Urinary NCLEX QUESTIONS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

3. The nurse cannot delegate teaching.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

4. This is a potentially life-threatening problem.

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

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

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

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

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

1. This indicates the teaching is effective.

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

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

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

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

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

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

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

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

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

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

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

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

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