Saunders NCLEX-RN 7th Study - Renal

The nurse is planning discharge teaching for a client newly diagnosed with chronic kidney disease (CKD). Which factor will enhance the educational process? 1. Anxiety 2. Memory deficits 3. Presence of family 4. Short attention span

3 R: literally the only positive option

The client with a crush injury to the leg has a highly positive urine myoglobin level. The nurse should assess this client carefully for signs and symptoms of which problem? 1. Brain attack 2. Respiratory failure 3. Myocardial infarction 4. Acute tubular necrosis

4 R: The normal urine myoglobin level is negative. After extensive muscle destruction or damage, myoglobin is released into the bloodstream, where it is cleared from the body by the kidneys. When a large amount of myoglobin is being cleared from the body, there is a risk of the renal tubules being clogged with myoglobin, causing acute tubular necrosis. This is one form of acute kidney injury. The remaining options are unrelated to a positive myoglobin level.

A client with chronic kidney disease (CKD) has been taking aluminum hydroxide gel. On the basis of this information, the nurse determines that the client is most at risk for which problem? 1. Constipation 2. Dehydration 3. Inability to tolerate activity 4. Impaired physical mobility

1 R: Options 3&4 are too similar and can be eliminated. Aluminum hydroxide can cause constipation, so option 1 is most correct.

The nurse has a prescription to obtain a urinalysis specimen from a client with an indwelling urinary catheter. Which actions should the nurse include in performing this procedure? Select all that apply. 1. Explaining the procedure to the client 2. Clamping the tubing of the drainage bag 3. Aspirating a sample from the port on the drainage tubing 4. Obtaining the specimen from the urinary drainage bag 5. Wiping the port with an alcohol swab before inserting the syringe

1,2,3,5 R: A urine specimen is not taken from the urinary drainage bag. Urine undergoes chemical changes while sitting in the bag, so its properties do not necessarily reflect current client status. In addition, it may become contaminated with bacteria from opening the system. The remaining options are correct interventions for obtaining the specimen.

The nurse is performing an assessment on a client after a cystoscopy. Which assessment finding indicates a need to notify the health care provider (HCP)? 1. A temperature of 99.4°F (37.4°C) 2. Grossly bloody urine with clots 3. A bluish or green tinge to the urine 4. A blood pressure of 120/82 mm Hg

2 R: 1&4 are both WNL so they're incorrect. 3 may be caused by contrast dyes for the cystoscopy. "Grossly bloody" indicates it's actively still bleeding which can lead to hemorrhage.

A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. Which should the nurse expect to observe in the client? 1. Bradycardia 2. Hypertension 3. Decreased cardiac output 4. Decreased central venous pressure

2 R: Signs of AKI=hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for any form of renal failure.

A home care nurse is making home visits to an older client with urinary incontinence who is very concerned about the incontinent episodes. Which finding by the nurse indicates that the client has an environmental barrier to normal voiding? 1. Presence of hand railings in the bathroom 2. Having 1 bathroom on each floor of the home 3. Bathroom located on the second floor, bedroom on the first floor 4. Night light present in the hall between the bedroom and bathroom

3 R: all the other options are beneficial for an older patient. Only option 3 can cause a problem with incontinence.

A client who is undergoing peritoneal dialysis calls the nurse at the renal unit and reports the presence of severe abdominal pain and diarrhea. The client also informs the nurse that the peritoneal dialysis returns are brown-tinged in color. Which would the nurse suspect? 1. Infection 2. An intact catheter 3. Bowel perforation 4. Bladder perforation

3 R: brown=poop

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

4. R: Urethritis usually involves dysuria, so 1&3 are incorrect. Proteinuria is r/t kidney dysfunction, so option 2 is also incorrect. Urethritis is also associated with chlamydia, so discharge is expected. Hematuria is not assoc. with urethritis.

The nurse is working with a client newly diagnosed with chronic kidney disease (CKD) 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 which problem? 1. Anger 2. Projection 3. Depression 4. Withdrawal

1 R: sounds angry to me

The nursing student is caring for a client with benign prostatic hyperplasia (BPH). The nursing instructor asks the student to identify the clinical manifestations associated with this condition. The student needs further teaching if the student states that which finding is an early symptom of BPH? 1. Nocturia 2. Hematuria 3. Decreased force of urine stream 4. Difficulty initiating urine stream

2 R: you won't see hematuria until BPH progresses. All other options (1, 3, 4) are common initially. Think of option 2 as more severe, so it takes time to get that bad.

The nurse is preparing to perform a discharge teaching with a client who is started on hemodialysis. Which information should the nurse provide regarding the hemodialysis schedule? 1. 5 hours of treatment 2 days per week 2. 2 hours of treatment 6 days per week 3. 3 to 4 hours of treatment 3 days per week 4. 2 to 3 hours of treatment 5 days per week

3 R: Dialysis is usually 3x/week for 3-4hrs. Can be MWF or any other variation.

The nurse has administered a dose of meperidine hydrochloride to a client with renal colic as treatment for pain. The nurse carefully monitors this client for which side and adverse effect of this medication? 1. Bradycardia 2. Hypertension 3. Urinary retention 4. Increased respirations

3 R: Meperidine hydrochloride is an opioid analgesic. Side effects of meperidine hydrochloride include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

A client with urolithiasis (struvite stones) has a history of chronic urinary tract infections. What should the nurse plan to teach the client to avoid? 1. Antibiotics 2. Foods that make the urine more acidic 3. Wearing synthetic underwear and pantyhose 4. Fruits such as currants, blueberries, and cranberries

3 R: wear cotton, not synthetic so everything can breathe down there

A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the health care provider (HCP)? 1. Red, bloody urine 2. Pain rated as 2 on a 0-10 pain scale 3. Urinary output of 200 mL higher than intake 4. Blood pressure, 100/50 mm Hg; pulse, 130 beats/minute

4 R: Options 1, 2, and 3 are all expected findings for several days after surgery. Option 4 sounds like a response to excessive blood loss.

The nurse is monitoring a client who has just returned from surgery after a transurethral resection of the prostate (TURP). The client has a 3-way Foley catheter in place for ongoing bladder irrigation. The nurse is observing the color of the client's urine and should expect which urine color during the immediate postoperative period? 1. Pale pink urine 2. Dark pink urine 3. Tea-colored urine 4. Bright red blood with small clots in the urine

1 R: Option 2 means the irrigation solution should be increased (dark=concentrated). 3 is more r/t renal failure. 4 would indicate a complication, so you'd need to call the HCP.

A female client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which problem? 1. Rupture of the bladder 2. The development of a vesicovaginal fistula 3. Extreme stress because of the diagnosis of cancer 4. Altered perineal sensation as a side effect of radiation therapy

2 R: A complication of radiation therapy for bladder cancer is fistula formation. In women, this frequently is manifested as a vesicovaginal fistula, which is an opening between the bladder and the vagina.

In performing a physical assessment of a client with chronic kidney disease (CKD), which finding should the nurse anticipate? 1. Glycosuria 2. Polyphagia 3. Crackles auscultated in the lungs 4. Blood pressure of 98/58 mm Hg

3 R: CKD is a condition in which the kidneys have progressive problems in clearing nitrogenous waste products and controlling fluid and electrolyte balance within the body. Cardiovascular symptoms of heart failure and hypertension are caused by the fluid volume overload resulting from the kidneys' inability to excrete water. Signs and symptoms of heart failure include jugular venous distention, S3 heart sound, pedal edema, increased weight, shortness of breath, and crackles auscultated in the lungs. The typical signs and symptoms of CKD include proteinuria or hematuria, not glycosuria. The nurse would observe anorexia and nausea in this client, not polyphagia.

The nurse has completed teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse should determine that education was effective if the client states to record which parameters daily? 1. Pulse and respiratory rate 2. Amount of activity and sleep 3. Intake and output (I&O) and weight 4. Blood urea nitrogen (BUN) and creatinine levels

3 R: Option 3 fluctuates daily and can indicate fluid overload which should be avoided

A client has just had a Foley catheter removed and is to be started on a bladder retraining program. Which intervention will provide the most useful information about the client's ability to empty the bladder? 1. Calculating total fluid intake for the shift 2. Recording the amount of the client's voidings 3. Assisting the client to the bathroom every 2 hours 4. Measuring postvoid residual using a bladder scan

4

The nurse is admitting a client who has an arteriovenous (AV) fistula in the right arm for hemodialysis. Which nursing intervention is the best way to prevent injury to the AV site? 1. Putting a large note about the access site on the front of the medical record 2. Applying an allergy bracelet to the right arm, indicating the presence of the fistula 3. Telling the client to inform all caregivers who enter the room about the presence of the access site 4. Placing a sign at the bedside that reads "No blood pressure measurements or venipunctures in the right arm"

4

The nurse is preparing to care for a client after a renal scan. Which intervention should the nurse include in the postprocedure plan of care? 1. Limit contact with the client to 20 minutes per hour. 2. Place the client on radiation precautions for 18 hours. 3. Save all urine in a radiation-safe container for 18 hours. 4. Wear gloves if contact with the client's urine will occur.

4

The nurse assessing the ureterostomy of a postoperative client interprets that the stoma has normal characteristics if which is observed? 1. Dry 2. Pale 3. Dark-colored 4. Red and moist

4 R: Following ureterostomy, the stoma should be red and moist. A dry stoma may indicate fluid volume deficit. A pale stoma may indicate an inadequate vascular supply. Any darkness or duskiness of the stoma may mean loss of vascular supply and must be corrected immediately to prevent necrosis.

The nurse is reviewing the assessment findings for a client with a diagnosis of nephrotic syndrome. Which should the nurse expect to note in this client? 1. Decreased serum lipids 2. Signs of fluid volume deficit 3. Decreased protein in the urine 4. Decreased serum albumin levels

4 R: Hallmark signs and symptoms of this syndrome include increased serum lipids, edema, increased excretion of protein in the urine, and decreased serum albumin levels.

A client with nephrolithiasis arrives at the clinic for a follow-up visit. Laboratory analysis of the stone that the client passed 1 week earlier indicates that the stone is composed of calcium oxalate. Based on these data, what food item does the nurse instruct the client to avoid? 1. Pasta 2. Lentils 3. Lettuce 4. Spinach

4 R: Many kidney stones are composed of calcium oxalate. Foods that raise urinary oxalate excretion include spinach, rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. Pasta, lentils, and lettuce are acceptable to consume.

The spouse of a client with acute kidney injury secondary to heart failure asks the nurse how a heart problem can affect the kidneys. The nurse should formulate a response using what fact about the kidneys? 1. The kidneys get fatigued from having to filter too much fluid. 2. The kidneys can react adversely to moderate doses of furosemide. 3. The kidneys will shut down easily if serum levels of digoxin are high. 5. The kidneys generally require and receive about 20% to 25% of the resting cardiac output.

4 R: No perfusion by the heart = no perfusion to kidneys = damage

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication? 1. Warmth, redness, and pain in the left hand 2. Ecchymosis and audible bruit over the fistula 3. Edema and reddish discoloration of the left arm 4. Pallor, diminished pulse, and pain in the left hand

4 R: Arterial STEAL syndrome involves vascular insufficiency (literally stealing the blood that the hand's tissue needs!). So you'd see pallor and other signs of decr. perfusion. 1&3 sound more like an infection so they're incorrect. Option 2 is a normal finding for a fistula.

The nurse is caring for a client who was prescribed furosemide. The nurse should monitor the client for damage of which kidney structure? 1. Pelvis 2. Calyx 3. Nephron 4. Renal artery

3

The nurse is caring for a client with a bladder infection. The nurse plans care understanding that the primary risk factor for spread of infection in this client is dysfunction of which structure? 1. Urethra 2. Nephron 3. Glomerulus 4. Ureterovesical junction

4 R: The ureterovesical junction is the point at which the ureters enter the bladder. At this juncture, the ureter runs obliquely for 1.5 to 2 cm through the bladder wall before opening into the bladder. This anatomical pathway prevents reflux of urine back into the ureter and, in essence, acts as a valve to prevent urine from traveling back into the ureter and up to the kidney.

A client with an arteriovenous fistula in the left arm who is undergoing hemodialysis is at risk for infection. Which should the nurse formulate as the best outcome goal for this client problem? 1. The client washes hands at least once per day. 2. The client's temperature remains lower than 101°F (38.3°C). 3. The client avoids blood pressure (BP) measurement in the left arm. 4. The client's white blood cell (WBC) count remains within normal limits.

4 R: WBC is the BEST indicator of infection out of all the options.

A client who has had a prostatectomy has been instructed in perineal exercises to gain control of the urinary sphincter. The nurse determines that the client demonstrates a need for further teaching when he states that he will perform which movement as part of these exercises? 1. Bearing down as if having a bowel movement 2. Tightening the muscles as if trying to prevent urination 3. Contracting the abdominal, gluteal, and perineal muscles 4. Tightening the rectal sphincter while relaxing abdominal muscles

1 R: Bearing down (vagal/vasalva) may increase bleeding from surgical site, and should be avoided. Option 4 is different bc relaxing the abd muscles prevents the vasalva maneuver.

A client with chronic kidney disease has completed a hemodialysis treatment. The nurse should use which standard indicators to evaluate the client's status after dialysis? 1. Vital signs and weight 2. Potassium level and weight 3. Vital signs and blood urea nitrogen level 4. Blood urea nitrogen and creatinine levels

1 R: weight is measured before and after to make sure the right amount of fluid was extracted.

The nurse is creating a plan of care for a client with a diagnosis of nephrotic syndrome whose glomerular filtration rate (GFR) is normal. Which interventions should the nurse include in the plan of care? Select all that apply. 1. Monitor daily weight. 2. Maintain sodium restrictions. 3. Maintain a diet low in protein. 4. Monitor intake and output (I&O). 5. Maintain bed rest when edema is severe.

1,2,4,5 R: Controlling edema is a critical aspect of therapeutic management of nephrotic syndrome. If the GFR is normal, dietary intake of proteins is needed to restore normal plasma oncotic pressure and thereby decrease edema. Daily measurement of weight and abdominal girth, and careful monitoring of I&O will determine whether weight loss is caused by diuresis or protein loss. Dietary modifications may include salt restriction and fluid restriction and are based on the client's symptoms. Bed rest is prescribed to promote diuresis when edema is severe.

The nurse is reviewing the urinalysis results for a client with glomerulonephritis. Which findings should the nurse expect to note? Select all that apply. 1. Proteinuria 2. Hematuria 3. Positive ketones 4. A low specific gravity 5. A dark and smoky appearance of the urine

1,2,5 R: In the client with glomerulonephritis, characteristic findings in the urinalysis report are gross proteinuria and hematuria. The specific gravity is elevated, and the urine may appear dark and smoky. Positive ketones are not associated with this condition but may indicate a secondary problem.

A client with chronic kidney disease (CKD) is being managed by continuous ambulatory peritoneal dialysis (CAPD). During outflow, the nurse notes that only half of the 2-L dialysate has returned and the flow has stopped. Which interventions should the nurse take to enhance the outflow? Select all that apply. 1. Reposition the client. 2. Encourage a low-fiber diet. 3. Make sure the peritoneal catheter is not kinked. 4. Slide the peritoneal catheter farther into the abdomen. 5. Check that the drainage bag is lower than the client's abdomen. 6. Assess the stool history, and institute elimination measures if the client is constipated.

1,3,5,6 R: If the flow has stopped, it's either because of a kink or obstruction (may be caused by constipation). Readjusting the patient and assessing for possible obstructions is the appropriate actions. High-fiber diet should be encouraged to prevent constipation. Moving the catheter is contraindicated.

The nurse provides instructions to a client about newly prescribed furosemide. Which information should the nurse use to provide instructions in this teaching session? 1. The medication acts on the distal tubule of the nephron. 2. The medication acts on the loop of Henle in the nephron. 3. The collecting duct of the nephron will be affected by this medication. 4. The site of action for furosemide is the proximal tubule of the nephron.

2 R: Furosemide works by acting to excrete sodium, potassium, and chloride in the ascending limb of the loop of Henle; therefore, options 1, 3, and 4 are incorrect.

A client diagnosed with polycystic kidney disease has been taught about the treatment plan for this disease. The nurse should determine that the client needs further teaching if the client states that which is included in the treatment plan? 1. Genetic counseling 2. Sodium restriction 3. Increased water intake 4. Antihypertensive medications

2 R: Individuals with polycystic kidney disease seem to waste rather than retain sodium. Unless the client has problems with uncontrolled hypertension, increased sodium and water intake is needed. Antihypertensive medications are prescribed to control hypertension. Genetic counseling is advisable because of the hereditary nature of the disease.

The nurse is planning teaching for a female client diagnosed with urethritis caused by chlamydial infection. Which information should the nurse plan to include in the teaching session? 1. Alter the perineal pH by using a spermicide with a condom. 2. Keep follow-up appointments for repeat cultures in 4 to 7 days. 3. Discontinue antibiotics after 3 weeks of uninterrupted administration. 4. Identify sexual partners for the past 12 months so they can be treated.

2 R: notify within 30 days. spermicide doesn't alter pH. Take antibiotics until last prescribed dose.

A client with glomerulonephritis has developed acute kidney injury (AKI) as a complication. The nurse should expect to note which abnormal finding documented on the client's medical record? 1. Bradycardia 2. Hypertension 3. Decreased cardiac output 4. Decreased central venous pressure

2 R: the kidneys are unable to filter fluid leading to fluid overload (edema, tachycardia, HTN, oliguria, lethargy, etc). Glomerulonephritis is an intrarenal cause of AKI, but if it was prerenal then you'd see decreased CO and CVP.

The nurse has provided instructions to a client with a urinary tract infection regarding foods and fluids to consume that will acidify the urine. Which fluids should the nurse include in the client's teaching plan that will aid in acidifying the urine? Select all that apply. 1. Milk 2. Prune juice 3. Apricot juice 4. Cranberry juice 5. Carbonated drinks

2,3,4 R: Acidification of urine = less bacteria = less infection risk. Acidic: prune, apricot, cranberry, plum juice. Alkaline: milk & carbonated drinks

A client with renal cell carcinoma of the left kidney is scheduled for nephrectomy. The right kidney appears normal at this time. The client is anxious about whether dialysis will ultimately be needed. The nurse should plan to use which information in discussions with the client to alleviate anxiety? 1. There is a strong likelihood that the client will need dialysis within 5 to 10 years. 2. There is absolutely no chance of needing dialysis because of the nature of the surgery. 3. One kidney is adequate to meet the needs of the body as long as it has normal function. 4. Dialysis could become likely, but it depends on how well the client complies with fluid restriction after surgery.

3 R: Focus on the subject, alleviating the client's anxiety about nephrectomy. Eliminate option 2, noting the words absolutely no chance. Knowing that fluid restriction is unnecessary with a functioning kidney guides you to eliminate option 4 next. Regarding the remaining options, recall that a person can donate a kidney without adverse consequences or the need for dialysis. Applying that knowledge to this question would guide you to choose the correct option.

The nurse is reviewing the list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse should base the response on knowing that which is the action of the glucose in the solution? 1. Decreases the risk of peritonitis 2. Prevents disequilibrium syndrome 3. Increases osmotic pressure to produce ultrafiltration 4. Prevents excess glucose from being removed from the client

3 R: Increasing the glucose concentration makes the solution more hypertonic. The more hypertonic the solution, the higher the osmotic pressure for ultrafiltration and thus the greater the amount of fluid removed from the client during an exchange. The remaining options do not identify the purpose of the glucose.

A client undergoing hemodialysis begins to experience muscle cramping. What is the best action by the hemodialysis nurse in this situation? 1. Administer hypotonic saline. 2. Increase the ultrafiltration rate. 3. Decrease the ultrafiltration rate. 4. Administer magnesium sulfate.

3 R: Muscle cramps during hemodialysis result from either too rapid removal of water and sodium or neuromuscular hypersensitivity. The nurse corrects this situation by either slowing down the ultrafiltration rate on the hemodialyzer or administering hypertonic or isotonic normal saline. Magnesium sulfate is not prescribed to correct this occurrence.

The nurse is urging a client to cough and deep breathe after 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 most likely to be a result of which factor? 1. A stress response to the ordeal of surgery 2. A latent fear of needing dialysis if the surgery is unsuccessful 3. Pain that is intensified because of the location of the incision near the diaphragm 4. Effects of circulating metabolites that have not been excreted by the remaining kidney

3 R: Note the strategic words, most likely. The question asks for the most likely reason for the client's statement. Begin to answer the question by eliminating options 1 and 2 because data to support these options are lacking. Recalling that coughing and deep breathing will intensify pain after many surgical procedures helps you to choose the correct option.

A client passes a urinary stone, and laboratory analysis of the stone indicates that it is composed of calcium oxalate. On the basis of these data, which should the nurse specifically include in the dietary instructions? 1. Increase intake of dairy products. 2. Avoid citrus fruits and citrus juices. 3. Avoid green, leafy vegetables such as spinach. 4. Increase intake of meat, fish, plums, and cranberries.

3 R: Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. The food items in options 1, 2, and 4 are acceptable to consume.

A client is experiencing the syndrome of inappropriate antidiuretic hormone (ADH) secretion. When explaining this disorder to the client and family, the nurse recalls that ADH works to reabsorb water in which parts of the nephron? 1. The glomerulus and the calices 2. The loop of Henle and the distal tubule 3. The distal tubule and the collecting duct 4. The proximal tubule and the loop of Henle

3 R: The distal tubule and the collecting duct of the nephron require the presence of ADH for water reabsorption. The hormone increases the permeability of the membranes to allow water to flow more easily along the concentration gradient. The glomerulus filters but does not reabsorb. The calices are responsible for collecting the urine. The proximal tubule and the loop of Henle reabsorb water without the assistance of ADH.

The nurse instructor is evaluating a nursing student for knowledge regarding care of a client with acute kidney injury. Which statement by the student demonstrates the need for further teaching about the diuretic phase of acute kidney injury? 1. "The increase in urine output indicates the return of some renal function." 2. "The diuretic phase develops about 14 days after the initial insult and lasts about 10 days." 3. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." 4. "The blood urea nitrogen and creatinine levels will continue to rise during the first few days of diuresis."

3 R: The diuretic phase of acute kidney injury is characterized by an increase in urine output of more than 1000 mL in a 24-hour period. This increase in urine output indicates the return of some renal function; however, blood urea nitrogen and creatinine levels continue to rise during the first few days of diuresis. The diuretic phase develops about 14 days after the initial insult and lasts about 10 days.

The health care provider writes prescriptions for a client with chronic kidney disease (CKD). Which prescription should the nurse question? 1. Insert a saline lock. 2. Obtain a daily weight. 3. Provide a high-protein diet. 4. Administer a calcium supplement with each meal.

3 R: When a client experiences CKD, the blood urea nitrogen (BUN) and serum creatinine levels rise. The client also experiences increased potassium, increased phosphates, and decreased calcium. BUN and creatinine are the byproducts of protein metabolism, so monitoring protein intake is important, with care taken to include proteins of high biological value. Clients with CKD will have protein restricted early in the disease to preserve kidney function. In end-stage disease, protein is restricted according to the client's weight, the type of dialysis, and protein loss. With CKD, the nurse is concerned about fluid volume overload and accumulation of waste products. Because of the kidneys' inability to excrete fluid, it is important for the nurse to prevent as well as assess for early signs of fluid volume excess. Infusing an intravenous (IV) solution into a client with CKD significantly increases the risk for overload. If an IV access is needed, it usually involves only a saline lock. Obtaining the client's daily weight is one of the most important assessment tools for evaluating changes in fluid volume. The kidneys also are responsible for removing waste products. The client also receives phosphate binders, calcium supplements, and vitamin D to prevent bone demineralization (osteodystrophy) from chronically elevated phosphate levels.

A client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. Which is the priority nursing intervention? 1. Check the shunt for the presence of bruit and thrill. 2. Observe the site once during the shift as time permits. 3. Check the results of the prothrombin time as they are determined. 4. Ensure that small clamps are attached to the arteriovenous shunt dressing.

4 R: An external arteriovenous shunt is a less common form of access site but carries a risk for bleeding when it is used because 2 ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also should be assessed at least every 4 hours. Checking the shunt for the presence of bruit and thrill relates to patency of the shunt. Although checking the results of the prothrombin time is important, it is not the priority nursing action.

A 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? 1. During dialysis 2. Just before dialysis 3. The day after dialysis 4. On return from dialysis

4 R: Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting an entire day to resume the medication. This would lead to ineffective control of the blood pressure.

The nurse is caring for an older client. Which finding should the nurse expect to note in this client while evaluating renal function? 1. Tubular reabsorption increases 2. Urine-concentrating ability increases 3. Medications are metabolized in larger amounts 4. The glomerular filtration rate (GFR) diminishes

4 R: As part of the normal aging process, the GFR decreases, along with each of the other functional abilities of the kidney. Tubular reabsorption and urine-concentrating ability also decrease. The kidneys have decreased ability to metabolize medications.

The home health nurse is planning to make a home visit to a client who has undergone surgical creation of an ileal conduit. The nurse should include which information on ostomy care in discussion with the client? 1. Plan to do appliance changes in the late evening hours. 2. Cut an opening that is slightly smaller than the stoma in the face plate of the appliance. 3. Appliance odor from urine breakdown to ammonia can be minimized by limiting fluids. 4. Cleanse the skin around the stoma, using gentle soap and water, and then rinse and dry well.

4 R: Focus on the subject, ostomy care. Begin to answer this question by eliminating option 3. Fluid limitation will not limit ammonia odor; in fact, decreased fluids will increase the concentration of the urine, making it stronger. Option 2 is eliminated next because an appliance cut in this way will be too small to fit over the stoma. Regarding the remaining options, recall that urine flow is slowest in the early morning as a result of decreased intake during the night.

The nurse is giving general instructions to a client receiving hemodialysis. Which statement would be most appropriate for the nurse to include? 1. "It is acceptable to eat whatever you want on the day before hemodialysis." 2. "It is acceptable to exceed the fluid restriction on the day before hemodialysis." 3. "Medications should be double-dosed on the morning of hemodialysis because of potential loss." 4. "Several types of medications should be withheld on the day of dialysis until after the procedure."

4 R: It's impossible to tell how much medication will be dialyzed, so don't double dose. Don't disregard diet/fluid restrictions either.

The nurse is working on a medical-surgical nursing unit and is caring for several clients with chronic kidney disease. The nurse interprets that which client is best suited for peritoneal dialysis as a treatment option? 1. A client with severe heart failure 2. A client with a history of ruptured diverticula 3. A client with a history of herniated lumbar disk 4. A client with a history of 3 previous abdominal surgeries

1 R: Peritoneal dialysis may be the treatment option of choice for clients with severe cardiovascular disease. Severe cardiac disease can be worsened by the rapid shifts in fluid, electrolytes, urea, and glucose that occur with hemodialysis. For the same reason, peritoneal dialysis may be indicated for the client with diabetes mellitus. Contraindications to peritoneal dialysis include diseases of the abdomen such as ruptured diverticula or malignancies; extensive abdominal surgeries; history of peritonitis; obesity; and a history of back problems, which could be aggravated by the fluid weight of the dialysate. Severe disease of the vascular system also may be a relative contraindication.

The nurse is conducting an interview of an older client and is concerned about the possibility of benign prostatic hyperplasia (BPH). Which are characteristics of this disorder? Select all that apply. 1. Nocturia 2. Incontinence 3. Enlarged prostate 4. Nocturnal emissions 5. Decreased desire for sexual intercourse

1, 2, 3 R: Option 4 is seen commonly in prepubescent males. 5 is seen w/ low testosterone levels. Nocturia=urination at night. Nocturnal emissions=ejaculation while sleeping lol.

The nurse has taught the client with polycystic kidney disease about management of the disorder and prevention and recognition of complications. The nurse should determine that the client understands the instructions if the client states that which should be reported to the health care provider (HCP)? Select all that apply. 1. Frequent urination 2. Burning on urination 3. A temperature of 100.6°F (38.1°C) 4. New-onset shortness of breath 5. A blood pressure of 105/68 mm Hg

1,2,3,4 R: The client with polycystic kidney disease should report any signs and symptoms of urinary tract infection, such as frequent urination, burning on urination, and elevated temperature so that treatment may begin promptly. Lowered blood pressure is not a complication of polycystic kidney disease, and it is an expected effect of antihypertensive therapy. The client would be concerned about increases in blood pressure because control of hypertension is essential. The client may experience heart failure as a result of hypertension, and thus any symptoms of heart failure, such as shortness of breath, are also a concern.

A client is diagnosed with epididymitis. The nurse checks the health care provider's prescriptions and expects that which measures will be prescribed? Select all that apply. 1. Sitz bath 2. Antibiotics 3. Scrotal elevation 4. Use of a heating pad 5. Bed rest with bathroom privileges

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

The nurse is caring for a client just after ureterolithotomy and is monitoring the drainage from the ureteral catheter hourly. Suddenly, the catheter stops draining. The nurse assesses the client and determines that which could be the cause of the problem? Select all that apply. 1. Blood clots 2. Mucous shreds 3. Ureteral edema 4. Chemical sediment 5. Catheter displacement

1,2,4,5 R: After ureterolithotomy, a ureteral catheter is put in place. Urine flows freely through it for the first 2 to 3 days. As ureteral edema diminishes, urine leaks around the ureteral catheter and drains directly into the bladder. At this point, drainage through the ureteral catheter diminishes. Immediately after surgery, absence of drainage usually is caused by blockage from blood clots, mucous shreds, chemical sediment, or catheter displacement.

A client diagnosed with chronic kidney disease (CKD) is scheduled to begin hemodialysis. The nurse determines that which neurological and psychosocial manifestations, if exhibited by this client, are related to the CKD? Select all that apply. 1. Agitation 2. Euphoria 3. Depression 4. Withdrawal 5. Labile emotions

1,3,4,5 R: "Clients with CKD may have labile emotions or personality changes and may exhibit withdrawal, depression, or agitation. Delusions and psychosis also can occur." Ok honestly who's gonna have Euphoria with dialysis and CKD

The nurse provides discharge instructions to a client after prostatectomy. What is the priority discharge instruction for this client? 1. Avoid driving a car for at least 1 week. 2. Increase fluid intake to at least 2.5 L/day. 3. Avoid lifting any objects greater than 30 pounds (13.6 kg). 4. Contact the health care provider (HCP) if small clots are noticed in the urine.

2 R: A daily intake of 2.5 L of fluid should be maintained to limit clot formation and prevent infection. Driving a car and sitting for long periods are restricted for at least 3 weeks. The client should be instructed to avoid lifting objects heavier than 20 pounds (9 kg) for at least 6 weeks. Passing small pieces of tissue or blood clots in the urine for up to 2 weeks after surgery is expected and does not necessitate contacting the HCP.

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 clinic nurse should ask which question first? 1. "Have you had any diarrhea?" 2. "Have you been constipated recently?" 3. "Have you had any abdominal discomfort?" 4. "Have you had an increased amount of flatulence?"

2 R: Reduced outflow from the dialysis catheter may be caused by the catheter position, infection, or constipation. Constipation may contribute to a reduced outflow because peristalsis seems to aid in drainage. Options 1, 3, and 4 are unrelated to the causes of reduced outflow from the dialysis catheter.

A client with benign prostatic hyperplasia undergoes a transurethral resection of the prostate. Postoperatively the client is receiving continuous bladder irrigations. The nurse assesses the client for manifestations of transurethral resection syndrome. Which assessment data would indicate the onset of this syndrome? 1. Tachycardia and diarrhea 2. Bradycardia and confusion 3. Increased urinary output and anemia 4. Decreased urinary output and bladder spasms

2 R: Transurethral resection 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.

The nurse is teaching a client with nephrotic syndrome about managing the disorder. What should the nurse instruct the client to adjust according to the amount of edema present? 1. Salt intake 2. Water intake 3. Activity level 4. Use of diuretics

3 R: The client is taught to adjust the activity level according to the amount of edema. As edema decreases, activity can increase. Correspondingly, as edema increases, the client should increase rest periods and limit activity. Bed rest is recommended during periods of severe edema. The client with nephrotic syndrome usually has a standard limit set on sodium intake. Fluids are not restricted unless the client also is hyponatremic. Diuretics are prescribed on a specific schedule, and doses are not titrated according to the level of edema.

Which client is most at risk for developing a Candida urinary tract infection (UTI)? 1. An obese woman 2. A man with diabetes insipidus 3. A young woman on antibiotic therapy 4. A male paraplegic on intermittent catheterization

3 R: Women are more likely to get UTIs, so eliminate 2&4. Taking antibiotics will reduce natural flora, so option 3 is most correct.

A client with epididymitis is upset about the extent of scrotal edema. Attempts to reassure the client that this condition is temporary have not been effective. The nurse should plan to address which client problem? 1. Pain related to fluid accumulation in the scrotum 2. Uneasiness related to inability to reduce scrotal swelling 3. Guilt related to the possibility of sterility secondary to scrotal swelling 4. Altered body appearance related to change in the appearance of the scrotum

4

The nurse has given instructions about Kegel exercises to a female client with a cystocele. The nurse determines that the client needs further instruction if she makes which statement? 1. "I should stop and start my stream of urine during a voiding." 2. "I should tighten my perineal muscles for up to 10 seconds several times a day." 3. "I should tighten my perineal muscles for up to 5 minutes 3 or 4 times a day." 4. "I should begin voiding and then stop the stream, holding residual urine for an hour."

4

A client with severe back pain and hematuria is found to have hydronephrosis due to urolithiasis. The nurse anticipates which treatment will be done to relieve the obstruction? Select all that apply. 1. Peritoneal dialysis 2. Analysis of the urinary stone 3. Intravenous opioid analgesics 4. Insertion of a nephrostomy tube 5. Placement of a ureteral stent with ureteroscopy

4, 5 R: "Urolithiasis is the condition that occurs when a stone forms in the urinary system. Hydronephrosis develops when the stone has blocked the ureter and urine backs up and dilates and damages the kidney. Priority treatment is to allow the urine to drain and relieve the obstruction in the ureter. This is accomplished by placement of a percutaneous nephrostomy tube to drain urine from the kidney and placement of a ureteral stent to keep the ureter open. Peritoneal dialysis is not needed since the kidney is functioning. Stone analysis will be done later when the stone has been retrieved and analyzed. Opioid analgesics are necessary for pain relief but do not treat the obstruction."

The nurse is assessing the renal function of a client at risk for acute kidney injury. After noting the amount of urine output and urine characteristics, the nurse proceeds to assess which as the best indirect indicator of renal status? 1. Blood pressure 2. Apical heart rate 3. Jugular vein distention 4. Level of consciousness

1 R: The kidneys normally receive 20% to 25% of the cardiac output, even under conditions of rest. For kidney function to be optimal, adequate renal perfusion is necessary. Perfusion can best be estimated by the blood pressure, which is an indirect reflection of the adequacy of cardiac output. The heart rate affects the cardiac output but can be altered by factors unrelated to kidney function. Jugular vein distention and level of consciousness are unrelated items.

A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all that apply. 1. Place the client on a cardiac monitor. 2. Notify the health care provider (HCP). 3. Put the client on NPO (nothing by mouth) status except for ice chips. 4. Review the client's medications to determine if any contain or retain potassium. 5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.

1, 2, 4 R: NPO is unnecessary. Adding extra fluid may worsen the situation and lead to fluid overload. Excess K can cause heart dysrhythmias, so 1&4 are appropriate. Calling the HCP is also necessary for further orders.

A client has been diagnosed with polycystic kidney disease. On assessment of the client, the nurse should observe for which most common manifestation of this disorder? 1. Headache 2. Hypotension 3. Flank pain and hematuria 4. Complaints of low pelvic pain

3 R: remember that kidney=flank. The most common findings with polycystic kidney disease are hematuria and flank or lumbar pain that is either colicky in nature or dull and aching. Other common findings include proteinuria, calculi, uremia, and palpable kidney masses. Hypertension is another common finding and may be associated with cardiomegaly and heart failure.

The nurse is caring for a client immediately after nephrectomy and renal transplantation. What is the most appropriate datum to use in planning administration of intravenous fluids to this client? 1. A strict hourly rate of 100 mL 2. A strict hourly rate of 150 mL 3. One half of the previous hour's urine output 4. The number of milliliters in the previous hour's urine output

4 R: Intravenous fluids are managed very carefully after nephrectomy and renal transplantation. Fluids are usually given according to a formula that takes into account the previous hour's urine output. The desired urine output is generally high; therefore, options 1, 2, and 3 are incorrect.

The nurse is providing instructions regarding the complications of peritoneal dialysis. The nurse emphasizes that onset of peritonitis, a serious complication, is most likely to be associated with which clinical manifestation? 1. Fever 2. Fatigue 3. Clear dialysate output 4. Leaking around the catheter site

1 R: -itis= inflammation/infection, which usually is accompanied by a fever

A client has chronic kidney disease (CKD) that does yet not require dialysis. Which client statement indicates the need for further teaching? 1. "I will reduce the sodium in my diet, and I can use salt substitutes to spice my food." 2. "The amount of fluid I can have every day depends on the amount of urine I put out." 3. "I will weigh myself on my bathroom scale every morning right after I have urinated." 4. "I should report a gain in weight, trouble with my breathing, or increased leg swelling."

1 R: CKD is a condition in which the kidneys have progressive problems in their ability to clear nitrogenous waste products and control fluid and electrolyte balance within the body. Conservative treatment of CKD slows progression of the disease and includes reducing the protein, sodium, potassium, and phosphorus in the diet and controlling the blood pressure. It is important to reduce the sodium in the diet. Salt substitutes usually are potassium-based and should not be used by a client with CKD because of the risk of hyperkalemia. The client should alter the fluid intake in relation to urine output. Obtaining a daily weight is an important measurement that indicates fluid volume. The client should also monitor for signs and symptoms of fluid overload, which could include an increase in weight, edema, and fluid collection in the lungs.

The client with chronic kidney disease has an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter dressing while bathing. Which action should the nurse immediately take? 1. Change the dressing. 2. Reinforce the dressing. 3. Flush the peritoneal dialysis catheter. 4. Scrub the catheter with povidone-iodine.

1 R: Clients with peritoneal dialysis catheters are at high risk for infection. A wet dressing is a conduit for bacteria to reach the catheter insertion site. The nurse ensures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnection of peritoneal dialysis.

Which finding noted in the client on continuous ambulatory peritoneal dialysis (CAPD) should be reported to the health care provider (HCP)? 1. Cloudy yellow dialysate output 2. Client refusal to take the stool softener 3. Previous evening's dwell time of 8 hours 4. Peritoneal catheter site is not red, and the skin has grown around the cuff

1 R: Cloudy = peritonitis

The nurse is caring for a client who has just returned from having a cystoscopy. The nurse should recognize which as an abnormal assessment finding for this client? 1. The nurse notes bright red urine output. 2. The nurse notes pink-tinged urine output. 3. The client reports having urinary frequency. 4. The client complains of burning when urinating.

1 R: Eliminate options 2, 3, and 4 because pink-tinged urine, urinary frequency, and burning with urination are normal findings after a cystoscopy.

Before providing care for a client in the late stages of chronic kidney disease (CKD), the nurse should review the results of which most relevant laboratory studies? 1. Serum potassium, serum calcium 2. Urinalysis, hematocrit, hemoglobin 3. Culture and sensitivity testing, serum sodium 4. Urine specific gravity, intravenous pyelogram

1 R: Hyperkalemia & hypocalcemia are both life-threatening complications. All the other options may not be entirely relevant.

The nurse is preparing to care for a client receiving peritoneal dialysis. Which should be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? 1. Maintain strict aseptic technique. 2. Add heparin to the dialysate solution. 3. Change the catheter site dressing daily. 4. Monitor the client's level of consciousness.

1 R: main risk is infection/peritonitis, which is reduced by maintaining aseptic technique.

The nurse provides home care instructions to a client undergoing hemodialysis with regard to care of a newly created arteriovenous (AV) fistula. Which client statement indicates that teaching was effective? 1. "I should check the fistula every day by feeling it for a vibration." 2. "I am glad that the laboratory will be able to draw my blood from the fistula." 3. "I should wear a shirt with tight arms to provide some compression on the fistula." 4. "I should check my blood pressure in the arm where I have my fistula every week."

1 R: option 1 checks for thrills/bruits which=patent fistula. All other options are inappropriate for a new AV fistula, or contraindicated completely.

The nurse discusses plans for future treatment options with a client with symptomatic polycystic kidney disease. Which treatment should be included in this discussion? Select all that apply. 1. Hemodialysis 2. Peritoneal dialysis 3. Kidney transplant 4. Bilateral nephrectomy 5. Intense immunosuppression therapy

1,3,4 R: Polycystic KD involves cysts that eventually rupture and damage the kidneys, leading to end-stage renal disease. This requires options 1, 3, or 4. 2 is contraindicated r/t infection. 5 won't help the pt's condition.

The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. Palpation of a thrill over the fistula 2. Presence of a radial pulse in the left wrist 3. Visualization of enlarged blood vessels at the fistula site 4. Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand

1. R: listen for a thrill or bruit over AV fistula site. All other options don't REALLY show if the AV fistula is patent, just that there's perfusion to the hand.

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

2 R: DM can cause renal complications. 1,3,&4 are irrelevant.

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 R: Patients with DM may req an increase in insulin w/ peritoneal dialysis bc there's an increased amount of time for glucose to absorb. Option 1 is r/t improper aseptic technique. 3 is just r/t renal imbalance. 4 is only with HEMOdialysis, not peritoneal.

The client diagnosed with benign prostatic hyperplasia (BPH) is scheduled for a transrectal ultrasound examination and a test to measure the level of prostate-specific antigen (PSA). The client says to the nurse, "I can't remember . . . can you tell me again why I need these tests to be done?" The nurse responds, knowing that these tests are done for which purpose? 1. Specifically to predict the course of BPH 2. Help to rule out the possibility of cancer 3. Pinpoint the likelihood of developing urinary obstruction 4. Give an indication of whether intermittent self-catheterization is needed

2 R: Recall that these diagnostic tests do not specifically predict the course of a disease, the likelihood of developing complications (such as obstruction), or whether self-catheterization is needed.

The nurse checks the serum myoglobin level for a client with a crush injury to the right lower leg because the client is at risk for developing which type of acute kidney injury? 1. Prerenal 2. Intrarenal 3. Postrenal 4. Extrarenal

2 R: Serum myoglobin levels increase in crush injuries when large amounts of myoglobin and hemoglobin are released from damaged muscle and blood cells. The accumulation may cause acute tubular necrosis, an intrarenal cause of renal failure. Prerenal causes are conditions that interfere with the perfusion of blood to the kidney. Postrenal causes include conditions that cause urinary obstruction distal to the kidney. The cause and the type of renal failure may determine the interventions used in treatment.

A client is being evaluated as a potential kidney donor for a family member. The client asks the nurse why separate teams are evaluating donor and recipient. What is the most appropriate response by the nurse? 1. Helps reduce the cost of the preoperative workup 2. Saves the client and the recipient valuable preoperative time 3. Avoids a conflict of interest between the team evaluating the recipient and the team evaluating the donor 4. Provides for a sufficient number of persons reviewing the case so that no information is overlooked

3

The nurse is creating a plan of care for a client with chronic kidney disease and uremia. The nurse is developing interventions to assist in promoting an increased dietary intake while at the same time maintaining necessary dietary restrictions. Which action should the nurse include in the plan of care? 1. Increase the amount of protein in the diet. 2. Increase the amount of potassium in the daily diet. 3. Maintain a diet high in calories with frequent snacks. 4. Encourage the client to eat a large breakfast and smaller meals later in the day.

3

A client with prostatitis following kidney infection has received instructions on management of the condition at home and prevention of recurrence. The nurse determines that education was effective if the client makes which statement? 1. "I will stop antibiotic therapy when pain subsides." 2. "I will exercise as much as possible to stimulate circulation." 3. "I should use warm tub baths and analgesics to increase comfort." 4. "I will keep fluid intake to a minimum to decrease the need to void."

3 R: Eliminate option 1 because stopping medication therapy before the end of the course is contraindicated. Also eliminate option 4, keeping fluid intake to a minimum, because fluid intake should be increased. From the remaining choices, recall that analgesics and warm tub baths provide comfort and that rest is helpful in the healing process.

A client is being discharged to home while recovering from acute kidney injury (AKI). Reduced dietary intake of which substance indicates to the nurse that the client understands the dietary teaching? 1. Fats 2. Vitamins 3. Potassium 4. Carbohydrates

3 R: The excretion of potassium and maintenance of potassium balance are normal functions of the kidneys. In the client with AKI or chronic kidney disease, potassium intake must be restricted as much as possible (to 60 to 70 mEq/day). The primary mechanism of potassium removal during AKI is dialysis. Vitamins, carbohydrates, and fats are not normally restricted in the client with AKI unless a secondary health problem warrants the need to do so. The amount of fluid permitted is generally calculated to be equal to the urine volume plus the insensible loss volume of 500 mL.

The nurse measures the cardiac output of a client and finds it to be 6 L/min. Which amount of kidney perfusion should the nurse anticipate? 1. 100 to 300 mL/min 2. 500 to 1000 mL/min 3. 1200 to 1500 mL/min 4. 2000 to 2500 mL/min

3 R: The kidneys normally receive about 20% to 25% of the cardiac output when the client is at rest. If the cardiac output is 6 L/min, the kidneys receive 1.2 to 1.5 L/min, which is equal to 1200 to 1500 mL/min.

The nurse is caring for a client whose urine output was 25 mL per hour for 2 consecutive hours. The nurse reviews the health care provider's prescriptions and plans care, knowing that which client-related factor would increase the amount of blood flow to the kidneys? 1. Physiological stress 2. Release of norepinephrine 3. Release of low levels of dopamine 4. Sympathetic nervous system stimulation

3 R: The release of low levels of dopamine exerts a vasodilating effect on the renal arteries, increasing urinary output. The other options cause renal vasoconstriction.

The registered nurse is instructing a new nursing graduate about hemodialysis. Which statement made by the new nursing graduate indicates an understanding of the procedure for hemodialysis? Select all that apply. 1. "Sterile dialysate must be used." 2. "Dialysate contains metabolic waste products." 3. "Heparin sodium is administered during dialysis." 4. "Dialysis cleanses the blood of accumulated waste products." 5. "Warming the dialysate increases the efficiency of diffusion."

3, 4, 5 R: "Heparin sodium is used during dialysis, and it inhibits the tendency of blood to clot when it comes in contact with foreign substances. Option 4 is the purpose of dialysis. The dialysate is warmed to approximately 100°F to increase the efficiency of diffusion and to prevent a decrease in the client's blood temperature. Dialysate is made from clear water and chemicals and is free from any metabolic waste products or medications. Bacteria and other microorganisms are too large to pass through the membrane; therefore, the dialysate does not need to be sterile."

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action? 1. Monitor the client. 2. Elevate the head of the bed. 3. Assess the fistula site and dressing. 4. Notify the health care provider (HCP).

4 R: "Disequilibrium syndrome may be caused by rapid removal of solutes from the body during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs and symptoms of disequilibrium syndrome and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The HCP must be notified. Monitoring the client, elevating the head of the bed, and assessing the fistula site are correct actions, but the priority action is to notify the HCP."

A client with chronic kidney disease (CKD) 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 presents with mental cloudiness, dementia, and complaints of bone pain. The nurse determines that these assessment data are compatible with which condition? 1. Advancing uremia 2. Phosphate overdose 3. Folic acid deficiency 4. Aluminum intoxication

4 R: Aluminum toxicity involves mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. It can 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.

The nurse is analyzing the posthemodialysis laboratory test results for a client with chronic kidney disease. The nurse interprets that the dialysis is having an expected but nontherapeutic effect if which value is decreased? 1. Potassium 2. Creatinine 3. Phosphorus 4. Red blood cell (RBC) count

4 R: Anemia occurs bc RBCs are lost during the dialysis process (sampling, residual blood in dialyzer, etc). Dialysis also lowers 1,2, and 3 but those are therapeutic & expected findings.

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? 1. Hypertension, tachycardia, and fever 2. Hypotension, bradycardia, and hypothermia 3. Restlessness, irritability, and generalized weakness 4. Headache, deteriorating level of consciousness, and twitching

4 R: Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. This is common in pt new to dialysis.

A client has urinary calculi composed of uric acid. The nurse is teaching the client dietary measures to prevent further development of uric acid calculi. The nurse should inform the client that it is acceptable to consume which item? 1. Steak 2. Shrimp 3. Chicken liver 4. Cottage cheese

4 R: With a uric acid stone, the client should limit intake of foods high in purines. Organ meats, sardines, herring, and other high-purine foods are eliminated from the diet. Intake of foods with moderate levels of purines, such as red and white meats and some seafood, also is limited. Avoiding the consumption of milk and dairy products is a recommended dietary change for calculi composed of calcium stones but is acceptable for the client with a uric acid stone.

A client undergoing hemodialysis is at risk for bleeding from the heparin used during the hemodialysis treatment. The nurse assesses for this occurrence by periodically checking the results of which laboratory test? 1. Bleeding time 2. Thrombin time 3. Prothrombin time (PT) 4. Partial thromboplastin time (PTT)

4 R: aPTT/PTT = heparin, PT/INR=warfarin

A client experiencing end-stage kidney disease has an arteriovenous (AV) fistula placed surgically for hemodialysis. Which action is most appropriate for the nurse to document in the plan for care of the AV fistula? 1. Palpate the bruit of the AV fistula weekly to assess for thrombosis. 2. Use the AV fistula site for blood draws to prevent increased pain of multiple blood draws. 3. Take the blood pressure readings in the extremity with the AV fistula to get a more accurate reading. 4. Teach the client to avoid carrying heavy objects that would compress the AV fistula and cause thrombosis.

4 R: all other options are contraindicated

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 that he or she will take which action? 1. Use latex condoms to prevent disease transmission. 2. Return to the clinic as requested for follow-up culture in 1 week. 3. Reduce the chance of reinfection by limiting the number of sexual partners. 4. Take an antibiotic so as to prophylactically prevent symptoms of Chlamydia.

4 R: don't take antibiotics prophylactically or you're in for a bad time

The nurse is caring for a client with acute kidney injury (AKI). The nurse should test the client's urine for proteinuria to determine which type of AKI? 1. Prerenal 2. Intrinsic 3. Atypical 4. Postrenal

2 R: Option 3 doesn't exist so it's incorrect. Remember that proteinuria occurs when the basement membrane of the glomerulus leaks, which is not prerenal (1) or postrenal (4).

The nurse instructs a client about continuous ambulatory peritoneal dialysis (CAPD). Which statement by the client indicates an accurate understanding of CAPD? 1. "No machinery is involved, and I can pursue my usual activities." 2. "A cycling machine is used, so the risk for infection is minimized." 3. "The drainage system can be used once during the day and a cycling machine for 3 cycles at night." 4. "A portable hemodialysis machine is used so that I will be able to ambulate during the treatment."

1 R: CAPD closely approximates normal renal function, and the client will need to infuse and drain the dialysis solution several times a day. No machinery is used, and CAPD is a manual procedure.

The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptom of benign prostatic hyperplasia? 1. Nocturia 2. Scrotal edema 3. Occasional constipation 4. Decreased force in the stream of urine

4 R: Option 1 is a later sign. 2&3 are irrelevant to BPH.

A client with a bladder injury has had surgical repair of the injured area with placement of a suprapubic catheter. Which is the most appropriate nursing action to prevent complications of this procedure? 1. Monitor urine output once per shift. 2. Measure specific gravity once per shift. 3. Encourage an excessive intake of oral fluids. 4. Ensure that the catheter tubing is not kinked.

4 R: The word "excessive" should eliminate option 3. Options 1&2 don't relate to surgical complications.

The nurse is reviewing a client's record and notes that the health care provider has documented that the client has chronic renal disease. On review of the laboratory results, the nurse most likely would expect to note which finding? 1. Elevated creatinine level 2. Decreased hemoglobin level 3. Decreased red blood cell count 4. Increased number of white blood cells in the urine

1 R: Creat is increased only by kidney dysfunction of at least 50% loss. 2&3 are irrelevant. 4 is more involved w/ UTIs.

The nurse has provided dietary instructions to a client with renal calculi who must learn about the foods that yield an alkaline residue in the urine. The nurse determines that education was effective if the client chooses which selections from a diet menu? 1. Spinach salad, milk, and a banana 2. Chicken, potatoes, and cranberries 3. Peanut butter sandwich, milk, and prunes 4. Linguini with shrimp, tossed salad, and a plum

1 R: In some client situations, the health care provider may prescribe a diet that consists of foods that yield either an alkaline or an acid residue in the urine. In an alkaline residue diet, all fruits are allowed except cranberries, blueberries, prunes, and plums. Options, 2, 3 and 4 represent an acid residue diet.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 1. Check the level of the drainage bag. 2. Reposition the client to his or her side. 3. Contact the health care provider (HCP). 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.

1,2,4,5 R: Try to fix the flow yourself before calling the HCP or messing with the flow rate. Imbalance may be r/t a kink or improper positioning so fix those first.

A cystectomy is performed for a client with a diagnosis of bladder cancer, and a Kock pouch is created for urinary diversion. In creating a discharge teaching plan for the client, the nurse should include which instruction in the plan? 1. Dietary restrictions 2. Technique of catheterization 3. External pouch and application care 4. Proper administration of prophylactic antibiotics

2 R: A Kock pouch is a continent internal ileal reservoir. The nurse instructs the client about the technique of catheterization. Dietary restrictions are not required. There is no external pouch. Antibiotics are not required unless an infection is present; also, antibiotics are prescribed by the health care provider.

The nurse is providing instructions to a client who is scheduled for cystoscopy and possible biopsy under general anesthesia. Which information should the nurse include? 1. The procedure will take about 4 hours. 2. Intravenous fluids may be started on the day of the procedure. 3. Preprocedure sedatives are never administered with general anesthesia. 4. Only a full liquid breakfast may be allowed on the day of the procedure.

2 R: Client preparation for cystoscopy and possible biopsy includes informing the client that intravenous fluids will be started the day of the procedure to ensure adequate hydration and flow of urine. The procedure will take approximately 30 minutes to 1 hour. An informed consent is obtained from the client, and preprocedure sedatives are administered as prescribed. If a general anesthetic is to be used, the client is told that fasting is necessary after midnight before the procedure.

The nurse caring for a client immediately after transurethral resection of the prostate (TURP) notices that the client has suddenly become confused and disoriented. Which is the priority nursing action for this client? 1. Reorient the client. 2. Notify the health care provider (HCP). 3. Ensure that a clock and calendar are in the room. 4. Increase the flow rate of the intravenous infusion.

2 R: Confusion and disorientation can be a sign of hyponatremia r/t the use of a hypotonic flushing solution during the procedure that is absorbed via prostate veins, which then enters the circulation.

The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination? 1. Fever, diarrhea, groin pain, and ecchymosis 2. Nausea, painful scrotal edema, and ecchymosis 3. Fever, nausea, vomiting, and painful scrotal edema 4. Diarrhea, groin pain, testicular torsion, and scrotal edema

3 R: -itis is associated w/ fever, so you can narrow it down to 1&3. Epididymitis does not involve bleeding so ecchymosis (option 1) is irrelevant. Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are accompanied by fever, nausea and vomiting, and chills.

The nurse is assessing a client who has returned from the postanesthesia care unit after transurethral resection of the prostate (TURP). The nurse should assess for which color in the urinary drainage tubing that indicates proper irrigation and adequate functioning of the device? 1. Pale pink 2. Dark pink 3. Bright red 4. Red with clots

1 R: If the bladder irrigation solution is infusing at a sufficient rate, the urinary drainage will be pale pink. A dark pink color (sometimes referred to as punch-colored) indicates that the speed of the irrigation should be increased. Bright red bleeding and red urine with clots should be reported to the surgeon because either finding could indicate complications.

The nurse is preparing to teach ostomy care to a client who has just had a urinary diversion; the client expresses concern about body appearance. Which client action indicates that the best initial positive adaptation is being made? 1. Agrees to look at the ostomy 2. Asks to defer ostomy care to the spouse 3. Asks to wait 1 more day before beginning to learn ostomy care 4. States that ostomy care is the nurse's job while the client is in the hospital

1 R: Only option 1 actually involves the patient being actively involved in their condition.

A client is admitted to the emergency department following a fall from a horse and the health care provider (HCP) prescribes insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? 1. Notify the HCP before performing the catheterization. 2. Use a small-sized catheter and an anesthetic gel as a lubricant. 3. Administer parenteral pain medication before inserting the catheter. 4. Clean the meatus with soap and water before opening the catheterization kit.

1 R: blood may = urethral trauma, so you need to notify the HCP first so you can identify the true cause of blood before catheterization. Since there's blood from an unknown cause, you need to assess first before doing anything that can worsen it.

A client with end-stage renal disease (ESRD) has the problem of ineffective coping. Which nursing interventions are appropriate in working with this client? Select all that apply. 1. Acknowledge the client's feelings. 2. Assess the client and family's coping patterns. 3. Explore the meaning of the illness with the client. 4. Set limits on mood swings and expressions of hostility. 5. Give the client information when the client is ready to listen.

1,2,3,5 R: Everything is correct except for 4, because setting limits is non-therapeutic I guess

The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, indicates an adequate understanding of the treatment plan for this client? 1. Prevent fluid overload. 2. Prevent loss of electrolytes. 3. Promote the excretion of wastes. 4. Reduce the urine specific gravity.

2 R: In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring. Options 1, 3, and 4 are not the primary concerns in this phase of AKI.

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 38.5°C (101.2°F). Which nursing action is most appropriate? 1. Encourage fluid intake. 2. Notify the health care provider. 3. Continue to monitor vital signs. 4. Monitor the site of the shunt for infection.

2 R: Options 3&4 involve assessment, which is normally good but not for a priority situation like this so they're incorrect (you'll just watch the pt deteriorate lol). You know that dialysis patients have fluid restrictions, so option 2 is the best choice since the HCP can order further & treatment.

A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which condition? 1. Pyelonephritis 2. Glomerulonephritis 3. Trauma to the bladder or abdomen 4. Renal cancer in the client's family

3 R: 1& 2 are similar/alike, and they would involve a fever. 4 would have flank pain instead of low abd pain.

The nurse is admitting a client from the postanesthesia care unit who has had percutaneous nephrolithotomy for calculi in the renal pelvis. The nurse anticipates that the client's care will most likely involve monitoring which device? 1. Ureteral stent 2. Suprapubic tube 3. Nephrostomy tube 4. Jackson-Pratt drain

3 R: A nephrostomy tube is put in place after percutaneous nephrolithotomy for calculi in the renal pelvis. The client also may have a Foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect elimination of the calculous fragments. Options 1, 2, and 4 are incorrect.

The nurse is providing dietary instructions to a client with an oxalate kidney stone. The nurse should instruct the client to avoid which food? 1. Breads 2. Poultry 3. Chocolate 4. Prune juice

3 R: Clients with oxalate stones should avoid foods high in oxalate, such as tea, instant coffee, cola drinks, beer, rhubarb, beans, asparagus, spinach, cabbage, chocolate, citrus fruits, apples, grapes, cranberries, and peanuts and peanut butter. Large doses of vitamin C may help increase oxalate excretion in the urine.

The nurse is planning a teaching session with a client who has chronic kidney disease (CKD) about managing the condition between dialysis treatments. The nurse should plan to include the instruction that weight gain between dialysis treatments should be ideally what value? 1. 11 to 13 lbs (5 to 6 kg) 2. 4.5 to 9 lbs (2 to 4 kg) 3. 2 to 3 lbs (1 to 1.5 kg) 4. 1 to 2 lbs (0.5 to 1.0 kg)

3 R: It may be helpful in answering this question to recall that 1 L of fluid weighs approximately 1 kg. Recalling that there is approximately 6 L of blood circulating in the body will help you eliminate options 1 and 2 as both being too large of a weight gain. Similarly, option 4 is eliminated because it is too small, representing only 500 to 1000 mL of fluid.

A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the prostate examination for which characteristic of this disorder? 1. Soft and swollen prostate gland 2. Swollen, and boggy prostate gland 3. Tender and edematous prostate gland 4. Tender, indurated prostate gland that is warm to the touch

4 R: The client with bacterial prostatitis has a swollen and tender prostate gland that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection, which often accompany the disorder. *Remember, -itis= inflammation/infection, so tenderness and local warmth is expected. so option 4 is most correct.

A client being discharged home after renal transplantation has a risk for infection related to immunosuppressive medication therapy. The nurse determines that the client needs further teaching on measures to prevent and control infection if the client states that it is necessary to take which action? 1. Take an oral temperature daily. 2. Use good hand-washing technique. 3. Take all scheduled medications exactly as prescribed. 4. Monitor urine character and output at least 1 day each week.

4 R: They need to assess urine at least 1x/day, not weekly.

A client has been diagnosed with pyelonephritis. The nurse interprets that which health problem has placed the client at risk for this disorder? 1. Diabetes mellitus 2. Orthostatic hypotension 3. Coronary artery disease 4. Intravenous (IV) contrast medium

1 R: Pyelonephritis is most commonly caused by entry of bacteria, obstruction, or reflux. Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, overuse of analgesics, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.

The nurse is monitoring the urine output of a client with low serum protein level and urinary output less than 30 mL in the last hour. Based on these data, the nurse understands that low urinary output is caused by which force within the kidneys? 1. Oncotic pressure 2. Osmotic pressure 3. Filtration pressure 4. Hydrostatic pressure

1 R: The pulling pressure within the capillaries that is exerted by the plasma proteins is referred to as the oncotic pressure. Osmotic pressure is the movement of water along a pressure gradient. Filtration pressure is the pressure that is exerted with ultrafiltration, in which the pressure within the capillaries is greater than the pressure outside them; this results in fluids being pushed across the membrane into Bowman's capsule. Hydrostatic pressure in the capillaries allows fluid to be filtered out of the blood in the glomerulus.

A client tells the nurse about a pattern of a strong urge to void, followed by incontinence before the client can get to the bathroom. Based on the data provided, which condition should the nurse suspect? 1. Urge incontinence 2. Total incontinence 3. Stress incontinence 4. Reflex incontinence

1 R: Urge incontinence occurs when the client experiences involuntary loss of urine soon after experiencing urgency. Total incontinence occurs when loss of urine is unpredictable and continuous. Stress incontinence occurs when the client voids in increments of less than 50 mL under conditions of increased abdominal pressure. Reflex incontinence occurs at rather predictable times that correspond to when a certain bladder volume is attained.

The nurse has performed a nutritional assessment on a client with cystitis. The nurse should tell the client to consume which beverage to minimize recurrence of cystitis? 1. Tea 2. Water 3. Coffee 4. White wine

2 R: Water helps flush bacteria out of the bladder, and an intake of 6 to 8 glasses per day is encouraged. Caffeine and alcohol can irritate the bladder. Therefore, alcohol- and caffeine-containing beverages such as coffee, tea, and wine are avoided to minimize risk.

A client with uric acid calculi is placed on a low-purine diet. The nurse instructs the client to restrict the intake of which food? 1. Fish 2. Plum juice 3. Fruit juice 4. Cranberries

1 R: Clients who form uric acid calculi should be placed on a low-purine diet. Their intake of fish and meats (especially organ meats) should be restricted. Dietary modifications also may help adjust urinary pH so that stone formation is inhibited. Depending on health care provider prescription, the urine may be alkalinized by increasing the intake of bicarbonates or acidified by drinking cranberry, plum, or prune juice.

A client with renal cancer is being treated preoperatively with radiation therapy. What statement by the client demonstrates understanding of proper care of the skin over the treatment field? 1. "I need to avoid skin exposure to direct sunlight and chlorinated water." 2. "I need to use lanolin-based cream on the affected skin on a daily basis." 3. "I need to use the hottest water possible to wash the treatment site twice daily." 4. "I need to remove the lines or ink marks using a gentle soap after each treatment."

1 R: no lotion/alcohol/deodorant or hot water, just cool/warm water and mild soap. Don't remove the ink marks bc that's what indicates where to place radiation. So basically protect the skin from extreme things (temp, sunlight, chlorine, etc.)

A client is about to begin hemodialysis. Which measures should the nurse employ in the care of the client? Select all that apply. 1. Using sterile technique for needle insertion 2. Using standard precautions in the care of the client 3. Giving the client a mask to wear during connection to the machine 4. Wearing full protective clothing such as goggles, mask, gloves, and apron 5. Covering the connection site with a bath blanket to enhance extremity warmth

1, 2, 3, 4 R: Infection is a major concern with hemodialysis. For that reason, the use of sterile technique and the application of a face mask for both nurse and client are extremely important. It also is imperative that standard precautions be followed, which includes the use of goggles, mask, gloves, and apron. The connection site should not be covered; it should be visible so that the nurse can assess for bleeding, ischemia, and infection at the site during the hemodialysis procedure.

The nurse is performing assessment on a client with acute kidney injury who is in the oliguric phase. Which should the nurse expect to note? Select all that apply. 1. Increased serum creatinine level 2. A low and fixed specific gravity 3. Increased blood urea nitrogen (BUN) level 4. A urine output of 600 to 800 mL in a 24-hour period 5. Urine osmolarity of approximately 300 mOsm/kg (300 mmol/kg)

1,2,3,5 R: During the oliguric phase of acute kidney injury, serum creatinine levels increase by approximately 1 mg/dL (88 mcmol/L) per day, and the BUN level increases by approximately 20 mg/dL (7.1 mmol/L) per day. The specific gravity of the urine is low and fixed, and the urine osmolarity approaches that of the client's serum level, or about 300 mOsm/kg (300 mmol/kg). Urine output is less than 100 mL in a 24-hour period.

The nurse is participating in a prostate screening clinic for men. Which complaints by a client are associated with prostatism? Select all that apply. 1. Inability to stop urinating 2. Postvoid dribbling of urine 3. Increased episodes of nocturia 4. Unusual force in urinary stream 5. Hesitancy on initiating the urinary stream

1,2,3,5 R: Signs and symptoms of prostatism include reduced force and size of urinary stream, intermittent stream, hesitancy in beginning the flow of urine, inability to stop urinating, a sensation of incomplete bladder emptying after voiding, postvoid dribbling of urine, and an increase in episodes of nocturia. These signs and symptoms are the result of pressure of the enlarging prostate on the client's urethra.

The nurse is caring for a client with acute kidney injury (AKI) experiencing metabolic acidosis. When performing an assessment, the nurse should expect to note which breathing pattern? 1. Apnea 2. Kussmaul respirations 3. Decreased respirations 4. Cheyne-Stokes respirations

2 R: The nurse would expect to note Kussmaul respirations as a result of the metabolic acidosis because the bodily response is to exhale excess carbon dioxide. The breathing patterns noted in options 1, 3, and 4 are not characteristic of AKI.

The nurse is monitoring the fluid balance of an assigned client. The nurse determines that the client has proper fluid balance if which 24-hour intake and output totals are noted? 1. Intake 1500 mL, output 800 mL 2. Intake 3000 mL, output 2000 mL 3. Intake 2400 mL, output 2900 mL 4. Intake 1800 mL, output 1750 mL

4 R: For the client on a normal diet, the normal fluid intake is approximately 1200 to 1800 mL of measurable fluids per day. The client's output in the same period should be about the same and does not include insensible losses, which are extra. Insensible losses are offset by the fluid in solid foods, which also is not measured. (Honestly just choose the one where the I&Os are most balanced)

A client who is to have a cystectomy with creation of an ileal conduit asks the nurse why the bowel needs to be cleansed before surgery if the bladder is being removed. Which response by the nurse is the most appropriate? 1. "All clients undergo bowel preparation with major surgery." 2. "This will decrease the chance of postoperative paralytic ileus." 3. "A portion of the bowel will be used to create the conduit for urinary diversion." 4. "This will reduce the chance that the surgeon will nick the bowel during surgery."

3 R: Cleansing the bowel is required bc part of the bowel is used for the resection, so it needs to be as clean as possible to prevent infection.

A client is scheduled for surgical creation of an internal arteriovenous (AV) fistula on the following day. The client says to the nurse, "I'll be so happy when the fistula is made tomorrow. This means I can have that other hemodialysis catheter pulled right out." Which interpretation should the nurse make based on the client's statement? 1. The client has an accurate understanding of the procedure and aftercare. 2. The client does not realize how painful removal of the dialysis catheter will be. 3. The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use. 4. The client is not aware that the alternative access site is left in place prophylactically for 2 months.

3 R: Fistulas take 1 to 2 weeks to mature (engorgement) or develop before they can be used for dialysis, so the current method of access must remain in place to be used during that period. Options 1, 2, and 4 are incorrect interpretations of the client's statement.

The nurse is teaching a client with renal cancer who is scheduled for a renal artery embolization about the procedure. Which statement by the client indicates that the educational session was effective? 1. "This will reduce the time needed for surgery by at least half because it provides hemostasis." 2. "This will cause the tumor to become tougher and easier to resect in surgery with the scalpel." 3. "This will prevent the risk of pulmonary embolism by occluding the renal artery and its branches." 4. "This will decrease the size of the tumor because its blood supply will be removed after placement of an absorbable gelatin sponge."

4 R: Renal artery embolization may be done instead of radiation therapy to shrink the kidney tumor by cutting off its blood supply and impairing its overall vascularity. A secondary benefit is that it reduces the risk of hemorrhage during surgery. This procedure can be accomplished in a number of ways, including placement of an absorbable gelatin sponge, a balloon, a metal coil, or any of various other substances.

A client with chronic kidney disease (CKD) is prescribed aluminum hydroxide. Which information should the nurse include while instructing the client regarding the action of this medication? 1. It prevents ulcers. 2. It prevents constipation. 3. It promotes the elimination of potassium from the body. 4. It combines with phosphorus and helps eliminate phosphates from the body.

4 R: "Aluminum hydroxide may be prescribed for a client with CKD. It binds with phosphate in the intestines for excretion in the feces, thus lowering phosphorus levels. It can cause constipation, and it does not promote the elimination of potassium. It may be used in the treatment of hyperacidity associated with gastric ulcers, but this is not the purpose of its use in the client with renal failure."

The nurse has provided instructions regarding home care measures for a client with acute pyelonephritis. Which statement by the client indicates a need for further teaching? 1. "I should try to maintain an acid ash diet." 2. "I should increase my fluid intake to 3 L per day." 3. "I should take my daily dose of vitamin C to acidify the urine." 4. "I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day."

4 R: Clients with acute pyelonephritis should be instructed to try to maintain an acid ash diet, which may be of some benefit. Also, they should increase fluid intake to 3 L per day; this helps relieve dysuria and flushes bacteria out of the bladder. However, for clients with chronic pyelonephritis and renal dysfunction, an increase in fluid intake may be contraindicated. Medications such as vitamin C help acidify the urine. Juices such as cranberry, plum, and prune juice will leave an acid ash in the urine. Caffeine, alcohol, chocolate, and highly spiced foods are avoided to prevent potential bladder irritation.

The graduate nurse is caring for a client with decreased renal perfusion. The registered nurse determines that the graduate nurse demonstrates understanding of why this is occurring if which statement is made? 1. "It can be due to an increase in serotonin levels." 2. "It may be due to overhydration with intravenous fluids." 3. "It may be due to the client's hemoglobin of 13.2 g/dL (132 mmol/L)." 4. "It may be a consequence of decreased dopaminergic receptor stimulation."

4 R: Dopaminergic receptors are found in the renal blood vessels and in the nerves. When stimulated, they dilate renal arteries and help modulate release of the neurotransmitter dopamine. Renal artery dilation helps improve urine output by increasing blood flow through the kidneys. Serotonin is a local hormone that is released from platelets after an injury; it constricts arterioles but dilates capillaries. Dehydration, not overhydration, would decrease renal perfusion. A hemoglobin of 13.2 g/dL (132 mmol/L) is a normal value.

A week after kidney transplantation, a client develops a temperature of 101°F (38.3°C), the blood pressure is elevated, and there is tenderness over the transplanted kidney. The serum creatinine is rising and urine output is decreased. The x-ray indicates that the transplanted kidney is enlarged. Based on these assessment findings, the nurse anticipates which treatment? 1. Antibiotic therapy 2. Peritoneal dialysis 3. Removal of the transplanted kidney 4. Increased immunosuppression therapy

4 R: Symptoms of rejection = fever, malaise, elevated white blood cell count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Treatment consists of increasing immunosuppressive therapy. Antibiotics are used to treat infection. Peritoneal dialysis cannot be used with a newly transplanted kidney due to the recent surgery. Removal of the transplanted kidney is indicated with hyperacute rejection, which occurs within 48 hours of the transplant surgery.

The ambulatory care nurse is providing instructions to a client after a cystoscopy. Which statement by the client indicates a need for further teaching? 1. "I should increase my fluid intake." 2. "I can apply heat to my lower abdomen." 3. "I may have some burning on urination for the next few days." 4. "If I notice any pink-tinged urine, I should contact the health care provider."

4 R: The client is instructed that pink-tinged urine and burning on urination are expected for 1 to 2 days after the procedure. Increased fluid intake is encouraged. Application of heat to the lower abdomen, administration of mild analgesics, and the use of sitz baths may relieve discomfort. The client also is advised to avoid alcoholic beverages for 2 days after the test.

A client is having difficulty coughing and deep-breathing because of pain after a nephrectomy. Which action by the nurse is helpful in promoting optimal respiratory function? 1. Administering pain medication just before ambulation 2. Administering pain medication when the client asks for it 3. Encouraging the use of the incentive spirometer every 8 hours 4. Assisting the client to splint the incision during respiratory exercise

4 R: The nurse assists the client by offering opioid analgesics when due, encouraging incentive spirometer use hourly, and assisting the client to splint the incision during coughing. If the client takes pain medication only before ambulation, control of pain may be insufficient, which will not promote optimal respiratory function (pain medication should be offered 30 to 45 minutes before the client ambulates).