerate the urine sample or keep it on ice.", (5) "At the end of 24 hours, void and save the urine."

A nurse is assisting in planning a teaching session with a female client diagnosed with urethritis caused by infection with chlamydia. The nurse would plan to include which of the following points in the teaching session?

. The most serious complication of this infection is sterility.

A client with a history of chronic cystitis comes to the outpatient clinic with signs and symptoms of this disorder. To prevent cystitis from recurring, the nurse recommends maintaining an acid-ash diet to acidify the urine, thereby decreasing the rate of bacterial multiplication. On an acid-ash diet, the client must restrict which beverage?

Milk

A nurse provides home care instructions to a client undergoing hemodialysis with regard to care of an arteriovenous (AV) fistula. Which statement by the client indicates an understanding of the instructions?

1. "I should check the fistula every day by feeling it for a vibration."

The nurse documents that the urine collected from a client diagnosed with early stage polycystic kidney disease is dilute and with a low-specific gravity. Based on this documentation, which specific gravity result was likely present?

1. 1.000

An alkaline-ash diet is prescribed for a client with renal calculi. Which of the following diet menus does the nurse advise the client to select?

1. A spinach salad, milk, and a banana

A client diagnosed with chronic renal failure is being treated at home with continuous ambulatory peritoneal dialysis. The client notes that there is a decrease in the catheter outflow following the prescribed 6-hour dwell time and calls the nurse to report this occurrence. The nurse should instruct the client to take which action?

1. Ambulate in the home.

A nurse is working with a client newly diagnosed with chronic renal failure (CRF) to set up a schedule for hemodialysis. The client states, "This is impossible! How can I even think about leading a normal life again if this is what I'm going to have to do?" The nurse determines that the client is exhibiting:

1. Anger

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

1. Assist the client to stand for voiding.

A client is admitted to the surgical nursing unit following transurethral resection of the prostate (TURP) for benign prostatic hypertrophy. The client has a bladder irrigation infusing, and output is light cherry colored. The blood pressure is 134/82 mm Hg, the pulse is 84 beats per minute, and the client is afebrile with a respiratory rate of 18 breaths per minute. The licensed practical nurse (LPN) assisting in caring for the client collects assessment data 1 hour after admission to the nursing unit. The LPN notifies the registered nurse (RN) immediately if which of the following is noted on data collection?

1. Blood pressure of 102/50 mm Hg, pulse 110 beats per minute

A nurse is assisting a client with cystitis to select foods that are appropriate for an acid-ash diet. The nurse encourages the client to eat which of the following foods?

1. Cheese

client with acute glomerulonephritis had a urinalysis sent to the laboratory. The report reveals that there is hematuria and proteinuria in the urine. The nurse interprets that these results are:

1. Consistent with glomerulonephritis

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

1. Diabetes mellitus

A nurse notes that a client's urinalysis report contains a notation of positive red blood cells (RBCs). The nurse interprets that this finding is unrelated to which of the following items that is part of the client's medical record?

1. Diabetes mellitus

A nurse is monitoring an older client suspected of having a urinary tract infection (UTI) for signs of the infection. The nurse would be alert to the presence of:

1. Fever

A nurse is providing instructions to the client regarding the complications of peritoneal dialysis. The nurse instructs the client that which manifestation is likely associated with the onset of peritonitis?

1. Fever

A client is scheduled for a myelogram, and the nurse provides a list of instructions to the client regarding preparation for the procedure. Which instructions should the nurse place on the list? Select all that apply.

1. Jewelry will need to be removed. 2. An informed consent will need to be signed. 4. The procedure will take approximately 45 minutes.

A nurse is assisting a client who is new to a low-potassium diet to select food items from the menu. Which of the following food items is lowest in potassium and would be recommended to the client who is on this dietary restriction?

1. Lima beans

A client hospitalized with urolithiasis has a sudden significant decrease in urine output. The nurse would immediately:

1. Notify the registered nurse.

A client who had a prostatectomy has learned perineal exercises to gain control of the urinary sphincter. The nurse determines that the client needs further instruction if the client states that he or she will perform which of the following as part of these exercises?

1. Perform the Valsalva maneuver.

A client is diagnosed with polycystic kidney disease, and the nurse provides information to the client about the treatment plan. The nurse determines that the client needs additional information if the client states that which of the following is a component of the treatment plan?

1. Sodium restriction

A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure?

Nephrotoxic injury secondary to use of contrast media

A client has received instructions on self-management of peritoneal dialysis. The nurse determines that the client needs further instruction if the client states to:

1. Use a strong adhesive tape to anchor the catheter dressing

A client diagnosed with renal calculi is experiencing severe pain despite having received pain medication. A nurse pages a physician. Which intervention can the nurse perform while awaiting the physician's response?

Perform nonpharmacologic pain interventions.

A 25-year-old female client seeks care for a possible urinary tract infection (UTI). Her symptoms include burning on urination and frequent, urgent voiding of small amounts of urine. She's placed on trimethoprim-sulfamethoxazole (Bactrim) to treat the possible infection. Another medication is prescribed to decrease the client's pain and frequency. Which of the following is most likely the second medication prescribed?

Phenazopyridine (Pyridium)

Two staff nurses on the urology unit are responsible for the unit schedule. The holidays are nearing, and many staff members would like to take vacation days. Which method might fairly solve the holiday staffing problem?

Poll the staff to find out their preferences.

Which steps should the nurse follow to insert a straight urinary catheter?

Prepare the client and the equipment, create a sterile field, put on gloves, clean the urinary meatus, and insert the catheter until urine flows.

During rounds, a client admitted with gross hematuria asks the nurse about the physician's diagnosis. To facilitate effective communication, what should the nurse do?

Provide privacy for the conversation.

Which of the following laboratory values supports a diagnosis of pyelonephritis?

Pyuria

A stepfather brings a child with a fever to the emergency department. The child is crying, calling for her mother, and attempting to get out of the stepfather's arms. Upon inspection, the nurse notes that the child's underpants are stained with a bloodlike substance. Which action should the nurse take?

Report the suspected abuse according to facility policy.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is most appropriate for this client?

Risk for infection

Which of the following is an appropriate nursing diagnosis for a client with renal calculi?

Risk for infection

A client who returned from a cystoscopic examination complains of pain while attempting to void. Which intervention should a nurse suggest to ease the client's pain while attempting to void?

Sit in a warm sitz bath.

A client with a history of heart failure is found to have a cystocele. When planning care for this client, the nurse is likely to formulate which nursing diagnosis?

Stress urinary incontinence

2. These crystals are uremic frost resulting from irritating toxins deposited in the client's tissues. Bathing in cool water will remove the crystals, promote client comfort, and decrease the itching resulting from uremic frost.

The UAP tells the nurse the client with ARF has a white crystal-like layer on top of the skin. Which intervention should the nurse implement? 1.Have the assistant apply a moisture barrier cream to the skin. 2.Instruct the UAP to bathe the client in cool water. 3.Tell the UAP not to turn the client in this condition. 4.Explain this is normal and do not do anything for the client.

A charge nurse in a long-term care facility is planning the nursing assignments for the oncoming shift. Her staff consists of four nursing assistants and a licensed practical nurse (LPN). How should she divide nursing care among the staff to adequately ensure safe, effective care?

The charge nurse performs treatments and supervises staff, the LPN administers medications and assists with care, and the nursing assistants provide direct client care.

1. An elevated PSA can be from urinary retention, BPH, prostate cancer, or prostate infarct.

The client asks, "What does an elevated PSA test mean?" On which scientiﬁc rationale should the nurse base the response? 1.An elevated PSA can result from several different causes. 2.An elevated PSA can be only from prostate cancer. 3.An elevated PSA can be diagnostic for testicular cancer. 4.An elevated PSA is the only test used to diagnose BPH.

4. Normal potassium level is 3.5 to5.5 mEq/L. A level of 6.8 mEq/L is life threatening and could lead to cardiac dysrhythmias. Therefore, the client may be dialyzed to decrease the potassium level quickly. This requires a health-careprovider order, so it is a collaborative intervention.

The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which collaborative treatment should the nurse anticipate for the client? 1.Administer a phosphate binder. 2.Type and crossmatch for whole blood. 3.Assess the client for leg cramps. 4.Prepare the client for dialysis.

3. Carbohydrates are increased to provide for the client's caloric intake and protein is restricted to minimize protein breakdown and to prevent accumulation of toxic waste products.

The client diagnosed with ARF is admitted to the intensive care unit and placed on a therapeutic diet. Which diet is most appropriate for the client? 1.A high-potassium and low-calcium diet. 2.A low-fat and low-cholesterol diet. 3.A high-carbohydrate and restricted-protein diet. 4.A regular diet with six (6) small feedings a day.

3. Regular insulin, along with glucose, will drive potassium into the cells,thereby lowering serum potassium levels temporarily.

The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level? 1.Erythropoietin. 2.Calcium gluconate. 3.Regular insulin. 4.Osmotic diuretic.

2. Bed rest reduces exertion and the metabolic rate, thereby reducing catabolism and subsequent release of potassium and accumulation of endogenous waste products (urea and creatinine).

The client diagnosed with ARF is placed on bed rest. The client asks the nurse, "Why do I have to stay in bed? I don't feel bad." Which scientiﬁc rationale supports the nurse's response? 1.Bed rest helps increase the blood return to the renal circulation. 2.Bed rest reduces the metabolic rate during the acute stage. 3.Bed rest decreases the workload of the left side of the heart. 4.Bed rest aids in reduction of peripheral and sacral edema.

1. Carrying heavy objects in the left arm could cause the ﬁstula to clot by putting undue stress on the site, so the client should carry objects with the right arm.

The client diagnosed with CKD has a new arteriovenous ﬁstula in the left forearm. Which intervention should the nurse implement? 1.Teach the client to carry heavy objects with the right arm. 2.Perform all laboratory blood tests on the left arm. 3.Instruct the client to lie on the left arm during the night. 4.Discuss the importance of not performing any hand exercises.

4. Because the client is in ESRD, ﬂuid must be removed from the body, so the output should be more than the amount instilled. These assessment data require intervention by the nurse.

The client diagnosed with CKD is receiving peritoneal dialysis. Which assessment data warrant immediate intervention by the nurse? 1.Inability to auscultate a bruit over the ﬁstula. 2.The client's abdomen is soft, is nontender, and has bowel sounds. 3.The dialysate being removed from the client's abdomen is clear. 4.The dialysate instilled was 1,500 mL and removed was 1,500 mL.

2. Assessment is the ﬁrst part of the nursing process and is priority. The renal colic pain can be so intense it can cause a vasovagal response, with resulting hypotension and syncope.

The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement ﬁrst? 1.Monitor the client's urinary output. 2.Assess the client's pain and rule out complications. 3.Increase the client's oral ﬂuid intake. 4.Use a safety gait belt when ambulating the client.

1, 2, 3 The health-care provider may order certain foods and medications when obtaining a 24-hour urine collection to evaluate for calcium oxalate or uric acid. When the collection begins, the client should completely empty the bladder and discard this urine. The test is started after the bladder is empty. All urine for 24 hours should be saved and put in a container with preservative,refrigerated, or placed on ice as indicated. Not following speciﬁc instructions will result in an inaccurate test result.

The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply. 1.Check for the ordered diet and medication modiﬁcations. 2.Instruct the client to urinate, and discard this urine when starting collection. 3.Collect all urine during 24 hours and place in appropriate specimen container. 4.Insert an indwelling catheter in client after having the client empty the bladder.5.Instruct the UAP to notify the nurse when the client urinates.

3. The UAP could assist the client to the car once the discharge has been completed.

The client diagnosed with renal calculi is scheduled for lithotripsy. Which post procedure nursing task is the most appropriate to delegate to the UAP? 1.Monitor the amount, color, and consistency of urine output. 2.Teach the client about care of the indwelling Foley catheter. 3.Assist the client to the car when being discharged home. 4.Take the client's postprocedural vital signs.

4. The white blood cell count is elevated;normal is 5,000 to 10,000/mm3.

The client had surgery to remove a kidney stone. Which laboratory assessment data warrant immediate intervention by the nurse? 1.A serum potassium level of 3.8 mEq/L. 2.A urinalysis shows microscopic hematuria. 3.A creatinine level of 0.8 mg/100 mL. 4.A white blood cell count of 14,000/mm3.

3. Clients lose potassium from the GI tract or through the use of diuretic medications. Potassium imbalances can lead to cardiac arrhythmias.

The client has been vomiting and has had numerous episodes of diarrhea. Which laboratory test should the nurse monitor? 1.Serum calcium. 2.Serum phosphorus. 3.Serum potassium. 4.Serum sodium.

2. The client has signs of phlebitis and the IV must be removed to prevent further complications.

The client has received IV solutions for three (3) days through a 20-gauge IV catheter placed in the left cephalic vein. On morning rounds, the nurse notes the IV site is tender to palpation and a red streak has formed. Which intervention should the nurse implement ﬁrst? 1.Start a new IV in the right hand. 2.Discontinue the intravenous line. 3.Complete an incident record. 4.Place a warm washrag over the site.

Discharge teaching has been performed for a client who is being discharged with an indwelling urinary catheter. Which action by the client indicates that the teaching was successful?

The client holds the drainage bag below the level of the bladder.

4. The client who has restricted kidney function from surgery should be monitored for damage as a result of the use of aminoglycoside antibiotics, such as vancomycin, which are nephrotoxic. This level is high and warrants notifying the HCP.

The client is 12 hours postoperative renal surgery. Which data warrant immediate intervention by the nurse? 1.The abdomen is soft, non-tender, and rounded. 2.Pain is not felt with dorsal ﬂexion of the foot. 3.The urine output is 60 mL for the past two (2) hours. 4.The client's trough vancomycin level is 24 mcg/mL.

1, 2, 5 TPN is a hypertonic solution with enough calories, proteins, lipids,electrolytes, and trace elements to sustain life. It is administered via a pump to prevent too-rapid infusion. TPN contains 50% dextrose solution;therefore, the client is monitored to ensure the pancreas is adapting to the high glucose levels. Intake and output are monitored toobserve for ﬂuid balance.

The client is NPO and is receiving total parenteral nutrition (TPN) via a subclavianline. Which precautions should the nurse implement? Select all that apply. 1.Place the solution on an IV pump at the prescribed rate. 2.Monitor blood glucose every six (6) hours. 3.Weigh the client weekly, ﬁrst thing in the morning. 4.Change the IV tubing every three (3) days.5.Monitor intake and output every shift.

3. Dehydration results in concentrated serum, causing laboratory values to increase because the blood has normal constituents but not enough volume to dilute the values to within normal range or possibly lower.

The client is admitted to a nursing unit from a long-term care facility with a hematocrit of 56% and a serum sodium level of 152 mEq/L. Which condition is a cause for these ﬁndings? 1.Overhydration. 2.Anemia. 3.Dehydration. 4.Renal failure.

1. Preventing and treating shock with blood and ﬂuid replacement will prevent acute renal failure from hypoperfusion of the kidneys.Signiﬁcant blood loss is expected in the client with a gunshot wound.

The client is admitted to the emergency department after a gunshot wound to the abdomen. Which nursing intervention should the nurse implement ﬁrst to prevent ARF? 1.Administer normal saline IV. 2.Take vital signs. 3.Place client on telemetry. 4.Assess abdominal dressing.

4. Clients with sodium levels less than 120 mEq/L are at risk for seizures as a complication. The lower the sodium level, the greater the risk of a seizure.

The client is admitted with a serum sodium level of 110 mEq/L. Which nursing intervention should be implemented? 1.Encourage ﬂuids orally. 2.Administer 10% saline solution IVPB. 3.Administer antidiuretic hormone intranasally. 4.Place on seizure precautions.

1, 2, 3 Renal failure affects almost every system in the body. Neurologically, the client may have drowsiness, headache, muscle twitching, and seizures. In the recovery period, the client is alert and has no seizure activity. In renal failure, levels of erythropoietin are decreased, leading to anemia. An increase in hemoglobin and hematocrit indicates the client is in the recovery period. Nausea, vomiting, and diarrhea are common in the client with ARF; there-fore, an absence of these indicates the client is in the recovery period.

The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the client is in the recovery period? Select all that apply. 1.Increased alertness and no seizure activity. 2.Increase in hemoglobin and hematocrit. 3.Denial of nausea and vomiting. 4.Decreased urine-speciﬁc gravity. 5.Increased serum creatinine level.

3. Venison, sardines, goose, organ meats,and herring are high-purine foods, which should be eliminated from the diet to help prevent uric acid stones.

The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent re-occurrence? 1.Beer and colas. 2.Asparagus and cabbage. 3.Venison and sardines. 4.Cheese and eggs.

4. Pain is priority. The pain can be so severe a sympathetic response may occur, causing nausea; vomiting; pallor;and cool, clammy skin.

The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client? 1.Fluid volume loss. 2.Knowledge deﬁcit. 3.Impaired urinary elimination. 4.Alteration in comfort.

2. Clients experiencing incontinence should eat a high-ﬁber diet to avoid constipation, which increases pressure on the bladder, which may increase incontinence.

The client is experiencing urinary incontinence. Which intervention should the nurse implement? 1.Teach the client to drink prune juice weekly. 2.Encourage the client to eat a high-ﬁber diet. 3.Discuss the need to urinate every six (6) hours. 4.Explain the importance of wearing cotton underwear.

2. Elevating the scrotum on a towel for support is a task which can be delegated to the UAP.

The client is one (1) day postoperative TURP. Which task should the nurse delegate to the UAP? 1.Increase the irrigation ﬂuid to clear clots from the tubing. 2.Elevate the scrotum on a towel roll for support. 3.Change the dressing on the ﬁrst postoperative day. 4.Teach the client how to care for the continuous irrigation catheter.

1. The nurse should place the client's chair with the head lower than thebody, which will shunt blood to the brain; this is the Trendelenburg position.

The client receiving dialysis is complaining of being dizzy and light-headed. Which action should the nurse implement ﬁrst? 1.Place the client in the Trendelenburg position. 2.Turn off the dialysis machine immediately. 3.Bolus the client with 500 mL of normal saline. 4.Notify the health-care provider as soon as possible.

3. Uremic frost, which results when the skin attempts to take over the function of the kidneys, causes itching, which can lead to scratching possibly resulting in a break in the skin.

The client receiving hemodialysis is being discharged home from the dialysis center. Which instruction should the nurse teach the client? 1.Notify the HCP if oral temperature is 102˚F or greater. 2.Apply ice to the access site if it starts bleeding at home. 3.Keep ﬁngernails short and try not to scratch the skin. 4.Encourage signiﬁcant other to make decisions for the client.

After having a transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?

The client reports bladder spasms and the urge to void.

1, 3, 4 The nurse should assess the drain postoperatively. The head of the bed should be lowered and the foot should be elevated to shunt blood to the central circulating system. The surgeon needs to be notiﬁed of the change in condition.

The client returned from surgery after having a TURP and has a P 110, R 24, BP90/40, and cool and clammy skin. Which interventions should the nurse implement?Select all that apply. 1.Assess the urine in the continuous irrigation drainage bag. 2.Decrease the irrigation ﬂuid in the continuous irrigation catheter. 3.Lower the head of the bed while raising the foot of the bed. 4.Contact the surgeon to give an update on the client's condition. 5.Check the client's postoperative creatinine and BUN.

3. Crackles and rhonchi in all lung ﬁeldsindicate the body is not able to processthe amount of ﬂuid being infused. This should be brought to the HCP's attention.

The client who has undergone an exploratory laparotomy and subsequent removal of a large intestinal tumor has a nasogastric tube (NGT) in place and an IV running at 150 mL/hr via an IV pump. Which data should be reported to the HCP? 1.The pump keeps sounding an alarm indicating the high pressure has been reached. 2.Intake is 1,800 mL, NGT output is 550 mL, and Foley output is 950 mL. 3.On auscultation, crackles and rhonchi in all lung ﬁelds are noted. 4.Client has negative pedal edema and an increasing level of consciousness.

2. These are signs and symptoms of hypocalcemia, and the nurse can conﬁrm this by tapping the cheek to elicit the Chvostek's sign. If the muscles of the cheek begin to twitch,then the HCP should be notiﬁed immediately because hypocalcemia is a medical emergency.

The client who is post-thyroidectomy complains of numbness and tingling around the mouth and the tips of the ﬁngers. Which intervention should the nurse implement ﬁrst? 1.Notify the health-care provider immediately. 2.Tap the cheek about two (2) cm anterior to the earlobe. 3.Check the serum calcium and magnesium levels. 4.Prepare to administer calcium gluconate IVP.

3. This is usually the length of time clients need to wait prior to having sexual intercourse; this is the information the client wants to know.

The client who is postoperative TURP asks the nurse, "When will I know if I will be able to have sex after my TURP?" Which response is most appropriate by the nurse? 1."You seem anxious about your surgery." 2."Tell me about your fears of impotency." 3."Potency can return in six (6) to eight (8) weeks." 4."Did you ask your doctor about your concern?"

4. The nurse should always assess any complaint before dismissing it as a commonly occurring problem.

The client with a TURP who has a continuous irrigation catheter complains of the need to urinate. Which intervention should the nurse implement ﬁrst? 1.Call the surgeon to inform the HCP of the client's complaint. 2.Administer the client a narcotic medication for pain. 3.Explain to the client this sensation happens frequently. 4.Assess the continuous irrigation catheter for patency.

3. A urinalysis can assess for hematuria,the presence of white blood cells,crystal fragments, or all three, which can determine if the client has a urinary tract infection or possibly a renal stone, with accompanying signs/symptoms of UTI.

The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client? 1.Increase water intake for the next 24 hours. 2.Take two (2) Tylenol to help decrease the temperature. 3.Come to the clinic and provide a urinalysis specimen. 4.Use a sterile 4 × 4 gauze to strain the client's urine.

4. No special preparation is needed for this noninvasive, nonpainful test. A conductive gel is applied to the back or ﬂank and then a transducer is applied which produces sound waves, resulting in a picture.

The client with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure? 1.Ask if the client is allergic to shellﬁsh or iodine. 2.Keep the client NPO eight (8) hours prior to the ultrasound. 3.Ensure the client has a signed informed consent form. 4.Explain the test is noninvasive and there is no discomfort.

2 Some clients develop a chronic infection and must receive antibiotic therapy as a routine daily medication to suppress the bacterial growth. The prescription will be reﬁlled after the 90 days and continued.

The clinic nurse is caring for a client diagnosed with chronic pyelonephritis who is prescribed trimethoprim-sulfamethoxazole (Bactrim), a sulfa antibiotic, twice a day for 90 days. Which statement is the scientiﬁc rationale for prescribing this medication? 1.The antibiotic will treat the bladder spasms that accompany a urinary tract infection. 2.If the urine cannot be made bacteria free, the Bactrim will suppress bacterial growth. 3.In three (3) months, the client should be rid of all bacteria in the urinary tract. 4.The HCP is providing the client with enough medication to treat future infections.

1. Clients who have urinary incontinenceare often embarrassed, so it is the responsibility of the nurse to approach this subject with respect and consideration.

The elderly client being seen in the clinic has complaints of urinary frequency,urgency, and "leaking." Which priority intervention should the nurse implement when interviewing the client? 1.Ensure communication is nonjudgmental and respectful. 2.Set the temperature for comfort in the examination room. 3.Speak loudly to ensure the client understands the nurse. 4.Ensure the examining room has adequate lighting.

3 Glomerular ﬁltration rate (GFR) is approximately 120 mL/min. If the GFR is decreased to 40 mL/min, the kidneys are functioning at about one-third ﬁltration capacity.

The elderly client is diagnosed with chronic glomerulonephritis. Which laboratory value indicates to the nurse the condition has become worse? 1.The blood urea nitrogen is 15 mg/dL. 2.The creatinine level is 1.2 mg/dL. 3.The glomerular ﬁltration rate is 40 mL/min. 4.The 24-hour creatinine clearance is 100 mL/min.

4. Use of the bladder training drill is helpful in stress incontinence. The client is instructed to void at scheduled intervals. After consistently being dry, the interval is increased by 15 minutes until the client reaches an acceptable interval.

The elderly client recovering from a prostatectomy has been experiencing stress incontinence. Which independent nursing intervention should the nurse discuss with the client? 1.Establish a set voiding frequency of every two (2) hours while awake. 2.Encourage a family member to assist the client to the bathroom to void. 3.Apply a transurethral electrical stimulator to relieve symptoms of urinary urgency. 4.Discuss the use of a "bladder drill," including a timed voiding schedule.

3. Dietary changes for preventing renal stones include reducing the intake of the primary substance forming the calculi. In this case, limiting vitamin D will inhibit the absorption of calcium from the gastrointestinal tract.

The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement? 1.Encourage the client to eat a low-purine diet and limit foods such as organ meats. 2.Explain the importance of not drinking water two (2) hours before bedtime. 3.Discuss the importance of limiting vitamin D-enriched foods. 4.Prepare the client for extracorporeal shock wave lithotripsy (ESWL).

A client with a genitourinary problem is being assessed in the emergency department. When palpating the client's kidneys, the nurse should keep which anatomical fact in mind?

The left kidney usually is slightly higher than the right one.

3. After the initial administration of erythropoietin, a client's antihypertensive medications may need to be adjusted. Therefore, this complaint requires notiﬁcation of the HCP. Erythropoietin therapy is contraindicated in clients with uncontrolled hypertension.

The male client diagnosed with CKD has received the initial dose of erythropoietin,a biologic response modiﬁer, 1 week ago. Which complaint by the client indicates the need to notify the health-care provider? 1.The client complains of ﬂu-like symptoms. 2.The client complains of being tired all the time. 3.The client reports an elevation in his blood pressure. 4.The client reports discomfort in his legs and back.

2. Reﬂecting the client's feelings and re-stating them are therapeutic responses the nurse should use when addressing the client's issues.

The male client diagnosed with CKD secondary to diabetes has been receiving dialysis for 12 years. The client is notiﬁed he will not be placed on the kidney transplant list. The client tells the nurse he will not be back for any more dialysis treatments. Which response by the nurse is most therapeutic? 1."You cannot just quit your dialysis. This is not an option." 2."Your angry at not being on the list, and you want to quit dialysis?" 3."I will call your nephrologist right now so you can talk to the HCP." 4."Make your funeral arrangements because you are going to die."

A client with suspected renal insufficiency is scheduled for a comprehensive diagnostic workup. After the nurse explains the diagnostic tests, the client asks which part of the kidney "does the work." Which answer is correct?

The nephron

3. The nurse cannot delegate teaching.

The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients. Which nursing intervention should the nurse perform? 1.Measure the client's output from the indwelling catheter. 2.Record the client's intake and output on the I & O sheet. 3.Instruct the client on appropriate ﬂuid restrictions. 4.Provide water for a client diagnosed with diabetes insipidus.

1. The UAP can collect specimens.Collecting a midstream urine specimen requires the client to clean the perineal area, to urinate a little, and then collect the rest of the urine output in a sterile container.

The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a medical ﬂoor. Which nursing task is most appropriate for the nurse to delegate? 1.Collect a clean voided midstream urine specimen. 2.Evaluate the client's 8-hour intake and output. 3.Assist in checking a unit of blood prior to hanging. 4.Administer a cation-exchange resin enema.

4. Noncompliance is a choice the client has a right to make, but the nurse should determine the reason for the noncompliance and then take appropriate actions based on the client's rationale. For example, if the client has ﬁnancial difﬁculties, the nurse may suggest how the client can afford the proper foods along with medications, or the nurse may be able to refer the client to a social worker.

The nurse caring for a client diagnosed with CKD writes a client problem of "noncompliance with dietary restrictions." Which intervention should be included in the plan of care? 1.Teach the client the proper diet to eat while undergoing dialysis. 2.Refer the client and signiﬁcant other to the dietitian. 3.Explain the importance of eating the proper foods. 4.Determine the reason for the client not adhering to the diet.

2. This client's dialysis access is compromised and he or she should be assessed ﬁrst.

The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess ﬁrst? 1.The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%. 2.The client who does not have a palpable thrill or auscultated bruit. 3.The client who is complaining of being exhausted and is sleeping. 4.The client who did not take antihypertensive medication this morning.

4. Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and some herbal remedies are nephrotoxic;therefore, asking about medications is appropriate.

The nurse is admitting a client diagnosed with acute renal failure (ARF). Which question is most important for the nurse to ask during the admission interview? 1."Have you recently traveled outside the United States?" 2."Did you recently begin a vigorous exercise program?" 3."Is there a chance you have been exposed to a virus?" 4."What over-the-counter medications do you take regularly?"

4. The client with urethral strictures will report a decrease in force and stream during voiding. The stricture is treated by dilation using small ﬁliform bougies.

The nurse is assessing a client diagnosed with urethral strictures. Which data support the diagnosis? 1.Complaints of frequency and urgency. 2.Clear yellow drainage from the urethra. 3.Complaints of burning during urination. 4.A diminished force and stream during voiding.

1. Blood urea nitrogen (BUN) levels reﬂect the balance between the production and excretion of urea from the kidneys. Creatinine is a by-product of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal sub-stance for determining renal clearance because it is relatively constant in the body and is the laboratory value most signiﬁcant in diagnosing renal failure.

The nurse is caring for a client diagnosed with ARF. Which laboratory values are most signiﬁcant for diagnosing ARF? 1.BUN and creatinine. 2.WBC and hemoglobin. 3.Potassium and sodium. 4.Bilirubin and ammonia level.

3. The lungs attempt to increase the blood pH level by blowing off the carbon dioxide (carbonic acid).

The nurse is caring for a client diagnosed with diabetic ketoacidosis (DKA). Which statement best explains the scientiﬁc rationale for the client's Kussmaul's respirations? 1.The kidneys produce excess urine and the lungs try to compensate. 2.The respirations increase the amount of carbon dioxide in the bloodstream. 3.The lungs speed up to release carbon dioxide and increase the pH. 4.The shallow and slow respirations will increase the HCO3 in the serum.

2. Hypotension, which causes a decreased blood supply to the kidney, is one of the most common causes of pre-renal failure(before the kidney).

The nurse is caring for a client diagnosed with rule-out ARF. Which condition predisposes the client to developing prerenal failure? 1.Diabetes mellitus. 2.Hypotension. 3.Aminoglycosides. 4.Benign prostatic hypertrophy

3. The classic sign/symptom of nephrotic syndrome is dependent edema located on the client's sacrum and ankles.

The nurse is caring for a client diagnosed with rule-out nephrotic syndrome. Which intervention should be included in the plan of care? 1.Monitor the urine for bright-red bleeding. 2.Evaluate the calorie count of the 500-mg protein diet. 3.Assess the client's sacrum for dependent edema. 4.Monitor for a high serum albumin level.

2. Bladder spasms are common, but being relieved with medication indicates the condition is improving.

The nurse is caring for a client with a TURP. Which expected outcome indicates the client's condition is improving? 1.The client is using the maximum amount allowed by the PCA pump. 2.The client's bladder spasms are relieved by medication. 3.The client's scrotum is swollen and tender with movement. 4.The client has passed a large, hard, brown stool this morning.

2. When an elderly client's mental status changes to confused and irritable, the nurse should seek the etiology, which may be a UTI secondary to an indwelling catheter. Elderly client soften do not present with classic signs and symptoms of infection.

The nurse is caring for an elderly client who has an indwelling catheter. Which data warrant further investigation? 1.The client's temperature is 98.0˚F. 2.The client has become confused and irritable. 3.The client's urine is clear and light yellow. 4.The client feels the need to urinate.

3. This is the correct scientiﬁc rationale for metabolic acidosis occurring in the client with CKD.

The nurse is caring for the client diagnosed with chronic kidney disease (CKD) who is experiencing metabolic acidosis. Which statement best describes the scientiﬁc rationale for metabolic acidosis in this client? 1.There is an increased excretion of phosphates and organic acids, which leads to anincrease in arterial blood pH. 2.A shortened life span of red blood cells because of damage secondary to dialysistreatments in turn leads to metabolic acidosis. 3.The kidney cannot excrete increased levels of acid because they cannot excreteammonia or cannot reabsorb sodium bicarbonate. 4.An increase in nausea and vomiting causes a loss of hydrochloric acid and therespiratory system cannot compensate adequately.

4. Excess fluid volume is priority because of the stress placed on the heart and vessels, which could lead to heart failure, pulmonary edema,and death.

The nurse is developing a nursing care plan for the client diagnosed with CKD. Which nursing problem is priority for the client? 1.Low self-esteem. 2.Knowledge deﬁcit. 3.Activity intolerance. 4.Excess ﬂuid volume.

3. Renal failure causes an imbalance of electrolytes (potassium, sodium, calcium,phosphorus). Therefore, the desired client outcome is electrolytes within normal limits.

The nurse is developing a plan of care for a client diagnosed with ARF. Which statement is an appropriate outcome for the client? 1.Monitor intake and output every shift. 2.Decrease of pain by 3 levels on a 1-10 scale. 3.Electrolytes are within normal limits. 4.Administer enemas to decrease hyperkalemia.

2. The elderly woman may have age-related changes (decreased bladder capacity, weakened urinary sphincter,and shortened urethra) causing urinary urgency or incontinence. The elderly client is at risk for falling while attempting to get to the bathroom, so this client should be seen ﬁrst.

The nurse is discussing how to prioritize care with the UAP. Which client should the nurse instruct the UAP to see ﬁrst? 1.The immobile client who needs sequential compression devices removed. 2.The elderly woman who needs assistance ambulating to the bathroom. 3.The surgical client who needs help changing the gown after bathing. 4.The male client who needs the intravenous catheter discontinued.

2. Many in the African American culture believe the body must be kept intact after death, and organ donation is rare among African Americans. This is also why a client of African American descent will be on a transplant waiting list longer than people of other races. This is because of tissue-typing compatibility. Remember, this does not apply to all African-Americans; every client is an individual.

The nurse is discussing kidney transplants with clients at a dialysis center. Which population is less likely to participate in organ donation? 1.Caucasian. 2.African American. 3.Asian. 4.Hispanic.

3 These are symptoms of cystitis, a bladder infection which may be caused by sexual intercourse as a result of the introduction of bacteria into the urethra during the physical act. A teenager may not want to divulge this information in front of the parent.

The nurse is examining a 15-year-old female who is complaining of pain, frequency,and urgency when urinating. After asking the parent to leave the room, which question should the nurse ask the client? 1."When was your last menstrual cycle?" 2."Have you noticed any change in the color of the urine?" 3."Are you sexually active?" 4."What have you taken for the pain?"

3. The drainage bag should be kept below the level of the bladder to prevent reﬂux of urine into the renal system; it should not be placed on the bed.

The nurse is observing the UAP providing direct care to a client with an indwelling catheter. Which data warrant immediate intervention by the nurse? 1.The UAP secures the tubing to the client's leg with tape. 2.The UAP provides catheter care with the client's bath. 3.The UAP puts the collection bag on the client's bed. 4.The UAP cares for the catheter after washing the hands.

2. Treatment includes diuretics to eliminate dependent edema, usually in the ankles and sacrum. Medication teaching is an appropriate intervention.

The nurse is preparing a teaching care plan for the client diagnosed with nephrotic syndrome. Which intervention should the nurse include? 1.Stop steroids if a moon face develops. 2.Provide teaching for taking diuretics. 3.Increase the intake of dietary sodium. 4.Report a decrease in daily weight.

2. The client or family needs to contact the surgeon if the client develops chills, ﬂank pain, decreased urinary output, or fever.

The nurse is preparing the discharge teaching plan for the male client with a left-sided nephrectomy. Which statement indicates the teaching is effective? 1."I can't wait to start back to work next week, I really need the money." 2."I will take my temperature and if it is above 101 I will call my doctor." 3."I am glad I won't have to keep track of how much I urinate in the day." 4."I am happy I will be able eat what I usually eat, I don't like this food."

1, 5 Vital signs should be monitored every two (2) hours until stable and more frequently if the client is unstable. Skin turgor and mucous membranes should be assessed every shift or more often depending on the client's condition.

The nurse is preparing the plan of care for a client with ﬂuid volume deﬁcit. Which interventions should the nurse include in the plan of care? Select all that apply. 1.Monitor vital signs every two (2) hours until stable. 2.Measure the client's oral intake and urinary output daily. 3.Administer mouth care when bathing the client. 4.Weigh the client weekly in the same clothing at the same time. 5.Assess skin turgor and mucous membranes every shift.

2. The treatment goal of the ﬂaccid bladder is to prevent overdistention.

The nurse is preparing the plan of care for the client diagnosed with a neurogenic ﬂaccid bladder. Which expected outcome is appropriate for this client? 1.The client has conscious control over bladder activity. 2.The client's bladder does not become overdistended. 3.The client has bladder sensation and no discomfort. 4.The client demonstrates how to check for bladder distention.

1. Polycystic kidney disease poses an increased risk for rupture of the kidney, and therefore sports activities or occupations with risks for trauma should be avoided.

The nurse is providing discharge teaching to the client diagnosed with polycystic kidney disease. Which statement made by the client indicates the teaching has been effective? 1."I need to avoid any activity causing a risk for injury to my kidney." 2."I should avoid taking medications for high blood pressure." 3."When I urinate there may be blood streaks in my urine." 4."I may have occasional burning when I urinate with this disease."

2. Clients who have been diagnosed with tuberculosis of the renal tract should use condoms to prevent transmission of the mycobacterium. If the infection is located in the penis or urethra,abstaining from sexual activity is recommended.

The nurse is teaching the female client diagnosed with tuberculosis of the urinary tract prior to discharge. Which information should the nurse include speciﬁc to this diagnosis? 1.Instruct the client to take the medication with food. 2.Explain condoms should be used during treatment. 3.Discuss the need for follow-up chest x-rays. 4.Encourage a well-balanced diet and ﬂuid intake.

2. Increasing the irrigation ﬂuid will ﬂush out the clots and blood.

The nurse observes red urine and several large clots in the tubing of the normal saline continuous irrigation catheter for the client who is one (1) day postoperative TURP. Which intervention should the nurse implement? 1.Remove the indwelling catheter. 2.Titrate the NS irrigation to run faster. 3.Administer protamine sulfate IVP. 4.Administer vitamin K slowly.

620 mL The amount of sterile normal saline is subtracted from the total volume removed from the catheter.

The nurse performs bladder irrigation through an indwelling catheter. The nurse instilled 90 mL of sterile normal saline. The catheter drained 710 mL. What is the client's output? ________

2. Fluid volume excess refers to an isotonic expansion of the extracellular ﬂuid by an abnormal expansion of water and sodium. Therefore, sodium is restricted to allow the body to excrete the extra volume.

The nurse writes the client problem of "ﬂuid volume excess" (FVE). Which intervention should be included in the plan of care? 1.Change the IV ﬂuid from 0.9% NS to D5W. 2.Restrict the sodium in the client's diet. 3.Monitor blood glucose levels. 4.Prepare the client for hemodialysis.

A client with bladder cancer has had his bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude?

The pouch faceplate doesn't fit the stoma.

1. A client with a peaked T wave could be experiencing hyperkalemia. Changes in potassium levels can initiate cardiac dysrhythmias and instability.

The telemetry monitor technician notiﬁes the nurse of the morning telemetry readings. Which client should the nurse assess ﬁrst? 1.The client in normal sinus rhythm with a peaked T wave. 2.The client diagnosed with atrial ﬁbrillation with a rate of 100. 3.The client diagnosed with a myocardial infarction who has occasional PVCs. 4.The client with a ﬁrst-degree atrioventricular block and a rate of 92.

Which statement describes the therapeutic action of loop diuretics?

They block sodium reabsorption in the ascending loop and dilate renal vessels.

A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?

This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.

A client with benign prostatic hyperplasia (BPH) doesn't respond to medical treatment and is admitted to the facility for surgical intervention. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for treatment of BPH?

Transurethral resection of the prostate (TURP)

Which of the following clinical findings would the nurse look for in a client with chronic renal failure?

Uremia

Which statement describing urinary incontinence in the elderly is true?

Urinary incontinence isn't a disease.

The nurse suspects that a client with a temperature of 103.6° F (39.8° C) and an elevated white blood cell count is in the initial stage of sepsis. What is the most common cause of sepsis in hospitalized clients?

Urinary tract infection (UTI)

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. Which data collection finding suggests that the client is experiencing acute renal failure (ARF)?

Urine output of 400 ml/24 hours

The nurse is reviewing the report of a client's routine urinalysis. Which value should the nurse consider abnormal?

Urine pH of 3.0

The client underwent a transurethral resection of the prostate gland 24 hours ago and has a continuous bladder irrigation. Which of the following nursing interventions is appropriate?

Use aseptic technique when irrigating the catheter.

A nurse reviews a client's medical record and notes that a physician ordered an indwelling urinary catheter due to client's urine retention. Which action should the nurse perform first?

Verify the client's identity.

Which of the following is a function of antidiuretic hormone (ADH)?

Water reabsorption and urine concentration

When a client with an indwelling urinary catheter insists on walking to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?

1. This client requires the most skill and knowledge because this client has the greatest potential for an infection;therefore, the client should not be assigned to a UAP.

Which client should the nurse not assign to a UAP working on a surgical ﬂoor? 1.The client with a suprapubic catheter inserted yesterday. 2.The client who has had an indwelling catheter for the past week. 3.The client who is on a bladder-training regimen. 4.The client who had a catheter removed this morning and is being discharged.

2. The severe ﬂank pain associated with a stone in the ureter often causes asympathetic response with associated nausea; vomiting; pallor; and cool,clammy skin.

Which clinical manifestations should the nurse expect to assess for the client diagnosed with a ureteral renal stone? 1.Dull, aching ﬂank pain and microscopic hematuria. 2.Nausea; vomiting; pallor; and cool, clammy skin. 3.Gross hematuria and dull suprapubic pain with voiding. 4.The client will be asymptomatic.

4. Clients with acute bacterial prostatitis will frequently experience a sudden onset of fever and chills. Clients with chronic prostatitis have milder symptoms.

Which data support to the nurse the client's diagnosis of acute bacterial prostatitis? 1.Terminal dribbling. 2.Urinary frequency. 3.Stress incontinence. 4.Sudden fever and chills.

1. Scheduled voiding allows the client to void every two (2) to three (3) hours apart, and when the client has remained consistently dry, the interval is increased by about 15 minutes.

Which information indicates to the nurse the client teaching about treatment of urinary incontinence has been effective? 1.The client prepares a scheduled voiding plan. 2.The client verbalizes the need to increase ﬂuid intake. 3.The client explains how to perform pelvic ﬂoor exercises. 4.The client attempts to retain the vaginal cone in place the entire day.

2. Passing a renal stone may negate the need for the client to have lithotripsy or a surgical procedure. Therefore, all urine must be strained, and a stone, if found, should be sent to the laboratory to determine what caused the stone.

Which intervention is most important for the nurse to implement for the client diagnosed with rule-out renal calculi? 1.Assess the client's neurological status every two (2) hours. 2.Strain all urine and send any sediment to the laboratory. 3.Monitor the client's creatinine and BUN levels. 4.Take a 24-hour dietary recall during the client interview.

1. Assessing the rate and volume of intravenous ﬂuid is the most important intervention for the client who has one(1) kidney because an overload of ﬂuids can result in pulmonary edema.

Which intervention is most important for the nurse to implement for the client with a left nephrectomy? 1.Assess the intravenous ﬂuids for rate and volume. 2.Change surgical dressing every day at the same time. 3.Monitor the client's PT/PTT/INR level daily. 4.Monitor the percentage of each meal eaten.

3. The output should be monitored to detect a decreased amount indicating an obstruction from edema or ureteralstenosis. Any decrease should be reported to the health-care provider.

Which intervention should the nurse implement for the client who has had an ileal conduit? 1.Pouch the stoma with a one (1)-inch margin around the stoma. 2.Refer the client to the United Ostomy Association for discharge teaching. 3.Report to the health-care provider any decrease in urinary output. 4.Monitor the stoma for signs and symptoms of infection every shift.

4. The nephrostomy tube should never be clamped or have kinks because an obstruction can cause pyelonephritis.

Which intervention should the nurse implement when caring for the client with a nephrostomy tube? 1.Change the dressing only if soiled by urine. 2.Clean the end of the connecting tubing with Betadine. 3.Clean the drainage system every day with bleach and water. 4.Assess the tube for kinks to prevent obstruction.

3. The nurse should ﬁrst assist the client in getting out of the wet clothes prior to any other action. Wet clothes are embarrassing to the client and can lead to skin breakdown.

Which intervention should the nurse implement ﬁrst for the client who has had an incontinent episode? 1.Palpate the client's bladder to assess for urinary retention. 2.Obtain a bedside commode for the client. 3.Assist the client with changing the wet clothes. 4.Request the UAP to change the client's linens.

1. The client should sit in a warm sitz bath for 10 to 20 minutes several time seach day to provide comfort and assist with healing.

Which intervention should the nurse include when preparing a teaching plan for the client with chronic prostatitis? 1.Sit in a warm sitz bath for 10 to 20 minutes several times daily. 2.Sit in the chair with the feet elevated for two (2) hours daily. 3.Drink at least 3,000 mL of oral ﬂuids, especially tea and coffee, daily. 4.Stop broad-spectrum antibiotics as soon as the symptoms subside.

4. This is a potentially life-threatening problem.

Which nursing diagnosis is priority for the client who has undergone a TURP? 1.Potential for sexual dysfunction. 2.Potential for an altered body image. 3.Potential for chronic infection. 4.Potential for hemorrhage.

3. The nurse should always assess for allergies to latex prior to inserting a latex catheter or using a drainage system because, if the client is allergic to latex,use of it could cause a life-threatening reaction.

Which nursing intervention is most important before attempting to catheterize a client? 1.Determine the client's history of catheter use. 2.Evaluate the level of anxiety of the client. 3.Verify the client is not allergic to latex. 4.Assess the client's sensation level and ability to void.

3. The client with ﬂuid volume excess has too much ﬂuid. Excess ﬂuid is reﬂected by adventitious breath sounds. Therefore, an expected outcome is to have no excess ﬂuid, as evidenced by normal, clear breath sounds.

Which outcome should the nurse identify for the client diagnosed with ﬂuid volume excess? 1.The client will void a minimum of 30 mL per hour. 2.The client will have elastic skin turgor. 3.The client will have no adventitious breath sounds. 4.The client will have a serum creatinine of 1.4 mg/dL.

1. This indicates the teaching is effective.

Which statement indicates discharge teaching has been effective for the client who is postoperative TURP? 1."I will call the surgeon if I experience any difﬁculty urinating." 2."I will take my Proscar daily, the same as before my surgery." 3."I will continue restricting my oral ﬂuid intake." 4."I will take my pain medication routinely even if I do not hurt."

1. An increased ﬂuid intake ensuring 2 to 3 L of urine a day prevents the stone-forming salts from becoming concentrated enough to precipitate.

Which statement indicates the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation? 1."I should increase my ﬂuid intake, especially in warm weather. "2."I should eat foods containing cocoa and chocolate." 3."I will walk about a mile every week and not exercise often." 4."I should take one (1) vitamin a day with extra calcium."

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding signals a significant problem during this procedure?

White blood cell (WBC) count of 20,000/mm3

A female client with a history of four urinary tract infections (UTIs) in the past 3 months comes to the urology clinic complaining of burning and urinary urgency and frequency. A physician makes the diagnosis of UTI. Which instruction should the nurse give the client to help prevent recurring infections?

Wipe the perineal area from front to back.

A client with dysuria is prescribed phenazopyridine (Pyridium). The nurse should advise the client that his urine will:

appear orange.

When a client returns from the operating room after undergoing a left nephrectomy, a nurse must make sure that urine is draining through the client's indwelling urinary catheter. This assessment is important for this client because it:

assesses function of the remaining kidney.

The nurse is inserting a urinary catheter into a client who is extremely anxious about the procedure. The nurse can facilitate the insertion by asking the client to:

breathe deeply.

A client in the short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should:

check the client's pedal pulses frequently.

A 3-way indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to inflating the balloon, the functions of the three lumens include:

continuous inflow and outflow of irrigation solution.

A client is admitted with a diagnosis of acute renal failure. The nurse should monitor closely for:

drug toxicity.

A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl. The most therapeutic pharmacologic intervention would be to administer:

epoetin alfa (Epogen)

The red blood cell (RBC) production in a client with chronic renal failure (CRF) has decreased. The nurse should monitor this client for:

fatigue and weakness.

A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include:

generalized edema, especially of the face and periorbital area.

The nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:

hyperkalemia

A client develops acute renal failure (ARF) after receiving an I.V. nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for:

hyperkalemia.

A nurse is told by an older woman that she has begun to be incontinent of urine at night and now drinks no fluids after 6:00 ᴘᴍ. The nurse's response should be guided by the knowledge that:

ncontinence at any age deserves urological attention.

The nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:

notify the physician about cloudy or foul-smelling urine.

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about:

recent streptococcal infection.

The nurse is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 5.9 mEq/L. Correct administration and the effects of this enema would include having the client:

retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.

A client receiving total parental nutrition is prescribed a 24-hour urine test. When initiating a 24-hour urine specimen, the collection time should:

start after a known voiding that empties the bladder.

During a routine examination, the nurse notes that the client seems unusually anxious. Anxiety can affect the genitourinary system by:

stimulating or hindering micturition.

The nurse is teaching a client with genital herpes. Education for this client should include an explanation of:

the importance of informing his partner of the disease.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:

water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

The nurse is caring for a male client with gonorrhea. The client asks how he can reduce his risk of contracting another sexually transmitted disease (STD). The nurse should instruct the client to:

wear a condom every time he has sexual intercourse.

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:

weight loss.

A client with an indwelling urinary catheter is suspected of having a urinary tract infection. The nurse should collect a urine specimen for culture and sensitivity by:

wiping the self-sealing aspiration port or stopcock with antiseptic solution and aspirating urine with a sterile needle and a sterile syringe.

A nurse is assigned to care for a client who has returned to the nursing unit following a left nephrectomy. The nurse places the highest priority on monitoring which of the following?

1. Hourly urine output

A nurse is admitting a client with chronic renal failure (CRF) to the nursing unit. The nurse monitors the client for which frequent cardiovascular sign that occurs in CRF?

1. Hypertension

A nurse is assisting in planning a diet for a client with acute renal failure (ARF). The nurse plans to restrict which of the following dietary components from this client's diet?

4. Potassium

A client with acute glomerulonephritis is admitted to the nursing unit. The nurse should plan to do which of the following immediately on admission?

4. Remove the water pitcher from the bedside.

The spouse of a client with acute renal failure secondary to heart failure asks the nurse how this could happen. The nurse plans to base a response in part on the fact that the kidneys:

1. Generally require and receive about 20% to 25% of the resting cardiac output

A nurse has given instructions to the client with a cystocele about Kegel exercises. The nurse determines that the client has not fully understood the directions if the client states to:

1. Begin voiding and then stop the stream, holding residual urine for an hour.

After a renal biopsy, the client complains of pain at the biopsy site, which radiates to the front of the abdomen. Based on this complaint, the nurse further monitors the client for:

1. Bleeding

A nurse is encouraging a client, who is incontinent, to participate in recreational therapy. What nursing intervention would the nurse consider performing first?

1. Change the client's soiled disposable brief.

A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic renal failure. Which finding indicates that the fistula is patent?

1. Palpation of a thrill over the fistula

A client with acute renal failure (ARF) has been treated with sodium polystyrene sulfonate (Kayexalate) by mouth. The nurse evaluates this therapy as effective if which of the following values is noted on follow-up laboratory testing?

1. Potassium, 4.9 mEq/L

A nurse is assigned to care for a client who has just returned to the nursing unit after having hemodialysis for the first time. The nurse monitors the client carefully for which signs and symptoms of disequilibrium syndrome?

1. Vomiting and headaches

A client who is performing peritoneal dialysis at home calls the clinic and reports that the outflow from the dialysis catheter seems to be decreasing in amount. The nurse appropriately asks which of the following questions first?

3. "Have you experienced any constipation recently?"

A nurse has provided dietary instructions to a client with renal calculi who must learn to eat an alkaline-ash diet. The nurse determines that the client has properly understood the information presented if the client chooses which of the following selections from a diet menu?

3. A spinach salad, milk, and a banana

A client's kidneys are retaining greater amounts of sodium. The nurse anticipates that the kidneys are also retaining greater amounts of:

3. Chloride and bicarbonate

A client has epididymitis as a complication of urinary tract infection (UTI). The nurse is giving the client instructions to prevent a recurrence. The nurse determines that the client needs further instruction if the client states the intention to:

3. Continue to take antibiotics until all symptoms are gone.

A nurse is caring for a client who has been diagnosed as having a kidney mass. The client asks the nurse the reason for a renal biopsy, when other tests such as computed tomography (CT) and ultrasound are available. In formulating a response, the nurse incorporates the knowledge that a renal biopsy:

3. Gives specific cytological information about the lesion

A client is seen in the health care clinic and acute pyelonephritis is suspected. The nurse reviews the client's record and would expect to note which associated signs and symptoms documented?

3. Nausea and vomiting

A client with chlamydial infection has received instructions on self-care and prevention of further infection. The nurse determines that the client needs additional instructions if the client states that he or she will:

3. Use doxycycline prophylactically to prevent symptoms of chlamydia.

A client with prostatitis resulting from kidney infection has received instructions on management of the condition at home and prevention of recurrence. The nurse determines that the client understood the instructions if the client has verbalized that he will:

3. Use warm sitz baths and analgesics to increase comfort.

A nurse has a prescription to collect a 24-hour urine specimen from a client. The nurse should avoid which of the following errors in technique while completing this procedure?

4. Ask the client to void, save the specimen, and note the start time.

A nurse is caring for a hospitalized client following cystoscopy and is monitoring for signs of complications associated with the procedure. Which of the following, if noted in the first few hours following the procedure, indicates the need to notify the registered nurse?

4. Bloody urine with clots

A client who has a cold is seen in the emergency department with inability to void. Because the client has a history of benign prostatic hyperplasia (BPH), the nurse questions the client about use of which medication?

4. Decongestants

The client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which of the following medications?

4. Decongestants

nurse is collecting data from a client who has had benign prostatic hyperplasia (BPH) in the past. To determine if the client is currently experiencing exacerbation of BPH, the nurse asks the client about the presence of which early symptom?

4. Decreased force in the stream of urine

A male client who is hospitalized is diagnosed with urethritis caused by chlamydial infection. The nursing assistant assigned to the client asks the nurse what measures are necessary to prevent a contraction of the infection during care. The nurse tells the assistant that:

4. Standard precautions are sufficient, because the infection is transmitted sexually.

A client complains of leaking urine whenever she sneezes, coughs, or laughs. The nurse recognizes that this report is consistent with which type of incontinence?

4. Stress

A young female client with acute pyelonephritis is scheduled for a voiding cystourethrogram. The nurse determines that this client would likely benefit from increased support and teaching about the procedure because:

4. The client must void while the micturition process is filmed.

A client has undergone a transurethral resection of the prostate (TURP) a few hours ago to treat symptoms of benign prostatic hypertrophy. The nurse notes bright red blood and clots in the urinary catheter drainage bag. What is the nurse's initial action?

Increase the flow rate of the continuous bladder irrigation.

4 Unless the nurse can determine the catheter has been inserted within a few days, the nurse should replace the catheter and then get a specimen. This will provide the most accurate specimen for analysis.

The client from a long-term care facility is admitted to the medical unit with a fever,hot ﬂushed skin, and clumps of white sediment in the indwelling catheter. Which intervention should the nurse implement ﬁrst? 1.Start an IV with a 20-gauge catheter. 2.Initiate antibiotic therapy IVPB. 3.Collect a urine specimen for culture. 4.Change the indwelling catheter.

1 Fever, chills, and costovertebral pain are symptoms of a urinary tract infection (acute pyelonephritis), which requires a urine culture ﬁrst to conﬁrm the diagnosis.

The client is reporting chills, fever, and left costovertebral pain. Which diagnostic test should the nurse expect the HCP to prescribe ﬁrst? 1.A midstream urine for culture. 2.A sonogram of the kidney. 3.An intravenous pyelogram for renal calculi. 4.A CT scan of the kidneys.

4 Coffee, tea, cola, and alcoholic beverages are urinary tract irritants.

The female client in an outpatient clinic is being sent home with a diagnosis of urinary tract infection (UTI). Which instruction should the nurse teach to prevent a recurrence of a UTI? 1.Clean the perineum from back to front after a bowel movement. 2.Take warm tub baths instead of hot showers daily. 3.Void immediately preceding sexual intercourse. 4.Avoid coffee, tea, colas, and alcoholic beverages.

2 Fatigue, headache, and polyuria as well as loss of weight, anorexia, and excessive thirst are symptoms of chronic pyelonephritis.

The nurse is caring for a client with chronic pyelonephritis. Which assessment data support the diagnosis of chronic pyelonephritis? 1.The client has fever, chills, ﬂank pain, and dysuria. 2.The client complains of fatigue, headaches, and increased urination. 3.The client had a group B beta-hemolytic strep infection last week. 4.The client has an acute viral pneumonia infection.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse should take which actions? Select all that apply.

2. Check the level of the drainage bag. 3. Reposition the client to his or her side. 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks.

A nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, would the nurse identify as a risk factor for this disorder?

2. Diabetes mellitus

A client has an arteriovenous (AV) shunt in place for hemodialysis. The nurse would take which priority precaution, knowing that bleeding is a potential complication?

2. Ensure that small clamps are attached to the AV shunt dressing.

A nurse is caring for a client undergoing peritoneal dialysis. The nurse checks the client and notes that the drainage from the outflow catheter is cloudy. The nurse notifies the registered nurse and plans to take which action?

2. Obtain a culture and sensitivity of the drainage.

1 A pregnant client diagnosed with a UTI will be admitted for aggressive IV antibiotic therapy. After symptoms subside, the client will be sent home to complete the course of treatment with oral medications.

The nurse is caring for a pregnant client diagnosed with acute pyelonephritis. Which scientiﬁc rationale supports the client being hospitalized for this condition? 1.The client must be treated aggressively to prevent maternal/fetal complications. 2.The nurse can force the client to drink ﬂuids and avoid nausea and vomiting. 3.The client will be dehydrated and there won't be sufﬁcient blood ﬂow to the baby. 4.Pregnant clients historically are afraid to take the antibiotics as ordered.

3 The client should be taught to take all the prescribed medication anytime a prescription is written for antibiotics.

The nurse is discharging a client with a health-care facility acquired urinary tract infection. Which information should the nurse include in the discharge teaching? 1.Limit ﬂuid intake so the urinary tract can heal. 2.Collect a routine urine specimen for culture. 3.Take all the antibiotics as prescribed. 4.Tell the client to void every ﬁve (5) to six (6) hours.

1, 4, 2, 3, 5 The procedure should be explained to the client. Incontinence pads should be placed under the client before beginning the sterile part of the procedure. The sterile ﬁeld must be set up prior to checking the bulb and cleaning the client's perineum. The bulb of the catheter should be tested to make sure it will inﬂate and deﬂate prior to inserting the catheter into the client. During the procedure, the perineum is swiped with Betadine swabs from front to back and also down the middle, then side to side with new swabs (clean to dirty).

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

3 A long-term complication of glomerulonephritis is it can become chronic if unresponsive to treatment,and this can lead to end-stage renal disease. Maintaining renal function is an appropriate long-term goal.

The nurse is preparing a plan of care for the client diagnosed with acute glomerulonephritis. Which statement is an appropriate long-term goal? 1.The client will have a blood pressure within normal limits. 2.The client will show no protein in the urine. 3.The client will maintain normal renal function. 4.The client will have clear lung sounds.

A nurse is caring for a client who had a renal biopsy. Which interventions would the nurse include in the plan of care for the client after this procedure? Select all that apply.

2. Administering pain medication as prescribed 3. Monitoring vital signs and the puncture site frequently 4. Testing serial urine samples with dipsticks for occult blood

A client with benign prostatic hypertrophy (BPH) undergoes a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigations postoperatively. The nurse monitors the client for signs of transurethral resection (TUR) syndrome, including:

2. Bradycardia and confusion

A nurse must ambulate a client who has a nephrostomy tube attached to a drainage bag. The nurse plans to do this most safely and effectively by:

2. Changing the drainage bag to a leg collection bag

A nurse is reviewing the client's record and notes that the health care provider has documented that the client has a renal disorder. On review of the laboratory results, the nurse would most likely expect to note which of the following?

4. Elevated blood urea nitrogen (BUN) level

A client newly diagnosed with renal failure will be receiving peritoneal dialysis. During the infusion of the dialysate, the client complains of abdominal pain. Which action by the nurse is appropriate?

4. Explain that the pain will subside after the first few exchanges.

The client with diabetes mellitus 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 the client experiencing:

4. Hyperglycemia

Which of the following would the nurse include in the plan of care for a client following a renal scan?

4. No special precautions, except to wear gloves if coming into contact with the client's urine.

The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication:

4. On return from dialysis

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse monitors this client for which manifestation of this disorder?

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