EXAM1: RENAL 1215
Which solution is hypotonic? A. Lactated Ringer solution B. 0.45% NaCl C. 0.9% NaCl D. 5% NaCl
B
A client has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The client has a continuous bladder irrigation system in place. The client reports bladder spasms. What is the most appropriate nursing action to relieve the discomfort of the client? A. Apply a cold compress to the pubic area. B. Notify the urologist promptly. C. Irrigate the catheter with 30 to 50 mL of normal saline as ordered. D. Administer a smooth-muscle relaxant as ordered.
D
The nurse is analyzing the electrocardiographic (ECG) rhythm tracing of a client experiencing hypercalcemia. Which ECG change is typically associated with this electrolyte imbalance? A. Prolonged PR intervals B. Prolonged QT intervals C. Peaked T waves D. Elevated ST segments
A
While assessing a client's peripheral IV site, the nurse observes edema around the insertion site. How should the nurse document this complication related to IV therapy? A. Air emboli B. Phlebitis C. Infiltration D. Fluid overload
C
Which of the following is the most sensitive indicator of renal function? A. Serum creatinine B. Blood urea nitrogen (BUN) C. Creatinine clearance D. Potassium
A
The nurse should assess the patient for signs of lethargy, increasing intracranial pressure, and seizures when the serum sodium reaches what level? A. 115 mEq/L B. 130 mEq/L C. 145 mEq/L D. 160 mEq/L
A
What does the nurse understand is the primary method by which fluid volume is regulated? A. Urine excretion B. Breathing C. Bowel elimination D. Perspiration
A
The nurse is caring for a client who has a type of urinary diversion that requires an external ostomy bag to collect the urine. This client has: A. an incontinent urinary diversion. B. a continent urinary diversion. C. a urethroplasty. D. a cystectomy.
A
A male client who is admitted with the diagnosis of urinary calculi complains of excruciating pain. The pain is suspected to be caused by increased pressure in the renal pelvis. Which measure would be most appropriate to provide pain relief? A. Encourage frequent ambulation. B. Encourage the client to void every 2 to 3 hours. C. Restrict the client's sodium intake. D. Encourage deep-breathing exercises.
A
A patient experiences hypotension, lethargy, and muscle spasms while receiving bladder irrigations after a transurethral resection of the prostate (TURP). What is the first action the nurse should take? A. Discontinue the irrigations. B. Increase the rate of the IV fluids. C. Administer a unit of packed red blood cells. D. Prepare the patient for an ECG.
A
What is true about extracorporeal shock wave lithotripsy (ESWL)? Select all that apply. A. Stones are shattered into smaller particles that are passed from the urinary tract. B. ESWL is administered with the client in a water bath or surrounded by a soft cushion while under light anesthesia or sedation. C. ESWL is a ureteroscopic approach. D. ESWL is done while the patient is undergoing a percutaneous nephrolithotomy.
A, B
Which of the following is classified as a upper urinary tract infection (UTI)? Select all that apply. A. Acute pyelonephritis B. Renal abscess C. Cystitis D. Urethritis E. Prostatitis
A, B
A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? A. 5% dextrose and normal saline solution B. Lactated Ringer's solution C. Half-normal saline solution D. 10% dextrose in water
B
After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded? A. The urine in the drainage bag appears red to pink. B. The client reports bladder spasms and the urge to void. C. The normal saline irrigant is infusing at a rate of 50 drops/minute. D. About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned.
B
A priority nursing intervention for a client with hypervolemia involves which of the following? A. Establishing I.V. access with a large-bore catheter. B. Drawing a blood sample for typing and crossmatching. C. Monitoring respiratory status for signs and symptoms of pulmonary complications. D. Encouraging the client to consume sodium-free fluids.
C
The community health nurse is performing a home visit to an older client recovering from hip surgery. The nurse notes that the client seems uncharacteristically confused and has dry mucous membranes. When asked about fluid intake, the client states, "I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom." What would be the nurse's best response? A. "I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete workup." B. "Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids." C. "It is normal to be a little confused following surgery, and it is safe not to urinate at night." D. "If you build up too much urine in your bladder, it can cause you to get confused, especially when your body is under stress. "
B
Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate? A. Give medications that promote fluid retention. B. Limit sodium and water intake. C. Assess for dehydration. D. Teach client behaviors that decrease urination.
B
A client with an intravenous infusion is rubbing his arm. The nurse assesses the site and decides to discontinue the current infusion because of concern that the client has developed phlebitis. Which of the following clinical manifestations would the nurse assess with phlebitis? Select all that apply. A. Cool area around the insertion site B. Reddened area along the path of the vein C. Tender area around the insertion site D. Ecchymosis at the insertion site E. Rapid, shallow respirations
B, C
The nurse is giving discharge instructions to the client with uric acid renal calculi. Which statement by the client indicates the client understands the prescribed diet? A. "Chocolate, spinach, and strawberries are not allowed." B. "I should avoid raw fruits and vegetables." C. "I should limit my intake of meat and fish." D. "I will eliminate milk and other dairy products from my diet."
C
The nurse knows which is the normal serum value for potassium? A. 135-145 mEq/L (135-145 mmol/L). B. 96-106 mEq/L (96-106 mmol/L). C. 3.5-5.0 mEq/L (3.5-5.0 mmol/L). D. 8.5-10.5 mg/dL (2.13-2.63 mmol/L).
C
Which nursing diagnosis is appropriate for a client with renal calculi? A. Ineffective tissue perfusion (renal) B. Functional urinary incontinence C. Risk for infection D. Decreased cardiac output
C
A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately? A. CO2 B. Sodium C. Chloride D. Potassium
D
A client is scheduled for a transurethral resection of the prostate (TURP). Which statement demonstrates that the expected outcome of "client demonstrates understanding of the surgical procedure and aftercare" has been met? A. "I'll have to stay in the hospital for about 3 to 4 days after the surgery." B. "I'll have a small incision on my lower abdomen after the procedure." C. "The surgeon is going to remove the entire prostate gland." D. "The surgeon is going to insert a scope through my urethra to remove a portion of the gland."
D
A client with nausea, vomiting, and abdominal cramps and distention is admitted to the health care facility. Which test result is most significant? A. Blood urea nitrogen (BUN) level of 29 mg/dl B. Serum sodium level of 132 mEq/L C. Urine specific gravity of 1.025 D. Serum potassium level of 3 mEq/L
D
The nurse is adding the intake and output results for a client diagnosed with dehydration. The nurse notes a 24-hour intake of 1500 mL/day between oral fluids and intravenous solutions. The output total is calculated as 2800 mL/day from urine output, emesis, and Hemovac drainage. Which nursing action is best to maintain an acceptable fluid balance? A. Suggest a fluid restriction. B. Encourage oral fluids. C. Remove the Hemovac. D. Offer a prescribed antiemetic medication.
D
The nurse is assessing the client's ileal conduit stoma in the clinic. Which assessment finding would be of greatest concern to the nurse? A. The urine has an ammonia odor. B. Yellow urine is draining from the stoma. C. The skin surrounding the stoma is red. D. The stoma is dusky red.
D
The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration? A. Cool and pale skin B. Crackles in the lung fields C. Distended jugular veins D. Dark, concentrated urine
D
The nurse is reviewing the results of a urinalysis on a client with acute pyelonephritis. Which of the following would the nurse most likely expect to find? A. High specific gravity B. Slightly acidic pH C. Absent proteinuria D. Pyuria
D
A gerontologic nurse is assessing a client who has numerous comorbid health problems. What assessment findings should prompt the nurse to suspect a UTI? Select all that apply. A. Food cravings B. Upper abdominal pain C. Insatiable thirst D. Fever E. New onset of confusion
D, E
The nurse is evaluating the effectiveness of discharge teaching for a client with an oxalate urinary stone. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply. A. "I will never have another urinary stone again." B. "I need to take allopurinol." C. "Tylenol is best to control my pain." D. "I need to drink eight to ten glasses of water every day." E. "I'm so glad I don't have to make any changes in my diet."
A, B, C, E
One of the potential problems for a client with a urinary diversion is disturbed body image related to change in appearance and function. The expected outcome is that the client will accept the altered appearance and perform self-care. Which activities would help in achieving that expected outcome? Select all that apply. A. Reassure the client that nursing staff will provide care until he or she is ready. B. Discuss the change in function and let the client know what to expect when recovery from surgery is complete. C. Help the client gain independence by reinforcing that self-care is quite manageable and providing time for practice. D. Begin exposure to the stoma immediately to help the client adapt properly.
A, B C
The nurse is assessing a client admitted with renal stones. During the admission assessment, what parameters should the nurse address? Select all that apply. A. Dietary history B. Family history of renal stones C. Medication history D. Surgical history E. Vaccination history
A, B, C
The nurse is caring for a client who had transurethral resection of the prostate (TURP) 1 day ago. Which assessment finding(s) does the nurse expect? Select all that apply. A. Large amounts of amber-colored urine in the drainage bag B. Rounded swelling above the pubis C. Reports of the urge to void from the client D. Drainage tube secured to the inner thigh E. Increasing pulse rate and diaphoresis
A, C, D
Which of the following would be appropriate nursing interventions for a client with hypokalemia? Select all that apply. A. Offer a diet with fruit juices and citrus fruits. B. Administer the ordered Kayexalate enema. C. Administer the ordered furosemide 60 mg po. D. Monitor intake and output every shift. E. Administer the ordered potassium 40 mg IV push.
A, D
A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. What factors contribute to this phenomenon? Select all that apply. A. Decreased kidney mass B. Increased conservation of sodium C. Increased total body water D. Decreased renal blood flow E. Decreased excretion of potassium
A, D, E
A client with a history of chronic cystitis comes to an outpatient clinic with signs and symptoms of this disorder. To prevent cystitis from recurring, the nurse recommends maintaining an acid-ash diet to acidify the urine, thereby decreasing the rate of bacterial multiplication. On an acid-ash diet, the client must restrict which beverage? A. Cranberry juice B. Coffee C. Prune juice D. Milk
D
A client has just undergone a urinary diversion procedure. What management issues related specifically to urinary diversion would be included in this client's care plan? Select all that apply. A. Observe for leakage of urine or stool from the anastomosis. B. Maintain renal function. C. Assess for signs and symptoms of peritonitis. D. Encourage oral intake.
A, B, C
A client was admitted to the unit with a diagnosis of hypovolemia. When it is time to complete discharge teaching, which of the following will the nurse teach the client and family? Select all that apply. A. Drink at least eight glasses of fluid each day. B. Drink caffeinated beverages to retain fluid. C. Drink carbonated beverages to help balance fluid volume. D. Drink water as an inexpensive way to meet fluid needs. E. Respond to thirst
A, D, E
The nurse is caring for a client who was admitted with fluid volume excess (FVE). Which nursing assessments should the nurse include in the ongoing monitoring of the client? Select all that apply. A. Nutritional status and diet B. Blood pressure, heart rate, and rhythm C. Intake and output, urine volume, and color D. Strength testing for muscle wasting E. Skin assessment for edema and turgor
B, C, E
A nurse reviews the results of an electrocardiogram (ECG) for a patient who is being assessed for hypokalemia. Which of the following would the nurse notice as the most significant diagnostic indicator? A. Widened QRS wave B. Flat P wave C. Elevated U wave D. Peaked T wave
C
