NCLEX Review Med Surg Renal & Urinary

The nurse has a prescription to collect a 24-hour urine specimen from a client. The unlicensed assistive personnel (UAP) has been instructed on the collection technique. Which action by the UAP demonstrates the UAP needs further teaching?

Asks the client to void, save the specimen, and note the start time

The 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 information in the client's medical record?

Diabetes mellitus

The nurse is assisting in planning a teaching session with a client diagnosed with urethritis caused by infection with Chlamydia. The nurse should plan to include which point in the teaching session?

The most serious complication of this infection is sterility.

A client with a history of prostatic hypertrophy has purchased the over-the-counter medication, diphenhydramine, to treat symptoms of a runny nose. The nurse explains to the client that this medication combined with prostatic hypertrophy could cause exacerbation of which symptom?

Urinary retention

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 further teaching if the client states that which component is part of the treatment plan?

sodium restriction

A male client has a tentative diagnosis of urethritis. The nurse collects data from the client knowing which are signs/symptoms of this disorder?

Dysuria and penile discharge

A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder?

Dysuria and penile discharge

The 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?

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

A client has received instructions on self-management of peritoneal dialysis. The nurse determines that the client needs further teaching if the client makes which statement

"I will use a strong adhesive tape to anchor the catheter dressing."

The nurse has reinforced 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 makes which statement?

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

Which is an appropriate question to ask to determine the specific type of incontinence?

"Have you been experiencing any urgency accompanied by dribbling or leaking urine?"

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 question first?

"Have you experienced any constipation recently?"

A client with acute pyelonephritis is scheduled for a voiding cystourethrogram. After the nurse provides information about this procedure, the client states, "I can't urinate in front of other people. I have a 'bashful' kidney." What is the nurse's best response?

"You will be screened and given as much privacy as possible."

The nurse suspects the client has a urinary tract infection (UTI). Which signs/symptoms suggest a UTI? Select all that apply.

1.Dysuria, 2.Hematuria, 3.Frequency, 4.Flank pain, 6.Cloudy urine

The nurse is speaking with a client who underwent a minimally invasive procedure treatment for recurrent urolithiasis. Which instructions are appropriate to reinforce in the teaching plan? Select all that apply.

1. Drink at least 3000 mL of fluid each day, 4. Complete the full course of prescribed antibiotics, 5. Filter urine and collect any stones to take to the urological health care provider

A client with end-stage kidney disease (ESKD) undergoes a surgical procedure to create an arteriovenous fistula for hemodialysis in the upper extremity. The nurse should take which actions when the client returns from surgery? Select all that apply.

1. Monitor pain and administer analgesics, 2. Monitor bleeding and swelling at the site, 5..Check for audible bruit and palpable thrill at the fistula site

A client who underwent kidney transplant 6 months earlier is seen in the clinic for a routine monthly appointment. The nurse reviews how the client has been doing and observes for signs/symptoms of acute rejection. Which signs/symptoms suggest acute rejection of the transplanted kidney? Select all that apply.

1. Oliguria, 4. Elevation of blood pressure over baseline, 5. Abdominal tenderness on the side of the kidney transplant, 6. Elevation of serum blood urea nitrogen (BUN) and creatinine

The nurse is caring for the client with epididymitis. Which treatment modalities should be implemented? Select all that apply.

1.Bed rest, 2.Sitz bath, 3.Antibiotics, 5.Scrotal elevation

The nurse is reviewing the client's record and notes that the primary health care provider (PHCP) has documented that the client has a renal disorder. Which laboratory results would indicate a decrease in renal function? Select all that apply.

1.Elevated serum creatinine level, 3.Decreased red blood cell (RBC) count, 5.Elevated blood urea nitrogen (BUN) level

Which actions are included in the nursing care of the client undergoing peritoneal dialysis? Select all that apply.

1.Monitor vital signs including temperature, 2.Weigh the client before and after dialysis, 3.Check color and volume of dialysate solution, 5.Maintain aseptic technique when accessing the peritoneal catheter.

A client with end-stage kidney disease (ESKD) begins peritoneal dialysis. The nurse observes for which signs/symptoms indicating peritonitis? Select all that apply.

1.Nausea and vomiting, 3.Abdominal tenderness, 4.Cloudy peritoneal effluent, 5.Oral temperature of 38° C

The nurse is caring for a client who had a renal biopsy. Which interventions should 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, who had experienced significant blood loss in an automobile crash, was admitted to the hospital 2 days earlier. The nurse observes the client for which signs/symptoms that indicate acute kidney injury (AKI)? Select all that apply.

2. Elevated urine specific gravity, 4. Rising serum blood urea nitrogen (BUN) and creatinine levels, 5. Urine output averaging 25 mL per hour while receiving an intravenous infusion at 150 mL/hour

The nurse is reviewing the laboratory results and physical examination of a client with acute glomerulonephritis. Which data should the nurse see? Select all that apply.

2. Hematuria, 3. Proteinuria, 5.Periorbital edema

Which statements indicate an understanding of the necessary dietary modifications of a client diagnosed with chronic kidney disease? Select all that apply.

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

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.

The nurse is caring for a client who received a recent kidney transplant. Besides actual rejection of the transplant, which are some of the most important complications this client is at risk for? Select all that apply.

2.Malignancies, 4.Cardiovascular disease, 5.Susceptibility to infection, 6.Corticosteroid-related complications

A client with acute kidney injury secondary to heart failure develops fluid volume excess. Which signs and symptoms should the nurse expect to see? Select all that apply.

2.Weight gain, 3.Decreased hematocrit, 4.Distended jugular veins, 6.Decreased specific gravity with high volume

The nurse is reviewing data on a client with sepsis and acute kidney injury with related azotemia and oliguria. Which are the primary features of azotemia and oliguria? Select all that apply.

3. Increase in serum creatinine, 4. Increase in blood urea nitrogen (BUN), 5. Urine output less than 0.5 mL/kg/hour

Which observations by the nurse caring for clients in a hospital medical-surgical unit should be immediately reported to the primary health care provider? Select all that apply.

3. New confused mental state and pulse rate of 106 beats per minute in a 72-year-old client, 5. A volume of 105 mL of urine over 4 hours in the collection bag of a 1-day postoperative client

The nurse is reinforcing instructions to a client about the types of fluids that assist in prevention and treatment of urinary tract infections (UTIs). The nurse instructs the client to consume which fluids? Select all that apply.

3.Prune juice, 4.Apple juice, 5.Cranberry juice

A client, on the waiting list for a renal transplant, receives a hemodialysis treatment. Which findings indicate to the nurse that the hemodialysis treatment has been effective? Select all that apply.

3.Serum potassium level is within the normal range, 4.The client's weight is 2 kilograms less than predialysis weight, 5.Serum blood urea nitrogen (BUN) and creatinine levels are lower than predialysis.

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

A spinach salad, milk, and a banana

A client with chronic kidney disease 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. Which does this data indicate?

Aluminum intoxication

A client diagnosed with chronic kidney disease 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 reinforce instructing the client to take which action?

Ambulate in the home

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

Ambulate in the room and hall for short distances.

The nurse is preparing a client scheduled for an intravenous pyelogram (IVP). The nurse should take which important action before the test?

Ask about allergies to iodine or shellfish

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?

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) if which is noted on data collection?

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

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 condition?

Blow or trauma to the bladder or abdomen

A client with benign prostatic hypertrophy (BPH) undergoes a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigations postoperatively. Which are the signs/symptoms of transurethral resection (TUR) syndrome?

Bradycardia and confusion

The nurse must ambulate a client who has a nephrostomy tube attached to a drainage bag. The nurse plans to do this most safely by performing which action?

Changing the drainage bag to a leg collection bag

The 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 food?

Cheese

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

Chills, General Weakness, Nausea/Vomiting

A client's kidneys are retaining larger than normal amounts of sodium. The nurse is reviewing the most recent laboratory data. The nurse should expect which laboratory value to be abnormal since the client is retaining sodium?

Chloride 112 mEq/L

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

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

The nurse is monitoring an older client suspected of having a urinary tract infection (UTI) for signs of infection. Which sign/symptom is likely to present first?

Confusion

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

Continue to take antibiotics until all symptoms are gone

A 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 (BPH), the nurse questions the client about use of which medication?

Decongestants

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

Ensure that small clamps are attached to the AV shunt dressing

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

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

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

Fever, nausea and vomiting, and painful scrotal edema

The nurse is collecting data from a client with epididymitis. The nurse should expect to note which signs and symptoms of this problem?

Fever, nausea and vomiting, and painful scrotal edema

The 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 serves which purpose?

Gives specific cytological information about the lesion

The 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 data?

Hourly urine output

Which condition places the client at risk for developing acute postrenal failure?

Hydronephrosis

The 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 make which dietary changes?

Increase intake of legumes in the diet.

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. Which response should be the nurse's initial action?

Increase the flow rate of the continuous bladder irrigation.

A client is admitted to the emergency department following a fall from a horse. The primary health care provider (PHCP) prescribes the insertion of an indwelling urinary catheter. The nurse notes blood at the urinary meatus while preparing for the procedure. Which action should the nurse take?

Notify the primary health care provider.

The client with chronic kidney disease who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril. When should the nurse plan to administer this medication?

On return from dialysis

The nurse is reinforcing instructions to a client with renal calculi about how to change the urine pH to be more acidic. The nurse determines that the client needs further teaching if the client states which type of drink is acceptable?

Orange juice

The 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 which contributing factor?

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

The nurse is admitting a client to the nursing unit who has returned from the postanesthesia care unit following prostatectomy. The client has a three-way Foley catheter with continuous bladder irrigation. The nurse should maintain the flow rate of the continuous bladder infusion to maintain which urine output characteristic?

Pale yellow or slightly pink

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

Pallor, diminished pulse, and pain in the left hand

The nurse is assisting in planning a diet for a client with acute kidney injury (AKI). The nurse plans to restrict which dietary component from this client's diet?

Potassium

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

Remove the water pitcher from the bedside

A male client is diagnosed with urethritis caused by chlamydial infection. The unlicensed assistive personnel (UAP) assigned to the client asks the nurse what measures are necessary to prevent a contraction of the infection during care. Which instruction should the nurse give the UAP?

Standard precautions are sufficient because the infection is transmitted sexually.

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

The client with chronic obstructive pulmonary disease (COPD)

The use of peritoneal dialysis for the treatment of chronic kidney disease would be contraindicated for which clients?

The client with chronic obstructive pulmonary disease (COPD)

The nurse is assessing a client with suspected acute kidney injury. Which finding would support a diagnosis of acute intrarenal failure?

Urine analysis positive for casts and cellular debris

A client with prostatitis resulting from kidney infection has received instructions on management of the condition at home and prevention of recurrence. Which statement indicates that the client understood the instructions?

Use warm sitz baths and analgesics to increase comfort.

The 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?

Vomiting and headaches

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 which complication?

acute tubular necrosis

The nurse is admitting a client with chronic kidney disease (CKD) to the nursing unit. The nurse monitors the client for which frequent cardiovascular sign that occurs in CKD?

hypertension

A client tells the nurse she completed an educational program to manage her stress incontinence but is now discouraged. Which information from the client indicates the need for further teaching? Select all that apply

1.She performs the Kegel exercises every other day., 3. She quit drinking coffee with cream but drinks diet cola, 5.She has begun an exercise program that includes lifting weights.

The nurse is caring for a hemodialysis client who has been receiving treatment for several years and is not a candidate for kidney transplant. The nurse knows that the majority of deaths of hemodialysis clients are related to which causes? Select all that apply.

1.Stroke, 4.Infectious complications, 5.Myocardial infarction (MI)

A long-term care nurse notes that an older client who is normally alert has become progressively confused and irritable. What diagnostic tests should the nurse anticipate the health care provider to prescribe? Select all that apply.

1.Urinalysis, 6. Complete blood count

The nurse is caring for a hospitalized client following cystoscopy. Which discharge instructions are given to the client? Select all that apply.

1.Use antispasmodics for pain., 4.Take sitz baths for voiding discomfort., 5.Report severe pain to health care provider.

A client is scheduled for intravenous pyelography (IVP). Which priority nursing action should the nurse take?

Determine if there is a history of allergies.

After a renal biopsy, the client complains of pain at the biopsy site that radiates to the front of the abdomen. Which would this indicate?

Bleeding

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

Decreased force in the stream of urine

A client with new-onset renal failure is having a first hemodialysis treatment. The nurse is especially careful to monitor the client for which signs/symptoms after the dialysis treatment?

Headache, decreasing level of consciousness, and seizures

A client with diabetes mellitus is receiving peritoneal dialysis. The nurse should ensure maintenance of the dwell time for the dialysis at the prescribed time because of risk for which complication?

Hyperglycemia

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 which complication?

Hyperglycemia

The nurse is talking with a client who has an arteriovenous fistula in the left arm. What statement by the client indicates a need for further teaching?

I sleep on my left side with my arm tucked under my pillow."

A client with chlamydial infection has received instructions on self-care and prevention of further infection. The nurse determines that the client needs further teaching if the client states which?

I will use an antibiotic prophylactically to prevent symptoms of Chlamydia.

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 teaching if the client states that he will perform which action as part of these exercises?

Perform the Valsalva maneuver.

Aluminum hydroxide is prescribed for the client with chronic kidney disease (CKD). When should the nurse instruct the client to take this medication?

With meals

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

Diabetes mellitus

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

Diabetes mellitus

A client contacts the primary health care provider's office to report she is not feeling well, has burning with urination, and suspects she may have a urinary tract infection. The nurse instructs the client to collect a urine specimen for testing. Which urinalysis findings indicate the presence of a urinary tract infection? Select all that apply.

1.Nitrites, present, 4.White blood cells, 6.Leukocyte esterase, present

The nurse is assessing a client's arteriovenous fistula being used for hemodialysis. Which findings would prompt the nurse to notify the primary health care provider immediately? Select all that apply.

1.No thrill palpated at fistula site, 2.No bruit auscultated at the fistula site, 4.Absent pulse distal to the arteriovenous fistula

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

Hyperglycemia

A client hospitalized with urolithiasis has a sudden significant decrease in urine output. The nurse should perform which action?

Notify the registered nurse

The 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?

Obtain a culture and sensitivity of the drainage.

The 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 kidney disease. Which finding indicates that the fistula is patent?

Palpation of a thrill over the fistula

The nurse is caring for a 58-year-old client with chronic kidney disease who is receiving peritoneal dialysis. Which finding is considered most important by the nurse, requiring primary health care provider notification? Refer to chart.

WBC 15,000 mm3

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

Lima beans

The nurse is reinforcing 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 action?

Limit protein intake