NCLEX Urinary Practice Questions

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 33% 2. Platelet count of 400,000 mm^3 3. White blood cell count of 6000 mm^3 4. Blood urea nitrogen level of 15 mg/dL

1 Rationale: Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hematocrit level is M: 42% to 52%; F: 37% to 47%. Therapeutic effect is seen when the hematocrit reaches between 30% and 33% The normal platelet count is 150,000 to 400,000 mm^3. The normal blood urea nitrogen level is 10 to 20 mg/dL. The normal white blood cell count is 5000 to 10,000 mm^3. Platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin.

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. Decreased hemoglobin level 2. Elevated serum creatinine level 3. Elevated thrombocyte cell count 4. Decreased red blood cell (RBC) count 5. Elevated blood urea nitrogen (BUN) level

1, 2, 4, 5 BUN testing is a frequently used laboratory test to determine renal function. The BUN and serum creatinine levels start to rise when the glomerular filtration rate decreases to less than 40% to 60%. A decreased RBC count as well as a decreased hemoglobin level may be noted if erythropoietin function by the kidney is impaired. Thrombocyte cell counts do not indicate decreased renal function.

The nurse is caring for the client with epididymitis. Which treatment modalities would be implemented? Select all that apply. 1. Bed rest 2. Sitz bath 3. Antibiotics 4. Heating pad 5. Scrotal elevation

1,2,3,5 Rationale: Common interventions used in the treatment of epididymitis include bed rest, elevation of the scrotum, ice packs, sitz baths, analgesics, and antibiotics. A heating pad would not be used because direct application of heat could increase blood flow to the area and increase the swelling.

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? 1. Peritonitis 2. Hyperglycemia 3. Hyperphosphatemia 4. Disequilibrium syndrome

2 Rationale: An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis. Peritonitis is a risk associated with breaks in aseptic technique. Hyperphosphatemia is an electrolyte imbalance that occurs with renal dysfunction. Disequilibrium syndrome is a complication associated with hemodialysis.

Bethanechol chloride is prescribed for a client with urinary retention. Which health problem would be a contraindication to the administration of this medication? 1. Gastric atony 2. Urinary strictures 3. Neurogenic atony 4. Gastroesophageal reflux

2 Rationale: Bethanechil chloride can be harmful to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions.

The nurse is reinforcing discharge instructions to a client receiving sulfadiazine. Which would be included in the list of instructions? 1. Restrict fluid intake. 2. Maintain a high fluid intake. 3. Decrease the dosage when symptoms are improving to prevent an allergic response. 4. If the urine turns dark brown, call the primary health care provider immediately.

2 Rationale: Each dose of sulfadiazine needs to be administered with a full glass of water, and the client needs to maintain a high fluid intake. The medication is more soluble in alkaline urine. The client would not be instructed to taper or discontinue the dose. Some forms of sulfadiazine cause urine to turn dark brown or red. This does not indicate the need to notify the PHCP.

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which health problem noted on the client's record would the nurse identify as a risk factor for this diagnosis? 1. Hypoglycemia 2. Diabetes mellitus 3. Coronary artery disease 4. Orthostatic hypotension

2 Rationale: Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of un-nary stones, and indwelling or frequent urinary catheterization.

11. The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse would take which actions? Select all that apply. 1. Contact the nephrologist. 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. 6. Increase the flow rate of the peritoneal dialysis solution.

2, 3, 4, 5 Rationale: If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the clients abdomen to enhance gravity drainage. The connecting tubing on the peritoneal dialysis system is also checked for kinks or twisting, and the clamps on the system are checked to ensure that they are open. There is no reason to contract the nephrologist. Increasing the flow rate is an inappropriate action and is unassociated with the amount of outflow solution.

A client is scheduled for intravenous pyelography (IVP). Which priority nursing action would the nurse take? 1. Restrict fluids. 2. Administer a sedative. 3. Determine if there is a history of allergies. 4. Administer an oral preparation of radiopaque dye.

3 Rationale: An iodine-based dye may be used during the IVP and can cause allergic reactions such as itching, hives, rash, tight feeling in the throat, shortness of breath, and bronchospasm. Checking for allergies is the priority. Options 1, 2, and 4 are unnecessary.

Following kidney transplantation, cyclosporine is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Hemoglobin level of 14.0 g/dL 2. Creatinine level of 0.6 mg/dL 3. Blood urea nitrogen level of 25 mg/dL 4. Fasting blood glucose level of 99 mg/dL

3 Rationale: Cyclosporine is an immunosuppressant. Nephrotoxicity can occur from the use of cyclosporine. Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen (10 to 20 mg/dL) and serum creatinine levels (M: 0.6 to 1.2 mg/dL; F: 0.5 to 1.1 mg/dL). Cyclosporine can lower complete blood cell count levels. A normal hemoglobin is M: 14 to 18 g/dL; F: 12 to 16 g/dL. A normal hemoglobin is not an adverse effect Cyclosporine does affect the glucose level. The normal fasting glucose is 70 to 99 mg/dL.

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? 1. Fever 2. Urgency 3. Confusion 4. Frequency

3 Rationale: In an older client, the only symptom of a UTI may be something as vague as increasing mental confusion or frequent unexplained falls. Frequency and urgency may commonly occur in an older client, and fever can be associated with a variety of conditions.

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? 1. Edema and purpura of the left arm 2. Warmth, redness, and pain in the left hand 3. Aching pain, pallor, and edema of the left arm 4. Pallor, diminished pulse, and pain in the left hand

4 Rationale: Arterial steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and diminished pulse distal to the fistula and complains of pain distal to the fistula, which is caused by tissue ischemia. Warmth, redness, and pain would more likely characterize a problem with infec-tion. Options 2 and 3 are not characteristics of steal syndrome.

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? 1. Bleeding 2. Infection 3. Renal colic 4. Normal, expected pain

1 Rationale: If pain originates at the biopsy site and begins to radiate to the flank area and around the front of the abdomen, bleeding would be suspected. Hypotension, a decreasing hematocrit, and gross or microscopic hematuria would also indicate bleeding. Signs of infection would not appear immediately after a biopsy. Pain of this nature is not normal. There are no data to support the presence of renal colic.

A sulfonamide is prescribed for a client with a urinary tract infection. During review of the client's record, the nurse notes that the client is taking warfarin sodium daily. Which prescription would the nurse anticipate for this client? 1. Discontinuation of warfarin sodium 2. A decrease in the warfarin sodium dosage 3. An increase in the warfarin sodium dosage 4. A decrease in the usual dose of the sulfonamide

2 Rationale: Sulfonamides can potentiate the effects of warfarin sodium, phenytoin, and orally administered hypoglycemics such as tolbutamide. When an oral anticoagulant is combined with a sulfonamide, a decrease in the anticoagulant dosage may be needed.

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? 1. Tachycardia and diarrhea 2. Bradycardia and confusion 3. Increased urinary output and anemia 4. Decreased urinary output and bladder spasms

2 Rationale: TUR syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure, such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.

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 take which action? 1. Drink an increased amount of fluids. 2. Limit the force of the stream during voiding. 3. Continue to take antibiotics until all symptoms are gone. 4. Use condoms to eliminate the risk associated with chlamydia and gonorrhea.

3 Rationale: The client who experiences epididymitis from UTI needs to increase intake of fluids to flush the urinary system. Because organisms can be forced into the vas deferens and epididymis from strain or pressure during voiding, the client needs to limit the force of the stream. Condom use can help to prevent urethritis and epididymitis from STIs. Antibiotics are always taken until the full course of therapy is completed.

The nurse who is administering bethanechol chloride is monitoring for acute toxicity associated with the medication. The nurse would check the client for which sign of toxicity? 1. Dry skin 2. Dry mouth 3. Bradycardia 4. Signs of dehydration

3 Rationale: Toxicity (overdose) produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intavenously.

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? 1. Stop antibiotic therapy when pain subsides. 2. Exercise as much as possible to stimulate circulation. 3. Use warm sitz baths and analgesics to increase comfort. 4. Keep fluid intake to a minimum to decrease the need to void.

3 Rationale: Treatment of prostatitis includes medication with antibiotics, analgesics, and stool softeners. The client is also taught to rest, increase fluid intake, and use sitz baths for comfort. Antimicrobial therapy is always continued until the prescription is completely finished.

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 do these data indicate? 1. Advancing uremia 2. Phosphate overdose 3. Folic acid deficiency 4. Aluminum intoxication

4 Rationale: Aluminum intoxication may occur when there is accumulation of aluminum, an ingredient in many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. This condition was formerly known as dialysis dementia. It may be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body. It can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum.

Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse would instruct the client to report which symptom if it developed during the course of this medication therapy? 1. Nausea 2. Diarrhea 3. Headache 4. Sore throat

4 Rationale: Clients taking trimethoprim-sulfamethoxazole need to be informed about early signs of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client needs to be instructed to notify the primary health care provider (PHCP) if these symptoms occur. The other options do not require PHCP notification.

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 would ask the client about the presence of which early symptom? 1. Nocturia 2. Urinary retention 3. Urge incontinence 4. Decreased force in the stream of urine

4 Rationale: Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client may then develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur.

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 needs to be questioned about the use of which class of medications? 1. Diuretics 2. Antibiotics 3. Antitussives 4. Decongestants

4 Rationale: Episodes of urinary retention can be triggered by certain medications such as decongestants, anticholinergics, and antidepressants. Diuretics, antibiotics, and antitussives generally do not trigger urinary retention. Retention also can be precipitated by other factors such as alcoholic beverages, infection, bed rest, and becoming chilled.

Phenazopyridine hydrochloride is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. Which instruction would the nurse reinforce to the client? 1. Take the medication at bedtime. 2. Take the medication before meals. 3. Discontinue the medication if a headache occurs. 4. A reddish-orange discoloration of the urine may occur.

4 Rationale: The nurse would instruct the client that a reddish-orange discoloration may occur. The nurse also would instruct the client that this discoloration can stain fabric. The medication needs to be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication an does not warrant discontinuation of the medication.

Oxybutynin chloride is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication? 1. Pallor 2. Drowsiness 3. Bradycardia 4. Restlessness

4 Rationale: Toxicity (overdose) of this medication produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdose.

A male client has a tentative diagnosis of urethritis. The nurse would assess the client for which manifestations of the disorder? 1. Hematuria and pyuria 2. Dysuria and proteinuria 3. Hematuria and urgency 4. Dysuria and penile discharge

4 Rationale: Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays. Hematuria is not associated with urethritis. Proteinuria is associated with kidney dysfunction.