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1. Which of the following methods are utilized to minimize the risk of rejection?
a. Careful tissue typing before the transplant to ensure a high degree of histocompatibility
b. Administering immunosuppressive drugs such as azathioprine !muran"# cyclosporine
$andimmune"# %&'() *rograf"# and +uromonab , C-. /&0."
c. 0ransplanting recipients only if an organ is donated from a family member
d. !ncreasing fre1uency and dose of immunosuppressants when signs and symptoms of infection
are noted
3. +ajor side effects of immunosuppressive drugs include all of the following e4cept2
a. 5ephroto4icity and hepato4icity
b. 5ausea and vomiting
c. !ncreased white blood cell count
d. %ever# chills# and tremors
Ans: C
.. A client with an invasive carcinoma of the bladder is receiving radiation to the lower abdomen in an
attempt to shrink the tumor before surgery. Considering the side effects of radiation the nurse should2
a. 6imit the intake of iron and protein
b. Administer enemas to remove sloughing tissue
c. *rovide a high7bulk diet to prevent constipation
d. /bserve the client8s feces for the presence of blood
Ans: D , 9adiation may damage the bowel mucosa# causing bleeding. A , iron and protein may need to
be increased to promote 9:C production and tissue healing. : , enemas are contraindicated with lower
abdominal radiation because of the damaged intestinal mucosa. C , diarrhea# not constipation# occurs with
;. When assessing a client during peritoneal dialysis# the nurse observes that drainage of the dialysate
from the peritoneal cavity has ceased before the re1uired amount has drained out. 0he nurse should
assist the client to2
a. -rink < oz of water
b. 0urn from side to side
c. -eep breathe and cough
d. *eriodically rotate the catheter
Ans: B , 0urning from side to side will change position of the catheter# thereby freeing the drainage
holes# which may be obstructed. A , taking fluids into the gastrointestinal tract does not influence drainage
of dialysate from the peritoneal cavity. C , this improves pulmonary ventilation and helps in maintaining
comfort but does not improve flow of dialysate form the catheter. - , the position of the catheter should
only be changed by the physician.
'. When caring for a client who has had an arteriovenous shunt inserted for hemodialysis# the nurse
a. Cover the entire cannula with an elastic bandage
b. =se strict aseptic techni1ue when giving shunt care
c. 5otify the physician if a bruit is heard in the cannula
d. 0ake the blood pressure every ; hours from the arm that contains the shunt
Ans: B , !nsertion of an arteriovenous shunt represents a break in the first line of defense against
infection# the skin. An infection of an arteriovenous shunt can be avoided by strict aseptic sterile"
techni1ue. A , an elastic would interfere with e4amination of the site. C , e4pected> bruit is auscultated by
virtue of the increased arterial pressure in the area. - , to prevent damage to the shunt# blood pressure
should not be measured in the affected arm.
). 0o gain access to a vein and an artery# an e4ternal shunt may be used for clients who re1uire
hemodialysis. 0he most serious problem with an e4ternal shunt is2
a. $epticemia
b. Clot formation
c. ?4sanguination
d. $clerosis of vessels
Ans: C , :ecause e4ternal shunt provides circulatory access to a major artery and vein# special safety
precautions must be taken to prevent disconnection of the cannulas. -isconnection can cause unimpeded
e4cessive blood loss and death. Clamps should be carried at all times by the client in case this emergency
should arise. A , although a potential complication# this does not pose the same immediate threat to life# as
does e4sanguinations. : and - , same as answer A.
@. 0he main indication for hemodialysis for a client who has chronic renal failure is2
a. Ascites
b. Acidosis
c. Aypertension
d. Ayperkalemia
Ans: D , *rotein breakdown liberates cellular potassium ins# leading to hyperkalemia# which can cause
cardiac dysrhythmia and standstill. 0he failure of the kidneys to maintain a balance of potassium is one of
the main indications for dialysis. A , Ascites occurs in liver disease and is not an indication for dialysis. : ,
dialysis is not usual treatment for acidosis. 0his usually responds to administration of alkaline drugs. C ,
dialysis is not a treatment for hypertension> this is usually controlled by antihypertensive medication and
<. 0he purpose of peritoneal dialysis is2
a. 9eestablish kidney function
b. Clean the peritoneal membrane
c. *rovide fluid for intracellular spaces
d. 9emove to4ins and metabolic wastes
Ans: D , *eritoneal dialysis uses the peritoneum as a selectively permeable membrane for diffusion of
to4ins and wastes from the blood into the dialyzing solution. A , peritoneal dialysis acts as a substitute for
kidney function> it does not reestablish kidney function. : , the dialysate does not clean the peritoneal
membrane> the semipermeable membrane allows to4ins and wastes to pass into the dialysate within the
abdominal cavity. C , fluid in the abdominal cavity does not enter the intracellular compartment.
B. A client chronic renal failure is to treated with continuous ambulatory peritoneal dialysis CA*-". 0he
nurse realizes this is done because it2
a. *rovides continuous contact of dialyzer and blood to clear to4ins by ultrafiltration
b. ?4changes and cleanses blood by correction of electrolytes and e4cretion of creatinine
c. -ecreases the need for immobility of the client because it clears to4ins in short intermittent
d. =ses the peritoneum as a semipermeable membrane to clear to4ins by osmosis and diffusion
Ans: D , -iffusion moves particles from an area of lesser concentration> osmosis moves fluid from an
area of lesser to an area of greater concentration of particles. A , the principle of ultrafiltration involves
pressure gradient# which is associated with hemodialysis# not peritoneal dialysis. : , peritoneal dialysis
cleanses the peritoneal cavity directly and the blood indirectly. C , dialysate does not clear to4ins in a short
time> e4changes may occur four or five times a day.
1(. 0he nurse should monitor a client with chronic renal failure for the occurrence of2
a. *ruritus# impotency# and polyuria
b. 9espiratory acidosis# lethargy# and anore4ia
c. Clucose intolerance# hypotension# and anemia
d. Azotemia# muscular twitching# and paresthesias
Ans: D , these adaptations result from e4cess nitrogenous wastes# altered fluid and electrolyte balance#
and altered regulatory functions. A , oliguria occurs because of e4tensive nephron damage. : , metabolic#
not respiratory# acidosis occurs because of the kidney8s inability to e4crete hydrogen and regulate sodium
and bicarbonate. C , hypotension does not occur> the blood pressure is normal or elevated as a result of
increased total body water.
11. A client with acute renal failure becomes confused and irritable. 0he nurse realizes that this behavior
may be caused by2
a. Ayperkalemia
b. Aypernatremia
c. An elevated :=5
d. 6imited fluid intake
Ans: C , An elevated blood urea nitrogen# indicating uremia# is to4ic to the central nervous system and
causes mental cloudiness# confusion# and loss of consciousness. A , hyperkalemia is associated with
muscle weakness# irritability# nausea# and diarrhea. : , hypernatremia is associated with firm tissue turgor#
oliguria# and agitation. - , if decreased fluid intake results in dehydration# it can cause fatigue# dry skin
and mucous membranes# and rapid pulse and respiratory rates.
13. A client with acute renal failure complains of tingling of the fingers and toes and muscle twitching. 0his
is caused by2
a. Acidosis
b. Calcium depletion
c. *otassium retention
d. $odium chloride depletion
Ans: B , !n renal failure# as the glomerular filtration rate decreases# phosphorous is retained. As
hyperphosphatemia occurs# calcium is e4creted. Calcium depletion hypocalcemia" causes tetany. A , the
symptoms described are not characteristic of this condition. C and - , same as answer A.
1.. A client with acute renal failure is to receive a very low7protein diet. 0his diet is based on the principles
a. A high7protein intake ensures an ade1uate daily supply of all amino acids to compensate for
b. ?ssential and nonessential amino acids are necessary in the diet to supply materials for issue
protein synthesis
c. =rea nitrogen cannot be used to synthesize amino acids in the body# so all the nitrogen for
amino acid synthesis must come from the dietary protein
d. !f the client is low in protein and supplies only essential amino acids the reduced amount of
metabolic waste products will decrease stress on the kidneys
Ans: D , 0he amount of protein permitted in the diet usually below '( g" depends on the e4tent of
kidney function> e4cess protein causes a rise in urea# which should be avoided> ade1uate calories are also
provided to prevent tissue catabolism that also results in an increase in metabolic waste products. A , the
diet used in managing renal failure is low in protein because the kidneys are unable to eliminate the waste
products from the body. : , the body is able to synthesize the nonessential amino acids. C , urea is a
wave product of protein metabolism> the body is able to synthesize the non7essential amino acids.
1;. 0he nurse understands that metabolic acidosis develops in renal failure as a result of2
a. !nability of renal tubules to secrete hydrogen ions and conserve bicarbonate
b. !nability of renal tubules to reabsorb water to dilute the acid contents of blood
c. -epression of respiratory rate by metabolic wastes causing carbon dio4ide retention
d. !mpaired glomerular filtration causing retention of sodium and metabolic waste products
Ans: A , :icarbonate buffering is limited# hydrogen ions a accumulate# and acidosis results. : , the fluid
balance does not significantly alter the pA. C , the rate if respirations increases in metabolic acidosis to
compensate for a low pA. - , the retention of sodium ions is related to fluid retention and edema rather
than to acidosis.
1'. 0o obtain an accurate urine output for a client with a continuous bladder irrigation C:!"# the nurse
a. +easure the contents of the bedside drainage bag
b. $top the irrigation until the urine output is determined
c. $ubtract the volume of irrigant from the total drainage
d. ?nsure that urine and irrigant drain two separate bags
Ans: C , Continuous bladder irrigation re1uires a three way indwelling catheter so that the irrigant
infuses through one port and both urine and irrigant drain out together through another port> the third port
allows for inflation of the balloon that keeps the catheter in the bladder. A , the bedside drainage bag
contains both irrigant and urine. : , the purpose of C:! is to prevent obstruction of the catheter> stopping
the irrigation would increase the risk of obstruction. - , both urine and irrigant mi4 in the bladder and drain
from the same port.
1). When irrigating an indwelling urinary catheter the nurse should2
a. /btain and use sterile e1uipment
b. !nstill the fluid under high pressure
c. Warm the solution to body temperature
d. Aspirate immediately to ensure return flow
Ans: A , the bladder is a sterile body cavity. Any time a solution or catheter is introduced into the urinary
meatus. $trict surgical asepsis is re1uired. : , e4cessive pressure can traumatize the lining of the urinary
tract. C , the solution is generally administered at room temperature. - , this would only be done if the
fluid did not return by gravity> the negative pressure e4erted during aspiration may cause trauma.
1@. A client who has just had a suprapublic prostatectomy returns from the postanesthesia care unit and
accidentally pulls out the urethral catheter. 0he nurse should2
a. 9einsert a new catheter
b. 5otify the physician immediately
c. Check for bleeding by irrigating the suprapubic tube
d. 0ake no immediate action if the suprapubic tube is draining
Ans: B , 0he catheter must be reinserted by the physician to ensure bladder emptying# maintain
pressure at the operative site# and prevent hemorrhage. A , because of the danger of further trauma to the
urethra and surgical site# the surgeon should insert the catheter. C , irrigation re1uire a physician8s order.
- , in addition to urinary drainage# the balloon of the urethral catheter e4erts pressure against the prostate
to help control bleeding and should be reinserted.
1<. A client has undergone a suprapubic prostatectomy. !n addition to a %oley catheter# the nurse should
e4pect the client to have a2
a. =recterostomy with gravity drainage
b. 5ephrostomy tube with tidal drainage
c. 9ectal incision and a ureteral catheter
d. Cystostomy tube and an abdominal incision
Ans: D , A suprapubic prostatectomy involves an abdominal incision to gain access to the prostate
through the bladder. *ostoperatively the client has a suprapubic cystotomy tube to instill a C= irrigant to
dilute the urine and limit clot formation as well as a %oley catheter under tension to limit bleeding and drain
urine. A , the ureters are not involved in this surgery. : , the kidneys are not involved in this surgery. C ,
an incision is made in the lower abdomen> a ureteral catheter is not used.
1B. After a nephrectomy a client arrives in the postanesthesia unit with a plastic airway in place. When
observing the client for sings of hemorrhage# the nurse must be certain to2
a. 0urn the client to observe the dressings
b. &eep the client8s nail beds in view at all times
c. /bserve the client for hemoptysis when suctioning
d. 9eport any increase in the client8s blood pressure immediately
Ans: A , :ecause of the anatomic position of the incision# drainage would flow by gravity and
accumulate under the client lying in the supine position. : , nail beds would indicate peripheral perfusion#
not early hemorrhage. C , respiratory hemorrhage is not common after kidney surgery. - , blood pressure
decreases in hemorrhage# and pulse increases.
3(. 0he nurse recognizes that the major disadvantage of an ileal conduit is that2
a. *eristalsis is greatly decreased
b. $tool continuously oozes from it
c. =rine continuously drains from it
d. Absorption of nutrients is diminished
Ans: C , 0he ureters are implanted in a segment of the ileum# and urine drains continually because
there is no sphincter. A , ileal conduits are not neurologically innervated> therefore no peristalsis e4ists. : ,
no feces are present in an ileal conduit. - , nutrients are not normally absorbed from urine.
31. :ladder irritability may follow radiation therapy for cancer of the prostate. A sign of this complication
would probably be2
a. -ysuria
b. *olyuria
c. -ribbling
d. Aematuria
Ans: A , -ysuria# nocturia# and urgency are all signs of an irritable bladder after radiation therapy. :# C#
and - , this is not of bladder irritability.
33. client has been diagnosed as having bladder cancer# and a cystectomy and an ileal conduit are
scheduled. *reoperatively# the nurse plans to2
a. 6imit fluid intake for 3; hours
b. 0each7muscle7tightening e4ercises
c. 0each the procedure for irrigation of the stoma
d. *rovide cleansing enemas and la4atives as ordered
Ans: D , *reoperative cleansing of the bowel is mandated before surgical resection and formation of
urinary conduit. A , fluids should not be restricted until after midnight of the operative day. : , muscle7
tightening e4ercises have no effect on this procedure. C , the stoma of an ileal conduit is not irrigated.
3.. A client has a heminephrectomy and returns from the postanesthesia care unit with a nephrostomy
tube and an indwelling catheter. 0he client8s urinary output is '(mlDhr. 0he nurse should2
a. Chart the findings
b. ?ncourage oral fluids
c. !rrigate the nephrostomy
d. 5otify the physician immediately
Ans: A , An output of '( m6Dhr is ade1uate> when output drops below .( m6Dhr it may indicate renal
failure and the physician should be notified. : , contraindicated> the client would probably still be under
influence of anesthesia and have no gag response. C , this is unnecessary and would re1uire a
physician8s order. - , the physician should be notified if hourly output drops below .( m6.
3;. 0he diet of choice for a client with renal calculi of calcium o4alate composition would be2
a. 6ow in purines# alkaline ash
b. 6ow in methionine# acid ash
c. 6ow in calcium and o4alate# acid ash
d. 6ow in calcium and o4alate# alkaline ash
Ans: C , Calcium o4alate renal stones can be prevented by adhering to a diet low in calcium and
o4alate and high in acid ash. A , purines are catabolized to uric acid and must be avoided in gout. : ,
methionine is an essential amino acid and must be included in the diet. - , the diet should be high in acid#
not alkaline# ash to control production of these stones.
3'. :ackground knowledge that helps the nurse understand the reasons for a strict 3((7mg calcium diet for
. days with daily urinary calcium test for a client suspected of having renal calculi is2
a. ?4ercise calcium intake has a little influence on renal stone formation
b. 0he thyroid hormone controls the serum levels of calcium and phosphorus
c. !f calcium e4cretion is still elevated on the test diet# dietary influences can be ruled out
d. !f calcium e4cretion is lowered on the test diet# hyperparathyroidism can be identified as the
cause of the calculi
Ans: C , 0his is a low calcium intake and continued high e4cretion levels would then have to be from
other than a dietary source> recurrent infections and inade1uate fluids contribute most to formation of
calculi> most stones are calcium or o4alate in nature. A , calcium intake through the diet may affect the
blood calcium levels. : , parathyroid hormone controls the serum calcium levels. - , this is not conclusive
evidence that parathyroidism is the cause.
3). 0he pathology report states that a client8s urinary calculus is composed of uric acid. 0he nurse should
instruct the client to avoid2
a. +ilk and fruits
b. ?ggs and cheese
c. /rgan meats and e4tracts
d. 9ed meats and vegetables
Ans: C , =ric acid stones are controlled by a low7purine diet. %oods high in purine# such as organ meats
and e4tracts# should be avoided. A , calcium stones are controlled by a low7calcium# low7phosphate diet>
milk# fruits# and vegetables need not be avoided with uric acid stones. : , cystine not uric acid# stones are
controlled by a lowEmethionine diet# which e4cludes meat# milk# eggs# and cheese from the diet. - , only
organ meats must be avoided> vegetables need not be controlled.
3@. -iet therapy for renal calculi of calcium phosphate composition would probably be2
a. 6ow calcium and phosphorous# acid ash
b. Aigh calcium and phosphorous# acid ash
c. 6ow purine and phosphorous# alkaline ash
d. Aigh calcium and phosphorous# alkaline ash
Ans: A , calcium and phosphorous are components of these stones and should therefore be avoided.
Also an acid environment is not favorable to their development. : , diets high in calcium must be avoided.
C and - , this diet is indicated for clients with gout.
3<. /n the third postoperative day following a heminephrectomy the nurse notices a large amount of bright
red blood coming through the dressing. 0he nurse should immediately2
a. Change the dressing
b. Apply direct pressure
c. +ilk the nephrostomy tube
d. 5ote the amount and chart it
Ans: B , large amount of bright red blood indicates hemorrhage> immediate pressure should compress
vessels which will limit blood flow. A , this unsafe> it will not correct the problem. C , this is unsafe. - , this
is unsafe as a first action> charting would be done later.
3B. A client is about to have surgery to remove a urinary bladder stone needs education about a2
a. Cystometry
b. Cystolithiasis
c. Cyoe4traction
d. Cystolithectomy
Ans: D , cystolithectomy refers to the removal of bladder stones. A , cystometry is the process of
measuring the bladder8s pressure and capacity. : , cystolithiasis denotes the presence of stones in the
bladder. C , cryoe4traction refers to the use of subfreezing temperatures in the removal of tissue>
generally used in cataract e4traction.
.(. A lithotripsy so break up renal calculi is unsuccessful and nephrolithotomy is performed. A
postoperative observation that the nurse should report to the physician would be2
a. *assage of pink7tinged urine
b. !ntake of 1@'( ml in 3; hours
c. *ink drainage on the dressing
d. =rine output of 3( to .( ml per hour
Ans: D , /utput should be about '( mlDhr with an intake of at least 13(( ml per 3; hours. A , some
blood# tinting the urine pink# is e4pected but not bright red drainage. : , this intake is ade1uate> however# a
higher intake is usually preferred. C , drainage may be pink> bright red drainage should be reported.
.1. When caring for clients with renal calculi# the most important nursing action is to2
a. $train all urine
b. 6imit fluids at night
c. 9ecord blood pressure
d. Administer analgesics every . hours
Ans: A , =rine is strained to determine whether any calculi or calcium gravel has been passed. : ,
fluids should be encouraged to promote dilute urine and facilitate passage of the calculi. C , blood
pressure assessment is of no particular importance to the client with kidney stones. - , administration of
analgesics is based on the physician8s order.
.3. 0he immediate objective of nursing care for an overweight# midly hypertensive client with ureteral colic
and hematuria is to decrease2
a. *ain
b. Weight
c. Aematuria
d. Aypertension
Ans: A , $harp# severe pain renal colic" radiating toward the genitalia and thigh is caused by ureteral
distention. : , although the client is overweight and weight loss would be desirable# it is a long7term goal.
C , although this may occur# blood loss is usually not massive. - , hypertension is not specific to urinary
... 0o prevent recurrent attacks in a client with glomerulonephritis# the nurse should instruct the client to2
a. 0ake showers instead of tub baths
b. Avoid situations that involve physical activity
c. Continue the same restrictions on fluid intake
d. $eek early treatment for respiratory infections
Ans: D , hemolytic streptococci# common in throat infections# can initiate an immune reaction that
damages the glomerulus. A , baths have been linked to urethritis# not glomerulonephritis. : , moderate
activity is helpful in preventing urinary stasis. C , any fluid restrictions is moderated as the client improves>
fluid is allowed to prevent urinary stasis.
.;. When a client has hematuria# the nurse should observe for2
a. -iarrhea
b. Acetone in urine
c. $ymptoms of peritonitis
d. Cross blood in the urine
Ans: D , Changes in the amount of blood in the urine may indicate progressive increases in kidney
damage. A and C , this is unrelated to hematuria. : , this is unrelated to hematuria> it is associated with
breakdown of adipose tissue.
.'. When assessing the urine of a client with a urinary tract infection# each specimen of urine should be
assessed for2
a. Clarity
b. Fiscosity
c. $pecific gravity
d. $ugar and acetone
Ans: A , cloudy urine usually indicates purulent drainage associated with infection. : , viscosity is a
subjective characteristic that would not be measurable. C , specific gravity yields information related to
fluid balance. - , sugar and acetone are not affected by urinary tract infections.
.). A client in a nursing home is diagnosed with urethritis. :efore initiating treatment orders# the nurse
should plan to2
a. $tart a 3;7hour urine collection
b. Administer an oil7retention enema
c. *repare for urinary catheterization
d. /btain a urine specimen for culture and sensitivity
Ans: D , 0he causative organism should be isolated before starting antibiotic therapy. A , this test will
not determine the infective organisms causing the problem. : , the bowel is not affected by the diagnostic
enemas are not re1uired. C , catheterization is not a routine procedure for urethritis.
.@. A female has a higher risk of developing cystitis than does a male. 0his is because of the2
a. Altered urinary pA
b. Aormonal secretions
c. Gu4taposition of the bladder
d. *ro4imity of urethra and anus
Ans: D , because the female urethra is closer to the anus than in the male# it is at greater risk of
becoming contaminated. A , urinary pA is within the same range in both males and females. : , hormonal
secretions have no effect on the development of bladder infections. C , the position of the bladder is the
same in males and females.
.<. When teaching a female client with recurrent urinary tract infections# the nurse states that women are
most susceptible because of2
a. !nade1uate fluid intake
b. *oor hygienic practices
c. 0he length of the urethra
d. Continuity of the mucous membrane
Ans: C , 0he length of the urethra is shorter in females than in males> therefore microorganisms have a
shorter distance to travel to reach the bladder. 0he pro4imity of the meatus to the anus in females also
increases this incidence. A , fluid intake may be ade1uate in both males and females and would not
account for the difference. : , hygienic practices can be poor in males or females> however# the anatomic
length of the urethra in females prediscopes them to infection. - , mucous membranes are continuous in
both males and females and would not make a difference.
.B. A client has corrective surgery for a bladder laceration. 0he priority nursing intervention in this client8s
postoperative period would be2
a. 0urning and positioning
b. 9ange7of7motion e4ercises
c. :ack care three times daily
d. *lacing side rails in up position
Ans: A , fre1uent position changes are important to ensure proper urinary drainage> gravity promotes
flow# which prevents obstruction. : , range of motion would be of minimal importance# because the client
would be able to move without limitation. C , back care is necessary but is not priority. - , this is not a
priority unless the client is sedated.
;(. When caring for a client with a continuous bladder irrigation# the nurse should2
a. +onitor urinary specific gravity
b. 9ecord urinary output every hour
c. $ubtract irrigant from output to determine urine volume
d. !nclude irrigating solution in any 3;7hour urine tests ordered
Ans: C , 0he total amount of irrigation solution instilled into the bladder is eliminated with urine and
therefore must be subtracted from the total output to determine the volume of urine e4creted. A , an
accurate specific gravity cannot be obtained when irrigating solutions are being instilled into the bladder. :
, hourly outputs are indicated only if there is concern about renal failure or oliguria. - , twenty7four hour
urine tests would not be accurate if the client were receiving continuous irrigations.
;1. 0he nurse can best prevent infection from retention catheters by2
a. Cleansing the perineum
b. ?ncouraging ade1uate fluids
c. !rrigating the catheter
d. Cleansing around the meatus periodically
Ans: D , cleansing the urinary meatus and adjacent skin removes accumulated bacteria# limiting the
possible introduction of microbes into the urinary tract. A , although cleansing the perineal area is helpful#
it is actually the organisms closest to the meatus that gain entry to the urinary tract first. : , although
encouraging fluids helps prevent urinary stasis and subse1uent infection# the most common source of
infection is microorganisms from around the meatus. C , irrigations re1uire opening the closed drainage
system and allowing the entry of microorganisms> this increases the risk of infection.
;3. A client with cancer of the prostate re1uests the urinal at fre1uent intervals but either does not void or
voids in very small amounts. 0his is most likely caused by2
a. ?dema
b. -ysuria
c. 9etention
d. $uppression
Ans: C , Am enlarged prostate constrict the urethra# interfering with urine flow causing retention. When
the bladder fills and approaches capacity# small amounts can be voided but the bladder never empties
completely. A , edema does not cause the client to void fre1uently in small amounts because of decreased
production of urine. : , dysuria is painful of difficult urination that is not part of the client8s symptoms. - ,
the urge to void is caused by stimulation of the stretch receptors as the bladder fills with urine> in
suppression little or no urine is produced.
;.. A client e4periences difficulty in voiding after an indwelling urinary catheter is removed. 0his is probably
related to2
a. %luid imbalances
b. 0he client8s recent sedentary lifestyle
c. An interruption in normal voiding habits
d. 5ervous tension following the procedure
Ans: C , An indwelling catheter dilates the urinary sphincter# keeps the bladder empty# and short7circuits
the normal refle4 mechanism based on bladder distention. When the catheter is removed# the body must
adapt to functioning once again. A and - , although this could cause difficulty in voiding# there are no data
presented to draw this conclusion. : , this would not cause this problem.
;;. When a client with a urinary retention catheter in place complains of discomfort in the bladder and
urethra# the nurse should first2
a. 5otify the physician
b. +ilk the tubing gently
c. Check the patency of the catheter
d. !rrigate the catheter with prescribed solutions
Ans: C , catheter patency ensures drainage and prevents bladder distension and other complications.
0herefore patency of a catheter should be established before notifying the physician. A , assessment is
necessary before consultation with the physician. : , patency of the catheter should be assessed first.
+ilking the tubing may be necessary if usually re1uired when the drainage is viscous rather than li1uid. - ,
irrigation is avoided if possible because of the associated risk of infection.
;'. A routine urinalysis is ordered for a client. !f the specimen cannot be sent immediately to the laboratory#
the nurse should2
a. 0ake no special action
b. 9efrigerate the specimen
c. $tore on HdirtyI side of utility room
d. -iscard and collect a new specimen later
Ans: B ,refrigeration retards the growth of bacteria and may preserve the specimen for several hours. A
and C, growth of bacteria will alter the pA and the glucose and protein levels in the urine> it must be
refrigerated to retard growth. - , this represents an unnecessary waste of time# effort# and money.
;). When collecting a 3;7hour urine a specimen# the nurse should2
a. Check if any preservatives need to be added
b. Weigh the client before starting the collection
c. -iscard the last voided specimen of the 3;7hour period
d. Check the intake and output for the previous 3;7hour period
Ans: A , depending on the purpose of the collection# a preservative to prevent breakdown of the
specimen may be necessary. : , this is necessary. C , the last specimen should be collected as close as
possible to the end of the 3; hours period and added to the urine collected. - , this is not necessary# nor is
the measurement of each voiding during the 3;7hours collection# unless the client is on intake and output.
;@. A male client is to have the urethra dilated by the physician. 0he nurse understands that the structure
that encircles the male urethra is the2
a. ?pididymis
b. *rostate gland
c. $eminal vesicle
d. :ullbourethral gland
Ans: B , the prostate gland is a tubuloalveolar gland shaped like a ring# with the urethra passing through
its center. A , the epididymis lies along the top and sides of the testes. C , the seminal vesicles are on the
posterior surface of the bladder. - , this gland lies below the prostate.
;<. 0he reabsorption of water from glomerular filtrate in the kidney tubules"# the flow of water between the
intracellular and interstitial compartments# and the e4change of fluid between plasma and interstitial
fluid spaces are caused by2
a. -ialysis
b. /smosis
c. -iffusion
d. Active transport
Ans: B , osmosis is the diffusion of water through a selectively permeable membrane. $uch membranes
include cellular membranes and capillary walls. /smosis occurs in the kidney tubules and in all capillary
beds. A , dialysis is the diffusion of small molecules# other than water# down their concentration gradients
through a selectively permeable membrane. C , diffusion is the process by which particulate matter in a
fluid moves from an area of greater concentration to an area of lesser concentration. - , active transport is
the movement molecules against a concentration gradient and re1uires energy input> osmosis and
diffusion are passive processes.
;B. 0he most important means of maintaining the fluid and electrolyte balance of the body is2
a. Aldosterone
b. 0he urinary system
c. 0he respiratory system
d. Antidiuretic hormone A-A"
Ans: B , the kidneys are ultimately responsible for maintaining fluid and electrolyte balance by e4cretion
or retention based on body8s needs. A , aldosterone will cause retention of sodium ions by the nephrons
and subse1uent fluid retention. C , the lungs eliminate water and carbon dio4ide only if e4cess carbonic
acid is present> their role in fluid and electrolyte balance is less e4tensive than the kidney8s. - , antidiuretic
hormone has a direct effect on the nephrons# resulting in water retention.
'(. When teaching a client about the drug therapy for gonorrhea# the nurse should state that it2
a. Cures the infection
b. *revents complications
c. Controls its transmission
d. 9everses pathologic changes
Ans: A , Ceftria4one with do4ycycline is specific for Neisseria gonorrhea and eradicates the
microorganism> other treatment regimens are available for resistant strains. : , if the disease progresses
before diagnosis is made# complications such as sterility# valve damage# or joint degeneration may occur.
C , transmission is not controlled> the organism is eliminated. - , if tubal structures# valves# or joints
degenerate# the pathologic changes will not be reversed by antibiotic therapy.
'1. !n relation to the public health implications of gonorrhea diagnosed in a 1)7year7old# the nurse should
be most interested in>
a. %inding the client8s contacts
b. !nterviewing the client8s parent8s
c. 0he reasons for the client8s promiscuity
d. !nstructing the client about birth control measures
Ans: A , gonorrhea is a highly contagious disease transmitted through se4ual intercourse. 0he
incubation period varies# but symptoms usually occur 3 to 1( days after contact. ?arly effective treatment
prevents complications. : , the parents may be unaware that their child has gonorrhea. C , contracting
venereal disease is not necessarily indicative of promiscuity. - , most birth control measures do not
protect against the transmission of se4ually transmitted disease.
'3. $yphilis is not considered contagious in the2
a. 0ertiary stage
b. *rimary stage
c. !ncubation stage
d. $econdary stage
Ans: A , 0he tertiary stage is noncontagious> tertiary lesions contain only small numbers of treponemes>
fatal cases involve the aorta# C5$# or eye. : , the primary stage lasts < to 13 weeks# the chancre is
teeming with sprichetes# and the individual is contagious. C , the incubation stage lasts 3 to ) weeks>
spirochetes proliferate at entry site# and the individual is contagious. - , the duration of the secondary
stage is variable about ' years"> skin and mucosal lesions contain spirochetes# and the individual is highly
'.. A client cannot understand how syphilis was contracted because there has been no se4ual activity for
several days. As part of teaching the nurse e4plains that the incubation period for syphilis is about2
a. @3 hours
b. 1 week
c. 3 to ) weeks
d. ; months
Ans: C , although the usual incubation period of syphilis is about . weeks# clinical symptoms may
appear as early as B days or as long as . months after e4posure. A# :# and - , the normal incubation
period is 31 days.
';. A client is diagnosed with herpes genitalis. 0o prevent cross7contamination the nurse should2
a. !nstitute droplet precautions
b. Arrange transfer to a private room
c. Wear a gown an gloves when giving direct care
d. Close the door and wear a mask when in the room
Ans: C , the e4udates from herpes virus type 3 is highly contagious> gown and gloves provide a barrier#
a concept related to medical asepsis. A , the organism is not in respiratory tract secretions> the organism is
present in the e4udates from active lesions. : , this is unnecessary. - , this is not an airborne infectious
''. A nurse should be aware that benign prostatic hypertrophy :*A"2
a. !s a congenital abnormality
b. =sually becomes malignant
c. *redisposes to hydronephrosis
d. Causes an elevated acid phosphatase
Ans: C , inability to empty the bladder# as a result of pressure e4erted by the enlarging prostate on the
urethra# causes a backup of urine into the ureters and finally the kidneys hydronephrosis". A , :*A
develops over the client8s life span> it is not congenital. : , it is uncommon for :*A to become malignant.
- , this level is elevated in prostatic carcinoma.
'). With cancer of the prostate it is possible to follow the course of the disease by monitoring the serum
level of2
a. Creatinine
b. :lood urea nitrogen
c. 5onprotein nitrogen
d. *rostate7specific antigen
Ans: D , the *$A is an indication of cancer of the prostate> the higher the level# the greater the tumor
burden. A , elevated creatinine levels may be caused by impaired renal function as a result of blockage by
an enlarged prostate but do not indicate that metastasis has occurred. : , elevated :=5 levels may be
caused by impaired renal function as a result of blockage by an enlarged prostate but do not indicate that
metastasis has occurred. C , no protein nitrogen refers to waste products from metabolism of protein and
includes urea# creatinine# uric acid# and ammonia.
'@. 0orsion of the testes re1uires immediate surgical correction because2
a. 0here is no other way to control the pain
b. !rreversible damage occurs after a few hours
c. $welling is e4cessive and the testicle may rupture
d. 0he reduction in testicular blood flow leads to rapid death of sperm
Ans: B , when the testes are twisted# a decrease in their blood supply occurs. 0his can result in
gangrene. A , pain can be alleviated through the use of medication. C , although edema occurs# the testes
do not rupture. - , sperm are continually produced# so their destruction is not concern.
'<. When counseling a client after a vasectomy# the nurse should advise him that2
a. 9ecanalization of the vas deferens is impossible
b. $ome impotency is to be e4pected for several weeks
c. =nprotected coitus is possible within a week to 1( days
d. !t re1uires at least 1' ejaculations to clear the tract of sperm
Ans: D , some spermatozoa will remain viable in the vas deferens for a variable time after vasectomy. A
, although it is considered a permanent form of sterilization# there has been some success in reversing the
procedure. : , the procedure does not affect se4ual functioning. C , precautions must be taken to prevent
fertilization until absence of sperm in the semen has been verified.
'B. A client has a radium implant for cancer of the cervi4. :efore discharge the nurse should e4plain the
importance of2
a. 6imiting daily fluid intake
b. Continuing a low7residue diet
c. 9eturning for medical follow7up care
d. 0aking daily multivitamin supplements
Ans: C , before discharge it is important for the nurse to instruct the client to follow through with medical
care at specified intervals. A , fluids are not reduced unless other cardiac or renal pathology is present. :
, low7residue diet is indicated to avoid pressure from a distended colon only when the implant is in place>
the radium implant is removed before discharge. - , if diet is ade1uate# multivitamins are unnecessary.
)(. When caring for a client who has a radium implant for cancer of the cervi4# the nurse should2
a. 9estrict visitors to a 1(7minute stay
b. $tore urine in a lead7lined container
c. Wear a lead apron when giving care
d. Avoid giving !+ injections into the gluteal muscle
Ans: A , time# distance# and shielding are the important factors in determining the amount of radiation
the visitor receives. 9estriction of each visitor to a 1(7minute stay minimizes the risk of e4posure. +any
institutions will not allow visitors while an implant is in place. : , the urine is not radioactive# so no
precautions are indicated. C , lead aprons are effective shields against 47rays but not against rays emitted
by internal sources of radiation. - , radium implants will not affect the location of !+ injections.
)1. 0he nurse checking the perineum of a client with a radium implant for cervical cancer finds the packing
protruding from the vagina. 0he immediate action to take is to report this situation to the physician at
once because the packing2
a. +ust be removed
b. Aas become radioactive
c. *revents e4cessive loss of blood
d. -ecreases rectal and bladder trauma
Ans: D , radium# a radioactive isotope# is used to destroy or delay the growth of malignant cells> packing
maintains the insert in its correct placement to ma4imize the effect on cancerous tissue and minimize the
effect on normal tissue. A , the packing must be readjusted or replaced to protect normal tissue from
damage from the radium implant. : , this is not true. C , there should be no active bleeding with radium
implants although there may be cellular sloughing.
)3. $afety precautions the nurse should employ when radium that had been inserted in the vagina of a
client is being removed include2
a. Cleaning radium carefully in ether or alcohol
b. ?nsuring that long forceps are available for use
c. Aandling the radium carefully wearing foil7lined rubber gloves
d. Charting the date and hour of removal and the total time of treatment
Ans: B , radium must be handled with long7handled forceps because distance helps limit e4posure. A ,
a nurse not responsible for cleaning radium implants. C , foil7lined rubber gloves do not provide ade1uate
shielding from the gamma rays emitted by radium. - , the amount and duration of e4posure are important
in assessing the effect on the client> however# this will not affect safety during removal.
).. 0he symptoms observed in a client following radium insertion for cancer of the cervi4 that are indicative
of a radium reaction are2
a. 5ausea and vomiting
b. 9estlessness and irritability
c. Faginal discharge and e4coriation
d. *ain and elevation of temperature
Ans: D , pain and elevated temperature may indicate to4ic effects. ?4cessive sloughing of tissue can
cause hemorrhage or infection. A , these are e4pected side effects of internal radiotherapy. : , these are
associated with need to maintain position# not with radium itself. C , these are e4pected side effects of
internal radiotherapy.
);. Acute salpingitis is most commonly the result of2
a. $yphilis
b. Abortion
c. Conorrhea
d. Aydatidiform mole
Ans: C , gonorrhea fre1uently is an ascending infection and affects the fallopian tubes. A , syphilis# if
untreated# may spread to the nervous system via the blood> it does not usually cause ascending infection
of the fallopian tubes. : , absorption should not cause inflammation of the fallopian tubes. - , this is not
an infection# it is an aberrant growth> it would not cause inflammation of the fallopian tubes.
)'. A female client is very upset with her diagnosis of gonorrhea and asks the nurse# HWhat can ! do to
prevent getting another infection in the future?I 0he nurse is aware that the teaching has been
understood when the client state# H+y best protection is to2
a. -ouche after every intercourse.I
b. Avoid engaging in se4ual behavior.I
c. !nsist that my partner use a condom.I
d. =se a permicidal cream with intercourse.I
Ans: C , the nurse8s best response is one that is realistic# once people become se4ually active they
usually remain se4ually active> a condom. Although not 1((J effective# is the best protection against
gonorrhea in a se4ually active person. A , douching has no proven protective effect against se4ually
transmitted disease> e4cessive douching can actually alter the natural environment of the vagina and may
even promote an ascending infection. : , although this is the best way to prevent a se4ually transmitted
disease# it is not the most realistic response to a se4ually active person. - , spermicidal cream has no
protective effect against se4ually transmitted disease.
)). When teaching client how to self7administer a douche# the nurse should instruct the client to direct the
douche nozzle toward the2
a. 6eft
b. 9ight
c. $acrum
d. =mbilicus
Ans: C , this is the anatomic direction of the vaginal tract in the back7lying position. A# :# and - , the
vaginal tract may be injured when the douche nozzle is not directed with consideration of normal anatomy.
)@. 0he oral drug that is most likely to be prescribed for treatment of Trichomonas vaginalis is2
a. *enicillin
b. Centian violet
c. 5ystatin +yocostatin"
d. +etronidazole %lagyl"
Ans: D 7 metronidazole %lagyl" is a potent amerbicide. !t is e4tremely effective in eradicating the
protozoan Trichomonas vaginatalis. A , penicillin is administered for its effect on bacterial# not protozoal#
infections. : , gentian violet is a local antiinfective that is applied topically and may cause discoloration of
the skin> it is particularly effective against Candida alicans. C , nystatin is an antifungal used for infections
caused by Candida alicans.
)<. 0he nurse understands that the organism that causes a trichomonal infection is a2
a. Keast
b. %ungus
c. *rotozoan
d. $prichete
Ans: C , Trichomonas vaginalis is a protozoan that favors an alkaline environment. A , a years is a
unicellular# usually oval# nucleated fungus> it does not cause trichomonal infections. : , a fungus is a
simple parasitic plant> it does not cause trichomonal infections. - , a spirochete is a motile spiral7shaped
bacterium> it does not vause trichomonal infections.
)B. When a client is diagnosed as having gonorrhea the nurse should e4pect the physician to order2
a. Colistin
b. Ceftri4one
c. Actinomycin
d. Chloramphenicol
Ans: B , ceftria4one 9ocephin" inhibits the synthesis of bacterial cell walls. !t is effective against
Neisseria gonorrhoeae! a gram7negative diplococcus. A colistin sulfate is effective against most gram7
negative enteric pathogens such as Escherichia coli. C , actinomycin is an antieneoplastic agent. - ,
chloramphenicol is a broad7spectrum antimicrobial agent> however# it can cause bone severe infections
that do not respond to less to4ic drugs.
@(. 0he nurse teaches a client that gonorrhea is highly infectious and2
a. !s easily cured
b. /ccurs very rarely
c. Can produce sterility
d. !s limited to the e4ternal genitalia
Ans: C , in males the inflammatory process associated with the infection may lead to destruction of the
epididymis. !n females the gonorrhea infection causes destruction of the tubal mucosa and eventually
tuboovarian abscesses. A , gonorrhea has become more difficult to treat because many gonococci have
become penicillin resistant. : , gonorrhea is a common se4ually transmitted disease. - , Neisseria
gonorrhoeae invade internal structures# particularly the epididymis in male and the fallopian tubes in
@1. Clients who develop general paresis as a complication of syphilis are usually treated with2
a. *enicillin
b. +ajor tran1uilizers
c. :ehavior modification
d. ?lectroconvulsive therapy
Ans: A , massive doses of penicillin may limit C5$ damage if treatment is started before neural
deterioration from syphilis occurs. : , tran1uilizers are used to modify behavior# not to treat general
paresis. C , paresis is not a behavior and is therefore not suitably treated with behavior modification. - ,
electroconvulsive therapy is used in the treatment of certain psychiatric disorders.
@3. 0he term condylomata acuminata refers to2
a. $cabies
b. Aerpes zoster
c. Feneral warts
d. Cancer of the epididymis
Ans: C , Cond"lomata ac#minata are variably sized cauliflower7like warts occurring principally on the
genitals or the anogenital skin or mucosa of both females and males> they are transmitted by se4ual
activity. A , scabies is an infestation of the skin by Sarco$tes scaiei itch mite". : , herpes zoster is an
acute vesicular skin infection caused by the varicella zoster virus. - , cond"lomata ac#minata are warts
ocuring on the genitals or the females> the epididymis is part of the males reproductive system and is an
internal structure.
@.. 0he testes are suspended in the scrotum to2
a. *rotect the sperm from the acidity of urine
b. %acilitate the passage of sperm through the urethra
c. *rotect the sperm from high abdominal temperatures
d. %acilitate their maturation during embryonic development
Ans: C , sperm cells are very fragile and can be destroyed by heat# resulting in sterility. A , sperm do
not move through the urine> they are found in semen. : , sperm are motile# achieving this by motion of
their flagella> they move from the epididymis to the vas deferens to the ejaculatory ducts to the urethra. - ,
during this period the testes are not suspended.
@;. $permatogenesis occurs2
a. At the time of puberty
b. At any time following birth
c. !mmediately following birth
d. -uring embryonic development
Ans: A , primitive se4 cells# called spermatogonia# are present in newborn males. At puberty these cells
mature and form spermatozoa spermatogenesis". : , spermatogenesis does not occur until puberty. C ,
spermatogenia or primitive se4 cells are found at this time. - , only immature cells are found during this
@'. Which of the following is the pathologic alteration that occurs wit acute glomerulonephritis?
a. crystallization in the distal tubules of the kidney due to an untoward effect of antipyretic medication
b. destruction of gleomeruli due to the trapping of circulating7antigen7antibody comple4es
c. inhibition of antibodies resulting from an e4cess of leukocytes
d. sensitivity of to4ins resulting from an invading microorganisms
Ans: B antigen7antibody comple4es are trapped in the glomeruli# causing glomerular damage. /ther
options are incorrect.
@). 0he type of prostatectomy most likely to result in impotence is2
a. transurethral
b. retropubic
c. perineal
d. suprapubic
Ans: C in perineal prostatectomy# an incision is made in the perineum# between the scrotum and anus.
5erve pathways can easily be destroyed# resulting in se4ual dysfunction impotence". /ptions A# : and -
are surgical approaches that do not involve the perineal area and are therefore less likely to result in
@@. 0o prevent the most common type of urinary calculi from precipitating out in the urine# the treatment
most appropriate ate would be2
a. low7sodium diet and increased hydration
b. acid7ash diet and increased hydration
c. alkaline7ash diet and alkopurinol
d. increased fiber in diet
Ans: B eighty percent of all urinary stones contain calcium. An acid7ash diet is helpful in preventing
calcium ions from precipitating out of the urine and forming crystals and stones. !ncreased hydration also
helps prevent precipitation of calcium out of urine. /ther options are diets that will not aid in preventing
calcium stone formation.
@<. Goel# a .37year7old man# is admitted wit a diagnosis of renal calculus. /n admission to the unit# the
most important nursing priority for this client is to2
a. restrict fluids until the type of stone is diagnosed
b. relieve pain until the stone can be removed
c. monitor urinary output
d. prepare the client for diagnosis studies
Ans: B pain from renal calculi is e4cruciating and must be controlled with analgesic as a first priority#
after which urinary output can be monitored and the patient can be prepared for diagnostic studies. %luids
are increased# not restricted# to aid in the HflushingI of stones and stone fragments out of the urinary tract.
=rinary output must be monitored because of the possibly of developing an obstruction to urine flow>
however# administration of pain medication must be the nurse8s first priority in this case. -iagnostic studies
will be ordered# but are not the first priority.
@B. Which of the following is a risk for developing uric acid kidney stones?
a. gout
b. primary aldosteronism
c. large intake of dairy products
d. recurrent =0!s
Ans: A gout is a metabolic disease characterized by urate deposits# which cause painful arthritic joints. !t
strikes mainly the feet and legs and especially the great toe. As the disease progresses# it may cause
nephrolithiasis# as uric acid precipitates out of the urine into crystals and stones. *rimary aldosteronism
results in hypernatremia and has no relationship to uric acid calculi. 6arge intake of dairy products may
result in development of renal calculi# but the composition would be calcium instead of uric acid. 9ecurrent
urinary tract infections are associated with renal calculi# but are not risk factors for uric acid stones
<(. Which of the following may continue to the function of urinary calculi?
a. urinary stasis
b. an increase in :=5 level
c. elevated serum creatinine levels
d. increased fluid intake
Ans: A risk factors for urinary calculi include anything that causes either urinary stasis or supersaturation
of the urine with particles. 0his includes dehydration# immobility and increased calcium or other ions in the
urine. /ther options are incorrect.
<1. 9obert# a )3 year old man# with invasive bladder cancer# is scheduled for a total cystectomy and
&ock8s pouch &ock8s pouch
a. !s a large segment of ileum that is formed into a bladder# with urine entering via the ureters and
e4iting via the urethra
b. results in continuous flow of urine from an abdominal stoma
c. is preferred over an ileal conduit because if eliminates the need for an e4ternal collection bag and
lessens the potential for skin impairment
d. is a temporary reservoir for the collection of urine during treatment of bladder cancer
Ans: C a continent urostomy &ock8s pouch" differs from an ileal conduit because it has a nipple valve
beneath the stoma that prevents urine flowing through the stoma and# therefore# prevents e4coriation of
the surrounding skin. 0he client must catheterize the stoma at least every ) hours to empty the Hpouch.I A
large segment of ileum is used to form the pouch but urine does not e4it via the urethra. !t e4ists via an
abdominal stoma. &ock8s pouch is not temporary but a permanent replacement for the bladder.
<3. %ollowing a ureterolithotomy. 0homas has a %oley catheter# a urethral stent# and a *enrose drain. Ais
intake and output are closely monitored. !f his urinary output decrease# the 95 should first2
a. notify the surgeon if the change in urinary output occurs suddenly
b. reposition the client onto his side to facilitate drainage of the catheter ans stent
c. gently irrigate the uretral stent will .( cc sterile normal saline
d. check tube patency for possible kinks
Ans: D if urinary output decreases# the first action by the nurse is to check the %oley catheter tube for
kinks. When notified# the physician will want to know if the patency of the tube has been checked.
9epositioning a patient on his or her left side does not facilitate drainage from the catheter or the stent. A
physician8s order is needed to irrigate the stent# and no more than ' cc should be instilled into a stent via
gravity never force it" at one time.
<.. !n which kidney structure does filtration occur?
a. loop of Aenle
b. bowman8s capsule
c. glomerulus
d. distal convoluted tubule
Ans: C glomerular filtration occurs in the glomerulus. !t is the process of filtering the blood as it flows
through the kidney. /ther options are incorrect.
<;. Calcium imbalance is commonly seen in patients with renal failure. Appropriate treatment includes
a. calcium and phosphorous restricted diet
b. high7fiber diet
c. aluminum hydro4ide amphojel 1' ml# 1id with meals
d. calcitonim cibacalcin" (.' mg $c daily
Ans: C in chronic renal failure# the serum phosphorus level is elevated. 0here is an inverse relationship
between phosphorus and calcium in the blood> therefore# whenever one of these ions is elevated
phosphorus"# the other calcium" is below normal. 0o correct the hypocalcemia# aluminum hydro4ide
Amphojel" is given. !t acts by binding with phosphorus in the C!0 and preventing absorption# thereby
decreasing the serum phosphorus level and allowing the serum calcium to rise. 0he patient in chronic renal
failure should be encouraged to include foods rich in calcium in the diet. A high7fiber diet is appropriate for
the patient in renal failure# to prevent constipation resulting from the significant fluid restriction> however#
this would have no impact on the patient8s hypocalcemia. Calcitonin Cibalcin" inhibits bone resorption of
calcium# lowering serum calcium level. 0he patient in chronic renal failure has hypocalcemia.
<'. 0he most common complication o peritoneal dialysis is2
a. bowel or bladder perforation
b. peritonis
c. hypovolemia
d. dise1uilibrium syndrome
Ans: B peritonitis is the main complication of peritoneal dialysis. 0he delivery of dialysate into the
peritoneal cavity and its removal after a set period can result in introducing a pathogen into the peritoneal
cavity# causing peritonitis. *erforation of the bowel or bladder may occur when the catheter is initially
inserted# but it is not a common problem. Aypovolemia is not a problem for patients re1uiring dialysis. 0hey
have fluid volume e4cess. -ise1uilibrium syndrome is usually not a problem in peritoneal dialysis. !t is
more likely to occur with hemodialysis# as a result of rapid change in the composition of the e4tracellular
fluid. $olutes are removed more rapidly from the blood than from the $% and brain. 0he higher osmotic
gradient in the brain cells allows fluid to pass into these cells# causing cerebral edema.
<). Abby# a )<7year7old woman has a history of hypertension for which she has been taking a thiazide
diuretic. Aer plasma potassium is ..( m?1D6. 5ursing interventions for this patient should include which
of the following?
a. monitor for muscle weakness and fatigue
b. assess for positive chvostek8s sign
c. administer kaye4alate enemas as ordered
d. observe cardiac monitor pattern for elevation of t7wave
Ans: A- muscle weakness and fatigue are symptoms of hypokalemia which should be monitored for in a
patient receiving a thiazide diuretic. A positive Chvostek8s sign is seen in patients with hypocalcemia# not
hypokalemia. A kaye4alate enema will further decrease this patient8s potassium level# which is already
below normal. 0his patient cardiac pattern should be monitored2 however# the 07wave will be depressed#
not elevated# as a result of hypokalemia.
<@. Which of the following patients would be predisposed to the development of hypomagnesaemia?
a. patient with chronic alcoholism
b. patient with renal insufficiency
c. patient taking antacids for chronic gastrictis
d. patient on a high7protein diet
Ans: A7 patients who are at increased risk for developting hypomagnesemia include those with severe
malnutritioning# alcoholism due to inade1uate diet"# and prolonged intravenous or total parenteral nutrition
without magnesium replacement. 0he patient with renal insufficiency is prone to hypetrmagnesemia# not
hypomagnesemia# because the kidneys are the primary route for e4cretion of this electrolyte. 0he patient
taking antacids is prone to hypermagnesemia# not hypomagnesemia# if the antacid contains magnesium. A
high7protein diet should not be deficient in magnesium and would not# therefore# result in
<<. -uring a difficult procedure Gack begins to hyperventilate. 0he nurse understands that this can lead to2
a. respiratory acidosis
b. respiratory alkalosis
c. hyponatremia
d. hypernatremia
Ans: B-hyperventilation results in e4cessive loss or2 blowing offI of car bon dio4ide# which causes
alkalosis. As the respiratory system is fat fault# it would be respiratory alkalosis. 0his option is incorrect as
can be seen in rationale 3. Ayperventilation alone should have no substantial effect on the serum sodium
<B. Which of the following signs and symptoms are indicative of metabolic acidosis?
a. lethargy# disorientation# and tachycardia
b. tetany# tachycardia# and respiratory depression
c. circumoral tingling# muscle respiratory depression
d. muscle twitching# an4iety# and disoreintation
Ans: A-clinical manifestations of metabolic acidosis include drowsiness# confusion# coma# headache#
increased respiratory rate tachypnea"# arterial pA below @..'# bicarbonate less than 33 mmAg# and pC/3
normal or slightly decreased compensatory". 0hese options are incorrect as can be seen in rationale 1.
B(. Which of the following occurs as a compensatory mechanism when metabolic acidosis develops?
a. the body temperature rises
b. the heart rate slows
c. the respiratory rate increases
d. the urinary output decreases
Ans: C- when metabolic acidosis develops# the body increases its respiratory rate and depth to Hblow offI
carbon dio4ide which combines with water to form carbonic acid" and thereby decrease the acid level
compensate". 0he body temperature does not increase in response to metabolic acidosis. 0he heart rate
actually increases# rather than slows# in response to increased r;espirations. +etabolic acidosis does not
result in decreased urinary output.
B1. Gohn# a )<7year7old man# reports taking large amounts of antacids for the relief of
Hheatrtburn.I 0he nurse e4plains to him that this practice may result in2
a. hyperkalemia
b. hyponatremia
c. metabolic alkalosis
d. metabolic acidosis
Ans: C- taking large amounts of antacids# particularly baking soda# may result in metabolic alkalosis.
0aking large amounts of antacids does not result in hyperkalemia. !f the antacids are absorbed
systematically and result in metabolic alkalosis# the serum potassium level would actually decrease. 0aking
large amounts of antacids may result in hypernatremia# not hypernatremia# if the metabolic contains
sodium. Antacids cannot cause metabolic acidosis.
B3. A patient is admitted to the hospital with pneumonia. 0he nurse notes the moist crackles are present
and the patient is e4periencing shortness of breath. 0his patient is most likely suffering from the
following acid7base imbalance2
a. respiratory acidosis7 ph @.3'#pco3 )(# hco. 3)
b. metabolic acidosis7 ph @.3B# pco3 .3# hco. 1'
c. metabolic alkalosis7 ph @.;( pco3 .(# hco. 3(
d. respiratory alkalosis7 ph @.)(# pco3 3'# hco. 3;
Ans: A- the patient with moist rales and shortness of breath is not ventilating ade1uately. 0his results in a
decreased p/3 less than <( mmAg"# an increased pC/3 greater than ;' mmAg"# and respiratory
acidosis pA less than @..'". the bicarbonate level would be normal or above normal greater than 3)
mmAg" once compensation occurs. 0hese options are incorrect as can be seen in rationale 1.
B.. Which arterial blood gas findings is characteristic of a compensatory action in metabolic acidosis?
a. increased bicarbonate content
b. decreased bicarbonate content
c. increased carbon dio4ide content
d. decreased carbon dio4ide content
Ans: D- when metabolic acidosis occurs# the respiratory system attempts to correct the pA imbalance by
Hblowing offI rapid# deep breathing" carbon dio4ide. 0his result in an arteriorial pC/3 less than .' mmAg.
!n metabolic acidosis# the bicarbonate content is decreased. 0his is the initial problem# not a compensatory
effort. !f the carbon dio4ide is increased# respiratory acidosis would result. 0his certainly would not
compensate for metabolic acidosis# but instead would compound the problem
B;. 0he most appropriate nursing intervention when a patient8s serum sodium level is 1;( m?1D6 is2
a. advising the patient to avoid canned soups and vegetables# processed meats# and added table
b. carefully monitoring ?CC pattern for dysrhythmias
c. notifying the physician
d. continuing to monitor electrolyte values
Ans: D-a serum sodium level of 1;( m?1D6 is within the normal range of 1.' to 1;' m?1D6> therefore is no
need for a nursing intervention other than continue to monitor. 0hese option re incorrect as can be seen in
B'. An e4cess of e4tracellular sodium causes2
a. an increase in aldosterone production
b. fluid to leak out of the cells
c. cell size to increase
d. transient pain
Ans: B- when the e4tracellular sodium content is increased water from cells moves out from the area of
lower concentration to the area of higher concentration osmosis". A decrease# not an increase# in
e4tracellular sodium results in stimulation of the rennin7angiotensin response# which results in an increase
in aldosterone. 0his option is incorrect as seen in rationale 3.
B). A patient with diarrhea should be observed for hyponatremia because2
a. sodium is concentrated in gastrointestinal fluid
b. water lost in diarrhea causes an increase in sodium concentration
c. diarrhea triggers renal mechanisms to waste sodium
d. hyponatremia occurs as a result of treatment for diarrhea
Ans: A- gastrointestinal contents have a high sodium content and therefore loss of fluid from this area can
result in hyponatremia. 0hese options are incorrect as can be seen in rationale 1.
B@. 0he patient with a nasogastric tube to suction should be observed for2
a. metabolic alkalosis
b. muscle flaccidity
c. tachypnea
d. skin discoloration
Ans: A- the contents of the stomach are acidic. When these contents are removed from the body via
suction# the result is a net loss of acid and gain of alkali. 0he patient must be monitored for metabolic
alkalosis. 0here is no reason to assess this patient for muscle flaccidity or skin discoloration. When a
patient develops metabolic alkalosis# the respiratory system attempts to compensate by retaining carbon
dio4ide. 0herefore# the respiratory rate is decreased bradypnea".
B<. While +r. Williams is using the mechanical ventilator# some of his arterial blood gas findings are as
follows2 pA @.;<# pC/3 .(# p/3 <<# AC/. 3'. 0hese findings indicate that this patient is e4periencing
which type of acid7base abnormality?
a. metabolic acidosis
b. metabolic alkalosis
c. respiratory acidosis
d. respiratory alkalosis
Ans: D- this patient has respiratory alkalosis as a result of hyperventilation. Arterial blood gas findings in
respiratory alkalosis are pA normal or greater than @.;'# and pC/3 and bicarbonate normal 31 to 3<
m?1D6" these options are incorrect as can be seen in rationale ;.
BB. Goel# a ;@7year7old man# has been e4periencing symptoms of fluid retention. Ais physician prescribed
spironolactone Aldactone". 5ursing intervention related to this medication includes2
a. watching for muscle weakness and giving well7diluted potassium chloride kcl" supplement as
b. monitoring urine for changes in sugar and acetone
c. not giving medication at bedtime and observing for digitalis to4icity
d. not giving supplement kcl and monitoring for signs of electrolyte imbalance
Ans: D- $pironolactone Aldactone" is a potassium7sparing diuretic> therefore# potassium supplements are
not appropriate electrolyte imbalances can occur with the use in rationale ;. 0his option is incorrect as can
be seen in rationale ;. 0hese should be o changes in the presence or absence of sugar and acetone in the
urine as a result of this medication. All diuretics be given in the morning to lessen nocturia. *atients
receiving diuretics that are potassium sparing must be monitored for digitalis to4icity# because of
hypokalemia predisposes to this. Aowever# spironolactone Aldactone" is potassium sparing
1((. 0he nurse is directed to administer a hypotonic !F solution. 6ooking at the following labeled
solutions# she would choose2
a. (.;'J sodium chloride
b. (.BJ sodium chloride
c. 'J de4trose in water
d. 'J de4trose in normal saline
Ans: A-sodium chloride (.;'J is hypotonic as compared with our normal physiological saline (.BJ".
$odium chloride (.BJ is isotonic the same as normal saline". -e4trose 'J in water has the same
osmolarity as normal saline and therefore is isotonic> however# once administered it becomes hypotonic as
the body metabolizes the de4trose# leaving only water behind.