A nursing instructor is teaching her class about burns.

The instructor relates the following scenario: A

nurse is caring for a severly burned client who now has elevated hematocrit and blood cell counts. What
consequences should the nurse expect in this client?
A. Slow heart rate
B. Kidney stones and blood clots
C. Imbalance in electrolytes
D. Elevated central venous pressure (CVP)

B. Kidney stones and blood clots

Feedback: Severe burn injury may cause high fluid loss leading to hypovolemia. Elevated hematocrit
levels and blood cell counts indicate hemoconcentration, which means a high ratio of blood components
in relation to watery plasma. This increases the potential for blood clots and urinary stones. In
hypovolemia, the heart rate tends to be high because the heart tries to compensate for the drop in the
circulatory volume. Serum electrolyte levels tend to remain normal because they are depleted in
proportion to the water loss. CVP is usually below 4 cm H2O.

Which of the following conditions does the nurse need to confirm when he or she taps the facial nerve
of a client who has dysphagia?
A. Hypervolemia
B. Hypercalcemia
C. Hypomagnesemia
D. Hypermagnesemia

C. Hypomagnesemia
Feedback: If there is a unilateral spasm of facial muscles when the nurse taps over the facial muscle, it is
known as Chvostek's sign, which is a sign of hypocalcemia and hypomagnesemia. The additional
symptom of dysphagia reinforces the possibility of hypomagnesemia rather than hypocalcemia. A
positive Chvostek's sign does not apply to hypercalcemia, hypervolemia, or hypermagnesemia.

A 64-year-old client is brought in to the clinic feeling thirsty with dry, sticky mucous membranes;
decreased urine output; fever; a rough tongue; and is lethargic. Serum sodium level is above 145 mEq/L.
Should the nurse start salt tablets when caring for this client?
A. Yes, this will correct the sodium deficit
B. Yes, along with the hypotonic IV
C. No, start with the sodium chloride IV
D. No, sodium intake should be restricted

D. No, sodium intake should be restricted

Feedback: The symptoms and the high level of serum sodium suggest hyernatremia, (excess of sodium).
It is necessary to restrict sodium intake. Salt tablets and sodium chloride IV can only worsen this
condition but may be required in hyponatremia (sodium deficit). Hypotonic solution IV may be a part of
the treatment but not along with the salt tablets.

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You are caring for a client who has been admitted with a possible clotting disorder. The client is
complaining of excessive bleeding and bruising without cause. You know that you should take extra care
to check for signs of bruising or bleeding in what condition?
A. Dehydration
B. Hypokalemia
C. Hypocalcemia
D. Hypomagnesemia

C. Hypocalcemia
Feedback: Hypocalcemia or low serum calcium levels can affect clotting. Therefore, in this condition, the
nurse should take extra care to check for bruising or bleeding. There is no such risk in dehydration,
hypokalemia, or hypomagnesemia.

You are caring for a client with severe hypokalemia. The physician has ordered IV potassium to be
administered at 10 mEq/hr. The client complains of burning along his vein. What should you do?
A. Seek a physician's order to dilute the infusion
B. Switch to an oral formation
C. Increase the speed of transfusion
D. Change the electrolyte

A. Seek a physician's order to dilute the infusion

Feedback: Treatment of severe hypokalemia requires treatment with IV infusion of potassium. Clients
may experience burning along the vein with IV infusion of potassium in proportion to the infusion's
concentration. If the client can tolerate the fluid, consult with the physician about diluting the potassium
in a larger volume of IV solution. Oral potassium may not be enough in severe cases hypokalemia.
Hypokalemia requires treatment with potassium and not any other electrolyte.

Your clients lab values are sodium 166 mEq/L, potassium 5.0 mEq/L, chloride 115 mEq/L, and
bicarbonate 35 mEq/L. What condition is this client likely to have, judging by anion gap?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Respiratory acidosis

A. Metabolic acidosis
Feedback: The anion gap is the difference between sodium and potassium cations and the sum of
chloride and bicarbonate anions. An anion gap that exceeds 16 mEq/L indicates metabolic acidosis. In
this case, the anion gap is (166+5)-(115+35), yielding 21 mEq/L, which suggests metabolic acidosis.
Anion gap is not used to check for respiratory alkalosis, metabolic alkalosis, or respiratory acidosis.

The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The
physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an
acid-base imbalance that is shown in an ABG?
A. PaO2
B. PO2
C. Carbonic acid
D. Bicarbonate
D. Bicarbonate
Feedback: Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content
(PaCO2), and bicarbonate. An acid-base imbalance may accompany a fluid and electrolyte imbalance.
PaO2 and PO2 are not indications of acid-base imbalance. Carbonic acid levels are not shown in an ABG.

The nursing instructor is talking with her junior nursing class about fluid and electrolyte balance. What
would the instructor tell her students that the average daily fluid intake for an adult is?
A. 2000 mL
B. 2500 mL
C. 3000 mL
D. 3500 mL

B. 2500 mL
Feedback: In healthy adults, oral fluid intake averages about 2500 mL/day; however, it can range
between 1800 and 3000 mL/day, with a similar volume of fluid loss. Options A, C, and D are incorrect.

What is one process by which dissolved chemicals from one area of the body to another?
A. Passive osmosis
B. Free flow
C. Passive elimination
D. Active transport

D. Active transport
Feedback: Active transport requires an energy source, a substance called adenosine triphosphate (ATP),
to drive dissolved chemicals from an area of low concentration to an area of higher concentration-the
opposite of passive diffusion. Options A, B, and C are incorrect.

A client was admitted to your unit with a diagnosis of hypovolemia. When it is time to complete
discharge teaching, which of the following will the nurse teach the client and his family? Select all that
apply.
A. Drink at least eight glasses of fluid each day
B. Drink caffeinated beverages to retain fluid
C. Drink carbonated beverages to help balance fluid volume
D. Drink water as an inexpensive way to meet fluid needs
E. Respond to thirst

A. Drink at least eight glasses of fluid each day

D. Drink water as an inexpensive way to meet fluid needs
E. Respond to thirst
Feedback: In addition, the nurse teaches clients who have a potential for hypovolemia and their families
to respond to thirst because it is an early indication of reduced fluid volume; consume at least 8 to 10 (8
ounce) glasses of fluid each day and more during hot, humid weather; drink water as an inexpensive
means to meet fluid requirements; and avoid beverages with alcohol and caffeine because they increase
urination and contribute to fluid deficits.

The nurse is instructing on the body's negative feedback loop to ensure homeostasis to a class of sixth
graders. Which action by bases keeps the blood pH nearly neutral?
A. Bases cast off acids
B. Bases bind with hydrogen
C. Bases hold acidic properties
D. Bases have no contact with acids

B. Bases bind with hydrogen

Feedback: Acids are substances that release hydrogen into fluid, bases are substances that bind with
hydrogen. The delicate balance between acids and bases, as well as fluids and electrolytes, maintains
the nearly neutral blood pH.

The nurse is caring for a geriatric client in the home setting. Due to geriatric changes decreasing thirst,
the nurse is likely to see a decrease in which fluid location which contains the most body water?
A. Intracellular fluid
B. Extracellular fluid
C. Interstitial fluid
D. Intravascular fluid

A. Intracellular fluid
Feedback: About 60% of the adult human body is water. Most body water is located within the cell
(intracellular fluid). Due to several physiological changes of aging, geriatric clients have less bodily fluids.

The nurse is adding the intake and output results for a client diagnosed with dehydration. The nurse
notes a 24-hour intake of 1500 mL/day between oral fluids and intravenous solutions. The output total
is calculated as 2800 mL/day from urine output, emesis, and Hemovac drainage. Which nursing action is
best to maintain an acceptable fluid balance?
A. Suggest a fluid restriction
B. Encourage oral fluids
C. Remove the Hemovac
D. Offer a prescribed antiemetic medication

D. Offer a prescribed antiemetic medication

Feedback: When calculating the intake and output of a client, it is essential to understand that the
normal average intake is 2500 mL in adults. Ranges are often noted at 1800 to 3000 mL. Because the
client is vomiting, offering a prescribed antiemetic medication would decrease the output from emesis
and increase the input as the client may be more accepting of oral fluids. The client should be
encouraged more oral intake once vomiting has subsided, but if not possible, intravenous fluids should
be increased to avoid dehydration. A fluid restriction could cause dehydration. Removing the Hemovac
will decrease documented output but may lead to an internal infection from fluid accumulation.

The nurse is assessing residents at a summer picnic at the nursing facility. The nurse expresses concern
due to the high heat and humidity of the day. Although the facility is offering the residents plenty of
fluids for fluid maintenance, the nurse is most concerned about which?
A. Lung function
B. Summer allergies
C. Cardiovascular compromise
D. Insensible fluid loss
D. Insensible fluid loss
Feedback: Due to the high heat and humidity, geriatric clients are at a high risk for insensible fluid loss
through perspiration and vapor in the exhaled air. These losses are noted as unnoticeable and
unmeasureable. Those with respiratory deficits and allergies may be only able to be outside for a limited
period. Those with cardiovascular compromise may need to alternate outdoor activities with indoor
rest.

A client is experiencing edema in the tissue. The nurse is correct in anticipating which tonicity of
intravenous fluid?
A. Isotonic fluid
B. No intravenous solution
C. Hypertonic solution
D. Hypotonic solution

B. No intravenous solution
Feedback: There are three types (tonicity) of intravenous fluids, which are isotonic, hypotonic, and
hypertonic solutions. By process of osmosis and diffusion, solutes are moved through the body. A
hypertonic solution is used to pull water back in to circulation as a hypertonic solution has more
particles than the body's water. An isotonic solution is the same concentration as the body's water and
is used as an intravenous volume expander. A hypotonic solution has fewer particles than the body's
water thus shifting water from the vascular space to the tissue.

The nurse is correct to state that a client's body needs to have adequate nutrition to maintain energy.
Which type of transport of dissolved substances requires adenosine triphosphate (ATP)?
A. Osmosis
B. Passive diffusion
C. Facilitated diffusion
D. Active transport

D. Active transport
Feedback: Active transport requires the use of the body's energy molecule (ATP) to meet body needs for
fluid and particle transport. Osmosis is the movement of body fluids through a semipermeable
membrane that allows not all substances to pass through. Passive diffusion allows the movement of
substances from an area of higher concentration to lower concentration. Facilitated diffusion has certain
dissolved substances that require the assistance from a carrier module to pass through the
semipermeable membrane.

The nurse is reviewing lab work on a newly admitted client. Which of the following diagnostic studies
confirm the nursing diagnosis of Deficient Fluid Volume? Select all that apply.
A. An elevated hematocrit level
B. A low urine specific gravity
C. Electrolyte imbalance
D. Low protein level in the urine
E. Absence of ketones in urine

A. An elevated hematocrit level

C. Electrolyte imbalance
Feedback: Dehydration is a common primary or secondary diagnosis in healthcare. An elevated
hematocrit level reflects low fluid level and a hemoconcentration. Electrolytes are in an imbalance as
sodium and potassium levels are excreted together in client with dehydration. The urine specific gravity,
due to concentrated particle level, is high. Protein is not a common sign of dehydration. Ketones are
always present in the urine.

The nurse is conducting a lecture on the difference between hypovolemia and dehydration. When
completing a verbal comparison, which point needs clarified?
A. Similar causes are present in both conditions
B. Hypovolemia contains only low blood volume
C. In dehydration, only extracellular is depleted
D. Both conditions result in abnormal laboratory studies

C. In dehydration, only extracellular is depleted

Feedback: In clients diagnosed with dehydration, all fluid compartments including the intracellular and
extracellular compartment are reduced. The other options are correct. Both states can be from similar
disease process such as vomiting, fever, diarrhea and difficulty swallowing and also have abnormal lab
work. It is correct that hypovolemia relates to low blood volume.

Which laboratory result does the nurse identify as a direct result of the client's hypovolemia status with
hemoconcentration?
A. Abnormal potassium level
B. Elevated hematocrit level
C. Low white blood count
D. Low urine specific gravity

B. Elevated hematocrit level

Feedback: When hemoconcentration occurs due to a hypovolemic state, a high ratio of blood
components in relation to watery plasma occurs, thus causing an elevated hematocrit level. A high white
blood cell count and urine specific gravity is also noted. Other causes of an abnormal potassium level
may be present.

The nurse is providing nutritional instruction to the client diagnosed with hypovolemia. Which would the
nurse emphasize as something to avoid?
A. Eight to 10 glasses of water per day
B. Foods high in sodium
C. Potassium-rich fruit
D. Beverages with alcohol or caffeine

D. Beverages with alcohol or caffeine

Feedback: The nursing management of clients with hypovolemia is to restore fluid balance. The nurse
provides nutitional information and instructs the client to avoid beverages with alcohol and caffeine,
which increases urination and contributes to the fluid deficits. The clients should drink 8 to 10 glasses of
water daily, include sodium in the diet, and eat potassium-rich fruit.

The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign in indicative
of the disease process?
A. Low heart rate
B. Elevated blood pressure
C. Rapid respiration
D. Subnormal temperature

B. Elevated blood pressure

Feedback: Indicative of hypervolemia is a bounding pulse and elevated blood pressure due to the excess
volume in the system. Respirations are not typically affected unless there is fluid accumulation in the
lungs. Temperature is not generally affected.

The nurse is proving afternoon shift report and relates morning assessment findings to the oncoming
nurse. Which daily assessment data is necessary to determine changes in hypervolemia status?
A. Vital signs
B. Edema
C. Intake and output
D. Weight

D. Weight
Feedback: Daily weight provides the ability to monitor fluid status. A 2-lb weight gain in 24 hours
indicates that the client is retaining 1 L of fluid. Also, the loss of weight can indicate a decrease in
edema. Vital signs do not always reflect fluid status. Edema could respresent a shift of fluid within body
spaces and not a change in weight. Intake and output don't account for insensible fluid loss.

The nurse is documenting assessment findings of a client diagnosed with anasarca. Which nursing
documentation best shows improvement in disease progression?
A. Decreased abdominal girth
B. Increased level of consciousness
C. Weight maintenance
D. Pulse rate decrease

A. Decreased abdominal girth

Feedback: Third-spacing is the tanslocation of fluid from the intravascular to intercellular space to tissue
compartment. Anasarca is the general edema in the organ cavities such as the abdomen. Monitoring the
abdominal girth provides data on the localization of the fluid in the interstitual space. A decrease in
girth, in particular, notes improvement. Level of consciousness is not affected unless shock occurs.
Weight remains the same as there is a shifting in fluid; pulse rate could fluctuate according to fluid
movement

Which nursing action is anticipated by the nurse to restore colloidal osmotic pressure to clients with
third-spacing?
A. Initiate an IV of an isotonic solution
B. Initiate an IV of albumin
C. Manage an infusion of plasma
D. Manage an infusion of total parenteral nutrition

B. Initiate an IV of albumin
Feedback: The best answer to resotre colloidal osmotic pressure is to initiate an IV of albumin.
Administration of albumin pulls the trapped fluid back into the intravascular space. An isotonic solution
will not pull water from the intercellular space. Blood products are used for third-spacing management;
however, albumin is the product of choice. The management of total parenteral nutrition is not
associated with third-spacing.

The nurse is caring for four clients on a medical unit. The nurse is most correct to review which client's
laboratory reports first for an electrolyte imbalance?
A. A 7-year-old with a fracture tibia
B. A 65-year-old with a myocardial infarction
C. A 52-year-old with diarrhea
D. A 72-year-old with a total knee repair

C. A 52-year-old with diarrhea

Feedback: Electrolytes are in both intracellular and extracellular water. Electrolyte deficiency occurs
from an inadequate intake of food, conditions that deplete water such as nausea and vomiting, or
disease processes that cause an excess of electrolyte amounts. The 52-year-old with diarrhea would be
the client most likely to have an electrolyte imbalance. The orthopedic patients will not likely have an
electrolyte imbalance. Myocardial infarction patients will occasionally have electrolyte imbalance, but
this is the exception rather than the rule.

The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for
additional orders?
A. Potassium: 5.8 mEq/L
B. Sodium: 138 mEq/L
C. Magnesium: 2 mEq/L
D. Calcium: 10 mg/dL

A. Potassium: 5.8 mEq/L

Feedback: Normal potassium level is 3.5 to 5.5 mEq/L. Elevated potassium levels can lead to muscle
weakness, paresthesias, and cardiac dysrhythmias.

The nurse is assigned a client with calcium level of 4.0 mg/dL. Which system assessment would the
nurse ask detailed questions?
A. Endocrine system
B. Gastrointestinal system
C. Neurological system
D. Musculoskeletal system

C. Neurological system
Feedback: A client with a calcium level of 4.0 mg/dL has hypocalcemia. The nurse closely monitors the
client with hypocalcemia for neurological manifestations such as tetany, seizures, and spasms. If the
calcium level continues to decrease, seizure precautions are necessary. Cardiac dysrhythmias and airway
obstruction may also occur.

The nurse is caring for a client with multiple organ; failure and in metabolic acidosis. Which pair of
organs is responsible for regulatory processes and compensation?
A. Kidney and liver
B. Heart and lungs
C. Lungs and kidney
D. Pancreas and stomach

C. Lungs and kidney

Feedback: The lungs and kidneys facilitate the ratio of bicarbonate to carbonic acid. Carbon dioxide is
one of the components of carbonic acid. The lungs regulate carbonic acid levels by releasing or
conserving CO2 by increasing or decreasing the respiratory rate. The kidneys assist in acid-base balance
by retaining or excreting bicarbonate ions.

The nurse receives report that a client's pH level is 7.4. Which nursing action would be most
appropriate?
A. Call the physician with the report
B. Encourage the client to deep breath
C. Complete a head-to-toe assessment
D. Obtain an ECG

C. Complete a head-to-toe assessment

Feedback: The nurse realizes that a pH level of 7.4 is within normal limits. No additional measures need
obtained and the nurse would perform a usual head-to-toe assessment.

The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and
experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most
correct to identify which result of the disease process that causes the rise in pH?
A. The lungs are unable to breathe in sufficient oxygen
B. The lungs are unable to exchange oxygen and carbon dioxide
C. The lungs have ineffective cilia from years of smoking
D. The lungs are not able to blow off carbon dioxide

D. The lungs are not able to blow off carbon dioxide.

Feedback: In clients with chronic respiratory acidosis, the client is unable to blow off carbon dioxide
leaving in increased amount of hydrogen in the system. The increase in hydrogen ions leads to acidosis.
In COPD, the client is able to breathe in oxygen and gas exchange can occur, it is the lungs ability to
remove the carbon dioxide from the system. Although individuals with COPD frequently have a history
of smoking, cilia is not the cause of the acidosis.

The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a
nasogastric tube to low continuous suction. Which acid-base imbalance is most likely to occur?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis

B. Metabolic alkalosis
Feedback: Metabolic alkalosis results in increased plasma pH because of an accumulated base
bicarbonate or decreased hydrogen ion concentration. Factors the increase base bicarbonate include
excessive oral or parenteral use of bicarbonate-containing drugs, a rapid decrease in extracellular fluid
volume and loss of hydrogen and chloride ions as with gastric suctioning. Acidotic states are from excess
carbonic acid and hydrogen ions in the system. Respiratory alkalosis results from a carbonic acid deficit
that occurs when rapid breathing releases more CO2 than necessary.

Upon shift report, the nurse states the following laboratory values: pH, 7.44; PCO2, 30 mmHg; and
HCO3, 21 mEq/L for a client with noted acid-base disturbances. Which acid-base imbalance do both
nurses agree is the client's current state?
A. Compensated respiratory alkalosis
B. Uncompensated respiratory alkalosis
C. Compensated metabolic acidosis
D. Compensated metabolic alkalosis

A. Compensated respiratory alkalosis

Feedback: The question states that the client has a history of acid-base disturbance. The nurse would
first note that the pH has returned to close to normal indicating compensation. The nurse then assess
the PCO2 (normal: 35 to 45 mmHg) and HCO3 (normal: 22 to 27 mEq/L) levels. In a respiratory condition,
the pH and the PCO2 move in opposite direction; thus, the pH rises and the PCO2 drops (alkalosis) or
vice versa (acidosis). In a metabolic condition, the pH and the bicarbonate move in the same direction; if
the pH is low, the bicarbonate level will be low, also. In this client, the pH is at the high end of normal,
indicating compensation and alkalosis. The PCO2 is low, indicating a respiratory condition (opposite
direction of the pH).

The nurse is caring for a client prescribed a low sodium diet. Which food, identified as a client favorite,
will the nurse discourage?
A. A grilled chicken sandwich with mayonnaise
B. A natural fruit salad with nuts
C. A hot dog with catsup
D. A fresh grilled tuna entrée with fresh asparagus

C. A hot dog with catsup

Feedback: Foods high in sodium include processed meats, such as hot dogs and cold cuts; fast foods;
frozen meals; cheeses; soups and juices; and salted snack foods to name a few.

The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is
consistent with the dehydration?
A. Cool and pale skin
B. Crackles in the lung fields
C. Distended jugular veins
D. Dark, concentrated urine

D. Dark, concentrated urine

Feedback: Dehydration indicates a fluid volume deficit. Dark, concentrated urine indicates a lack of fluid
volume. Adding more fluid would dilute the urine. The other options indicate fluid excess.

The nurse is caring for a client with frequent dizziness. The nurse is evaluating the client for postural
hypotension. Which of the following symptoms would indicate a potential diagnosis?
A. A blood pressure elevation upon rising or activity
B. A drop in systolic blood pressure (15 mmHg) upon rising
C. A pulsating headache
D. A drop in distalic blood pressure (25 mmHg) upon rising

B. A drop in systolic blood pressure (15 mmHg) upon rising

Feedback: Postural hypotension occurs when the client rises from a spine or semi-Fowler's position to a
standing position and the systolic blood pressure drops by 15 mmHg. The client has symptoms of
dizziness or a near syncopal episode.

You are the nurse caring for a client in septic shock. You know to closely monitor your client. What
finding would you observe when the client's condition is in its initial stages?
A. A rapid, bounding pulse
B. A slow but steady pulse
C. A weak and thread pulse
D. A slow and imperceptible pulse

A. A rapid, bounding pulse

Feedback: A rapid, bounding pulse is observed in a client in the initial stages of septic shock. In case of
hypovolemic shock, the pulse volume becomes weak and thread and circulating volume diminishes in
the initial stage. In the later stages when the circulating volume has severely diminished, the pulse
becomes slow and imperceptible, and pulse rhythm changes from regular to irregular.

You are caring for a client with shock. You are concerned about hypoxemia and metabolic acidosis with
your client. What finding should you analyze for evidence of hypoxemia and metabolic acidosis in a
client with shock?
A. Serum thyroid level findings
B. Arterial blood gas (ABG) findings
C. Red blood cells (RBCs) and hemoglobin count findings
D. White blood cell count findings

B. Arterial blood gas (ABS) findings

Feedback: Analysis of ABG findings is essential for evidence of hypoxemia and metabolic acidosis. Low
RBCs and hemoglobin correlate with hypovolemic shock and can lead to poor oxygenation. An elevated
white blood cell count supports septic shock. Serum thyroid level findings do not help determine the
presence of hypoxemia or metabolic acidosis.

You are the nurse caring for a client with shock accompanied by lung congestion. How would you
position this client?
A. Completely supine
B. Low Fowler's with legs flat
C. Supine with lower extremities raised to approximately 45 degrees
D. Semi-Fowler's with lower extremities raised to approximately 15 degrees

D. Semi-Fowler's with lower extremities raised to approximately 15 degrees

Feedback: For a client with shock accompanied by lung congestion, the nurse should raise the client's
upper body to approximately 45 degrees and lower extremities to approximately 15 degrees. Elevating
the upper body lowers the diaphragm and provides more room for lung expansion and gas exchange.
Elevating the head reduces intracranial pressure. Elevating the legs promotes blood perfusion to the
heart, lungs, and brain. Therefore, options A, B, and C are incorrect.

You are a nursing student preparing to care for an ICU client with shock. Your instructor asks you to
name the different categories of shock. Which of the following is a category of shock?
A. Hypervolemic
B. Distributive
C. Restrictive
D. Cardiotonic

B. Distributive
Feedback: The four main categories of shock are hypovolemic, distributive, obstructive, and cardiogenic,
depending on the cause. This makes options A, C, and D incorrect.

You are caring for a client who is in neurogenic shock. You know that this is a subcategory of what kind
of shock?
A. Obstructive
B. Hypovolemic
C. Carcinogenic
D. Distributive

D. Distributive
Feedback: Three types of distributive shock are neurogenic, septic, and anaphylactic shock. There is no
such thing as carcinogenic shock. Obstructive and hypovolemic shock do not have subcategories.

You are a student nurse being precepted in the ICU. You are caring for a client in the compensatory
stage of shock who is hypovolemic. Which compensatory mechanism is most important in the
reabsorption and retention of fluid in the body?
A. Activation of renin-angiotensin-aldosterone system
B. Secretion of epinephrine and norepinephrine
C. Production of antidiuretic hormone and corticosteroid hormones
D. Release of catecholamines

C. Production of antidiuretic hormone and corticosteroid hormones

Feedback: Thus, they play an active role in controlling sodium and water balance. Both ADH and
corticosteroid hormones, then, promote fluid reabsorption and retention. The renin-angiotensin-
aldosterone system is a mechanism that restores blood pressure (BP) when circulating volume is
diminished. The release of catecholamines stimulates secretion of epinephrine and norepinephrine.

You are assessing a 6-year-old little girl in the emergency department (ED) who was brought in by her
mother. She was stung by a bee and is allergic to bee venom. The child is now having trouble breathing.
She is vasodilated, hypotensive, and has broken out in hives. What do you suspect is wrong with this
child?
A. She is having an allergic reaction and going into cardiogenic shock
B. She is having an allergic reaction and going into anaphylactic shock
C. She is having an allergic reaction and going into neurogenic shock
D. She is having an allergic reaction and going into obstructive shock
B. She is having an allergic reaction and going into anaphylactic shock
Feedback: Anaphylactic shock is a severe allergic reaction that follows exposure to a substance to which
a person is extremely sensitive. Common allergic substances include bee venom, latex, fish, nuts, and
penicillin. The body's immune response to the allergic substance causes mast cells in the connective
tissues, bronchi, and gastrointestinal tract to release histamine and other chemicals. The resulrs are
vasodilatation, increased capillary permeability accompanied by swelling of the airway and
subcutaneous tissues, hypotension, and hives or an itchy rash. Cardiogenic shock, neurogenic shock, and
obstructive shock would not begin with vasodilation, swelling of the airway, and hives. Therefore,
options A, C, and D are incorrect.

You are caring for a client in the compensation stage of shock. You know that one of the body's
mechanisms of compensation in this stage of shock is the renin-angiotensin-aldosterone system. What
does this system do?
A. Decreases peripheral blood flow
B. Increases catecholamine secretion
C. Increases the production of antidiuretic hormone
D. Restores blood pressure

D. Restores blood pressure

Feedback: The renin-angiotensin-aldosterone system is a mechanism that restores blood pressure (BP)
when circulating volume is diminished. It does not decrease peripheral blood flow, increase
catecholamine secretion, or increase the production of antidiuretic hormone.

You are caring for a client in shock who is deteriorating. You are infusing IV fluids and giving medications
as ordered. What type of medications are you most likely giving to this client?
A. Hormone antagonist drugs
B. Antimetabolite drugs
C. Adrenergic drugs
D. Anticholinergic drugs

C. Adrenergic drugs
Feedback: Adrenergic drugs are the main medications used to treat shock. This makes options A, B, and
D incorrect.

A patient presents to the ED in shock. At what point in shock does the nurse know that metabolic
acidosis is going to occur?
A. Compensation
B. Irreversible
C. Early
D. Decompensation

D. Decompensation
Feedback: The decompensation stage occurs as compensatory mechanisms fail. The client's condition
spirals into cellular hypoxia, coagulation defects, and cardiovascular changes. As the energy supply falls
below the demand, pyruvic and lactic acids increase, causing metabolic acidosis. Therefore, options A, B,
and C are incorrect.
The nurse is caring for a motor vehicle accident client who is unresponsive on arrival to the emergency
department. The client has numerous fractures, internal abdominal injuries, and large lacerations on the
head and torso. The family arrives and seeks update on the client's condition. A family member asks, "
What causes the body to go into shock?" Given the client's condition, which statement is most correct?
A. "The client is in shock because the blood volume has decreased in the system"
B. "The client is in shock because the heart in unable to circulate the body fluids"
C. "The client is in shock because your loved one is not responding and brain dead
D. "The client is in shock because all peripheral blood vessels have massively dilated"

A. "The client is in shock because the blood volume has decreased in the system"
Feedback: Shock is a life-threatening condition that occurs when arterial blood flow and oxygen delivery
to tissues and cells are inadequate. Hypovolemic shock, where the volume of extracellular fluid is
significantly diminished due to the loss of or reduced blood or plasma, frequently occurs with accidents.

The nurse is evaluating a client in the intensive care unit to identify improvement in the client's
condition. Which outcome does the nurse note as the result of inadequate compensatory mechanisms?
A. Liver dysfunction
B. Organ damage
C. Weight loss
D. Unsteady gait

B. Organ damage
Feedback: When the body is unable to counteract the effects of shock, further system failure occurs,
leading to organ damage and ultimately death. Liver dysfunction may occur as one of the organs which
fail. Weight fluctuations may occur if the body holds fluid or is administered a diuretic. Large
fluctuations are not noted between shifts. The client is not able to ambulate.

A client is in a driving accident creating a spinal cord injury. The nurse caring for a client realizes that the
client is at risk for which type of shock?
A. Anaphylactic
B. Neurogenic
C. Septic
D. Obstructive

B. Neurogenic
Feedback: Neurogenic shock results from an insult to the vasomotor center of the medulla or to the
peripheral nerves that extend from the spinal cord to the blood vessels. The tone of the sympathetic
nervous system is impaired, resulting in deceased arterial vascular resistance, vasodilation, and
hypotension. Anaphylactic shock has vasodilation also as a key characteristic, along with increased
capillary permeability, swelling of the airway, hives, and itching. Septic shock is associated with
overwhelming bacterial infections. Obstructive shock is when there is an interference of blood flow in
and out of the heart.

A client presents to the community health office experiencing rapidly increasing symptoms of
anaphylactic shock. Which nursing action would be completed first?
A. Obtain the name and information of the allergic substance
B. Administer an epinephrine injection
C. Notify a physician
D. Call 911

B. Administer an epinephrine infection

Feedback: The key words in the question are "increasing symptoms." The first action of the nurse is to
administer an epinephrine injection to abort the rapidly increasing symptoms. Next, the nurse will call
911.

The nurse is reviewing diagnostic lab work of a client developing shock. Which laboratory result does the
nurse note as a key in determining the type of shock?
A. Hemoglobin: 14.2 g/dL
B. Potassium: 4.8 mEq/L
C. WBC: 42,000/mm3
D. ESR: 19 mm/hour

C. WBC: 42,000/mm3
Feedback: Septic shock has the highest mortality rate and is caused by an overwhelming bacterial
infection; thus, an elevated WBC can indicate this type of shock. The outer lab values are within normal
limits.

A nurse educator is teaching students the types of shock and associated causes. Which combination of
shock type and causative factors are correct? Select all that apply.
A. Hypovolemic shock; blood loss
B. Obstructive shock; kidney stone
C. Cardiogenic shock; myocardial infarction
D. Anaphylactic shock; nuts
E. Septic shock; infection
F. Neurogenic shock; diabetes

A. Hypovolemic shock; blood loss

C. Cardiogenic shock; myocardial infarction
D. Anaphylactic shock; nuts
E. Septic shock; infection
Feedback: Shock is a life-threatening condition that occurs when arterial blood flow and oxygen delivery
to tissues and cells are inadequate. Hypovolemic shock occurs when the volume of extracellular fluid is
significantly diminished due to the loss of or reduced blood or plasma. Obstructive shock occurs when
there is interfere in blood flow through the heart. Cardiogenic shock occurs when the heart is ineffective
in pumping possibly due to a myocardial infarction. Anaphylactic shock occurs from an allergen such as
nuts. Septic shock occurs from a bacterial infection. Neurogenic shock results from an insult to the
vasomotor center in the medulla or peripheral nerves.

The nurse is caring for a critically ill client. Which of the following is the nurse correct to identify as a
positive effect of catecholamine release during the compensation stage of shock?
A. Decreased white blood cell count
B. Increase in arterial oxygenation
C. Decreased depressive symptoms
D. Regulation of sodium and potassium
B. Increase in arterial oxygenation
Feedback: Cateholamines are neurotransmitters that stimulate responses via the sympathetic nervous
system. A positive effect of catecholamine release increases heart rate and myocardial contraction as
well as bronchial dilation improving the efficient exchange of oxygen and carbon dioxide. The do not
decrease WBCs or decrease the depressive symptoms. They do not regulate sodium and potassium.

Which compensatory mechanism, during the first stage of shock, is the nurse most correct to identify as
responsible for stabilization of fluid balance?
A. Catecholamines
B. Corticosteroid hormones
C. Renin-angiotensin
D. Aldosterone

B. Corticosteroid hormones
Feedback: Corticosteroids, including mineralocorticoids such as aldosterone, conserve sodium and
promote potassium excretion. This plays an active role in controlling sodium and water balance.
Catecholamines impact the sympathetic nervous system. The renin-angiotensin-aldosterone system
impacts blood volume.

The nurse is caring for a client who has progressed to the decompensation stage of shock. Which
intravenous medication does the nurse anticipate as a prophylactic means to prevent complications?
A. Furosemide
B. Vancomycin
C. Morphine
D. Heparin

D. Heparin
Feedback: As a cell becomes damaged, an inflammatory response ensues. Platelets become sticky,
predisposing the client to microemboli. The nurse anticipates heparin, an anticoagulant, because it has
been found to reduce emboli. The other medications are not anticipated at this time.

The nurse is caring for a client diagnosed with shock. During report, the nurse reports the results of
which assessments that signal early signs of the decompensation stage? Select all that apply.
A. Vital signs
B. Nutrition
C. Skin color
D. Gait
E. Urine output
F. Peripheral pulses

A. Vital signs
C. Skin color
E. Urine output
F. Peripheral pulses
Feedback: Although shock can develop and progress quickly, the nurse monitors evidence of early signs
that blood volume and circulation is becoming compromised. Vital signs, skin color, urine output related
to blood perfusion of the kidneys, and peripheral pulses all provide assessment data relating blood
volume and circulation.

The nurse is obtaining physician orders which include a pulse pressure. The nurse is most correct to
report which of the following?
A. The difference between an apical and radial pulse
B. The difference between an upper extremity and lower extremity blood pressure
C. The difference between the systolic and diastolic pressure
D. The difference between the arterial and venous blood pressure

C. The difference between the systolic and diastolic pressure

Feedback: The nurse would report the difference between the systolic blood pressure number an the
diastolic blood pressure number as the pulse pressure.

The nurse is reporting the current nursing assessment to the physician. Vital signs: temperature, 97.2
degrees F; pulse, 6 beats/ minute, thread; respiration, 28 breaths/minute, blood pressure, 102/78
mmHg; and pedal pulses, palpable. The physician asks for the pulse pressure. Which would the nurse
report?
A. Within normal limits
B. Thready
C. 24
D. Palpable

C. 24
Feedback: The pulse pressure is the numeric difference between systolic and diastolic blood pressure.
By subtracting the two numbers, the physician would be told 24. The pulse pressure does not report
quality of the pulse.

The nurse is caring for a client with highly pigmented skin. Which assessment technique is used to
evaluate cyanosis?
A. Blanch the nail beds
B. Inspect the conjunctiva
C. Note dullness in skin color
D. Assess the earlobe

B. Inspect the conjunctiva

Feedback: In clients with highly pigmented skin, cyanosis is more accurately detected by inspecting the
conjunctiva and oral mucous membranes. The other options do not provide the best assessment for
cyanosis.

The seasoned nurse is instructing the new graduate on information obtained from central venous
pressure and pulmonary artery pressure. Which statement, made by the seasoned nurse, reflects the
most pertinent information regarding circulation?
A. "Central venous pressure reflects the pressure in the right atrium or venae cavae"
B. "A pulmonary artery pressure provides information about pressure on the left side of the heart"
C. "The trend in central venous pressure is more helpful than isolated readings"
D. "Pulmonary artery pressure and pulmonary capillary pressure is assessed by an inserted catheter"
B. "A pulmonary artery pressure provides information about pressure on the left side of the heart"
Feedback: The most pertinent information to share with a new nurse is the information that the
pulmonary artery pressure provides essential information about the effectiveness of left ventricle. The
left ventricle is most pertinent to circulation. The other information is correct but not as pertinent.

The nurse is initiating intravenous therapy for a client who is in shock. Which ratio of fluid to fluid lost is
anticipated?
A. 1:1
B. 2:1
C. 3:1
D. 4:1

C. 3:1
Feedback: Usually, a ratio of 3 L of fluid is administered for every 1 L of fluid lost.

The nurse is caring for a client who does not accept blood or blood products. Which nursing actions
conserve blood? Select all that apply.
A. Administer medications to stimulate bone marrow
B. Draw minimum volume of blood for diagnostic tests
C. Administer plasma to expand intravascular volume
D. Reinfuse the client's own blood via closed circuit container
E. Administer factor VIII to stimulate coagulation process
F. Administer blood product only in an emergency

A. Administer medication to stimulate bone marrow

B. Draw minimum volume of blood for diagnostic tests
D. Reinfuse the client's own blood via closed circuit container
E. Administer factor VIII to stimulate coagulation process
Feedback: The client that does not except blood or blood products will accept medications to stimulate
his natural production of cells or cause his current cells to last. Also measure that use the blood product
wisely are stressed. Plasma is a component of the blood so the client would not permit the infusion and
will not consent to blood products in an emergency.

The registered nurse is receiving a client from the emergency room on a dopamine drip. The registered
nurse asks the nurse to prepare the room for the client. The practical nurse obtains an IV pump, sets the
bed, arranges the furniture, and places towels and a gown in the bathroom. Which other piece of
equipment is essential?
A. A ventilator
B. Padded side rails
C. A tracheostomy set
D. An automatic blood pressure monitoring machine

D. An automatic blood pressure monitoring machine

Feedback: A client who is brought from the emergency department on a dopamine drip will need
continuous blood pressure monitoring. An automatic blood pressure monitoring machine will document
and trend the results. It is too early to assume a ventilator is needed. Padded side rails are used for
clients at risk for seizure activity. A tracheostomy set is needed for a client with airway concerns.
The nurse is administering a medication to the client with a positive inotropic effect. Which action of the
mediccation does the nurse anticipate?
A. Slow the heart rate
B. Increase the force of myocardial contraction
C. Depress the central nervous system
D. Dilate the bronchial tree

B. Increase the force of myocardial contraction

Feedback: The nurse realizes that when administering a medication with a positive inotropic effect, the
medication increases the force of heart muscle contraction. The heart rate increases not decreases. The
central nervous system is not depressed nor is there a dilation of the bronchial tree.

The nurse is caring for a client diagnosed with hypovolemic shock. Which outcome would be the best
evidence of an improvement in client condition?
A. A rise in blood count
B. Alertness in level of consciousness
C. Increased heart rate
D. Pulse oxygenation level of 92%

B. Alertness in level of consciousness

Feedback: In hypovolemic shock, the volume of extracellular fluid is significantly diminished because of
lost or reduced blood or plasma. Circulation is impaired. Alertness in the level of consciousness indicates
improved circulation and thus oxygenation to the brain. A documented rise in blood count is promising
unless tissue damage has already occurred. A decrease in heart rate would mean the heart is no longer
struggling to circulate blood to meet tissue needs. A pulse oxygenation level of 92% is a good sign of
available oxygen for the tissue.

The nurse is caring for the client with massive blood loss from a gunshot wound. With little time to
spare, which blood type is infused?
A. Type A
B. Type B
C. Type A/B
D. Type O

D. Type O
Feedback: When in an emergency situation, the safest blood type to infuse in type O, meaning that
there are no antigens on the red bloode cell. This is the universal donor blood type, which is compatible.
The other blood types may cause a transfusion reaction.

The nurse is performing hourly assessments on a client in the compensation stage of shock. In
documenting the hourly urine output of 40 mL from the Foley catheter, which nursing action is most
appropriate?
A. Reposition the client and make sure there are no kinks in the catheter tubing
B. Notify the physician of the houtly output and encourage physician assessment
C. Record 40 mL as the hourly output
D. Notify the family of the urine output
C. Record 40 mL as the hourly output
Feedback: Urine output above 35 mL/hour or 500 mL/day indicates adequate kidney perfusion. The
hourly output would be documented in the client record. There is no need to reposition the client or
look for a kink because adequate amounts of urine is collecting in the tube. There is no need to notify
the physician or family.

The nurse is planning care for a client diagnosed with cardiogenic shock. Which nursing intervention is
most helpful to decrease myocardial oxygen consumption?
A. Limit interaction with visitors
B. Avoid heavy metal
C. Maintain activity restriction to bedrest
D. Arrange personal care supplies nearby

C. Maintain activity restriction to bedrest

Feedback: Restricting activity to bedrest provides the best example of decreasing myocardial oxygen
consupmtion. Inactivity reduces the heart rate and allows the heart to fill with more blood between
contractions. The other options may be helpful, but the best option is limiting activity.

The community health nurse finds the client collapsed outdoors. The nurse assesses that the client is
shallow breathing and has a weak pulse. The 911 is called by the neighbor. Which nursing action is
helpful while waiting for the ambulance?
A. Place a cool compress on head
B. Elevate the legs higher than the heart
C. Shake the client to arouse
D. Cover the client with a blanket

B. Elevate the legs higher than the heart

Feedback: The client has shallow respiration and a weak pulse implying limited circulation and gas
exchange. Most helpful would be to elevate the legs higher than the heart to promote blood perfusion
to the heart, lungs, and brain. A cool compress would not be helpful not would shaking the client to
arouse. A client can be covered with a blanket, but this is not the most helpful.

The nurse is assisting the physician with placing a venticular assist device (VAD). Which assessment
finding would confirm the successful implementation?
A. Respiratory rate deceased
B. Heart rate increased
C. Pedal pulse stronger
D. Temperature within normal limits

C. Pedal pulse stronger

Feedback: The ventricular assist device (VAD) is a medical mechanical device used to improve cardiac
out put and redistribute blood. The best evidence to confirm successful implementation is by identifying
a strong pedal pulse in a lower extremity. Respiratory rate decreases as a client rests. Heart rate
decreases when the tissues obtain the needed oxygen. The temperature within normal limits does not
confirm successful implementation.
The nurse is caring for a client in the irreversible stage of shock. The nurse is explaining to the client's
family the poor prognosis. Which would the nurse be most accurate to explain as the rationale for
imminent death?
A. Endotoxims in the system
B. Limited gas exchange
C. Brain death
D. Multiple organ failure

D. Multiple organ failurewhich nursing action is anticipated by the nurse to restore

Feedback: In the irreversible stage of shock, significant cells and organs are damaged. The client's
condition reaches a "point of no return" despite treatment efforts. Death occurs from multiple system
failure as the kidneys, heart, lungs, liver, and brain cease to function.

You are the nurse caring for a client with shock accompanied by lung congestion. How would you
position this client?
A. Completely supine
B. Low Fowler's with legs flat
C. Supine with lower extremities raised to approximately 45 degrees
D. Semi-Fowler's with lower extremities raised to approximately 15 degrees

D. Semi-Fowler's with lower extremities raised to approximately 15 degrees

Feedback: For a client with shock accompanied by lung congestion, the nurse should raise the client's
upper body to approximately 45 degrees and lower extremities to approximately 15 degrees. Elevating
the upper body lowers the diaphragm and provides more room for lung expansion and gas exchange.
Elevating the head reduces intracranial pressure. Elevating the legs promotes blood perfusion to the
heart, lungs, and brain. Therefore, options A, B, and C are incorrect.

You are a nursing student preparing to care for an ICU client with shock. Your instructor asks you to
name the different categories of shock. Which of the following is a category of shock?
A. Hypervolemic
B. Distributive
C. Restrictive
D. Cardiotonic

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that
the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for
which associated manifestations?
A. Hypertension, tachycardia, and fever

B. Hypotension, bradycardia, and hypothermia

C. Restlessness, irritability, and generalized weakness

D. Headache, deteriorating level of consciousness, and twitching

D. Headache, deteriorating level of consciousness, and twitching

Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of
consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is
caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-
brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes
into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of
symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by
dialyzing for shorter times or at reduced blood flow rates.

A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. The nurse
should assess the client for which expected manifestation of AKI?
A. Bradycardia

B. Hypertension

C. Decreased cardiac output

D. Decreased central venous pressure

B. Hypertension
AKI caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of AKI
commonly manifests with hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid
overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of
the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not
part of the clinical picture for any form of renal failure.

The nurse is analyzing the post-hemodialysis laboratory test results for a client with chronic kidney
disease. The nurse interprets that the dialysis is having an expected but nontherapeutic effect if which
value is decreased?
A. Potassium

B. Creatinine

C. Phosphorus

D. Red blood cell (RBC) count

D. Red blood cell (RBC) count

Hemodialysis typically lowers the amounts of fluid, sodium, potassium, urea nitrogen, creatinine, uric
acid, magnesium, and phosphate levels in the blood. Hemodialysis also worsens anemia because RBCs
are lost during dialysis from blood sampling and anticoagulation and from residual blood left in the
dialyzer. Although all of these results are expected, only the lowered RBC count is nontherapeutic and
worsens the anemia already caused by the disease process.

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A client with chronic kidney disease (CKD) takes aluminum hydroxide gel (ALternaGEL) as a phosphate
binder. On the basis of this information, the nurse determines that the client is most at risk for which
problem?
A. Constipation

B. Dehydration

C. Inability to tolerate activity

D. Impaired physical mobility

A. Constipation
The client with CKD is almost certain to have a problem with constipation as a result of factors such as
fluid restriction, fatigue that limits exercise, and dietary restrictions. In addition, phosphate-binding
antacids such as aluminum hydroxide gel cause constipation as a side effect. The other problems listed
are unrelated to the information in the question.

A client with an arteriovenous fistula in the left arm and who is undergoing hemodialysis is at risk for
infection. Which should the nurse formulate as the best outcome goal for this client problem?
A. The client washes hands at least once per day.

B. The client's temperature remains lower than 101° F.

C. The client avoids blood pressure (BP) measurement in the left arm.

D. The client's white blood cell (WBC) count remains within normal limits.

D. The client's white blood cell (WBC) count remains within normal limits.
General indicators that the client is not experiencing infection include a temperature and WBC count
within normal limits. The client also should use proper hand washing technique as a general preventive
measure. Hand washing once per day is insufficient. It is true that the client should avoid BP
measurement in the affected arm; however, this would relate more closely to the problem of risk for
injury.

The nurse is giving general instructions to a client receiving hemodialysis. Which statement would be
most appropriate for the nurse to include?
A. "It is acceptable to eat whatever you want on the day before hemodialysis."

B. "It is acceptable to exceed the fluid restriction on the day before hemodialysis."

C. "Medications should be double-dosed on the morning of hemodialysis because of potential loss."

D. "Several types of medications should be withheld on the day of dialysis until after the procedure."

D. "Several types of medications should be withheld on the day of dialysis until after the procedure."
Many medications are dialyzable, which means that they are extracted from the bloodstream during
dialysis. Therefore many medications may be withheld on the day of dialysis until after the procedure. It
is not typical for medications to be double-dosed, because there is no way to be certain how much of
each medication is cleared by dialysis. Clients receiving hemodialysis are not routinely taught that it is
acceptable to disregard dietary and fluid restrictions.

A client with chronic kidney disease (CKD) has been on dialysis for 3 years. The client is receiving the
usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding
agent. The client now presents with mental cloudiness, dementia, and complaints of bone pain. The
nurse determines that these assessment data are compatible with which condition?
A. Advancing uremia

B. Phosphate overdose

C. Folic acid deficiency

D. Aluminum intoxication

D. Aluminum intoxication
Aluminum intoxication can occur when there is accumulation of aluminum, an ingredient in many
phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of
the bone with aluminum. It can be treated with aluminum-chelating agents, which make aluminum
available to be dialyzed from the body. It can be prevented by avoiding or limiting the use of phosphate-
binding agents that contain aluminum. The data in the question are not specifically associated with the
other conditions noted in the options.

A client undergoing hemodialysis is at risk for bleeding from the heparin used during the hemodialysis
treatment. The nurse assesses for this occurrence by periodically checking the results of which
laboratory test?
A. Bleeding time

B. Thrombin time

C. Prothrombin time (PT)

D. Partial thromboplastin time (PTT)

D. Partial thromboplastin time (PTT)

Heparin is the anticoagulant used most often during hemodialysis. The hemodialysis nurse monitors the
extent of anticoagulation by checking the PTT, which is the appropriate measure of heparin effect.
Thrombin and bleeding times are not used to measure the effect of heparin therapy, although they are
useful in the diagnosis of other clotting abnormalities. The PT is one test used to monitor the effect of
warfarin (Coumadin) therapy

The nurse is monitoring the fluid balance of an assigned client. The nurse determines that the client has
proper fluid balance if which 24-hour intake and output totals are noted?

A. Intake 1500 mL, output 800 mL

B. Intake 3000 mL, output 2000 mL

C. Intake 2400 mL, output 2900 mL

D. Intake 1800 mL, output 1750 mL

D. Intake 1800 mL, output 1750 mL

For the client taking a normal diet, the normal fluid intake is approximately 1200 to 1800 mL of
measurable fluids per day. The client's output in the same period should be about the same and does
not include insensible losses, which are extra. Insensible losses are offset by the fluid in solid foods,
which also is not measured.

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder,
if noted on the client's record, would the nurse identify as a risk factor for this disorder?

A. Hypoglycemia

B. Diabetes mellitus

C. Coronary artery disease

D. Orthostatic hypotension

B. Diabetes mellitus
Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi,
chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and presence of
an indwelling urinary catheter or frequent catheterization. The conditions noted in options 1, 3, and 4
are not associated risk factors.

The nurse is reviewing the medication record of a client diagnosed with chronic kidney disease (CKD).
The nurse notes that the client is receiving aluminum hydroxide (ALternaGEL). The nurse plans care,
knowing that which is the purpose of this medication?

A. Prevents ulcers.

B. Prevents constipation.

C. Promotes the elimination of potassium from the body.

D. Combines with phosphorus and helps eliminate phosphates from the body.

D. Combines with phosphorus and helps eliminate phosphates from the body.
Aluminum hydroxide binds with phosphate in the intestines for excretion in the feces, thus lowering
phosphorus levels. It can cause constipation, and it does not promote the elimination of potassium. It
may be used in the treatment of hyperacidity associated with gastric ulcers, but this is not the purpose
of its use in the client with renal failure.
The registered nurse is instructing a new nursing graduate about hemodialysis. Which statement, if
made by the new nursing graduate, would indicate an understanding of the procedure for hemodialysis?
Select all that apply.

A. "Sterile dialysate must be used."

B. "Dialysate contains metabolic waste products."

C. "Heparin sodium is administered during dialysis."

D. "Dialysis cleanses the blood of accumulated waste products."

E. "Warming the dialysate increases the efficiency of diffusion."

C. "Heparin sodium is administered during dialysis."

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

The nurse is caring for a client with acute kidney injury (AKI). When performing an assessment, the nurse
would expect to note which breathing pattern?

A. Apnea

B. Kussmaul's respirations

C. Decreased respirations

D. Cheyne-Stokes respirations

B. Kussmaul's respirations
Clinical manifestations associated with AKI occur as a result of metabolic acidosis. The nurse would
expect to note Kussmaul's respirations as a result of the metabolic acidosis because the bodily response
is to exhale excess carbon dioxide. The breathing patterns noted in options 1, 3, and 4 are not
characteristic of AKI.

The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic
phase. The nursing instructor asks the student about the primary goal of the treatment plan for this
client. Which goal, if stated by the nursing student, would indicate an adequate understanding of the
treatment plan for this client?
A. Prevent fluid overload.

B. Prevent loss of electrolytes.

C. Promote the excretion of wastes.

D. Reduce the urine specific gravity.

B. Prevent loss of electrolytes.

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

The nurse instructs a client about continuous ambulatory peritoneal dialysis (CAPD). Which statement, if
made by the client, indicates an accurate understanding of CAPD?

A. "No machinery is involved, and I can pursue my usual activities."

B. "A cycling machine is used, so the risk for infection is minimized."

C. "The drainage system can be used once during the day and a cycling machine for three cycles at
night."

D. "A portable hemodialysis machine is used so that I will be able to ambulate during the treatment."

A. "No machinery is involved, and I can pursue my usual activities."

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

Which client is most at risk for developing a Candida urinary tract infection (UTI)?

A. An obese woman

B. A man with diabetes insipidus

C. A young woman on antibiotic therapy

D. A male paraplegic on intermittent catheterization

C. A young woman on antibiotic therapy

Candida infections, which are fungal infections, develop in persons who are on long-term antibiotic
therapy because an alteration of normal flora occurs. These infections also are commonly seen in clients
with blood dyscrasias, diabetes mellitus, cancer, or immunosuppression and in those with a drug
addiction.

A cystectomy is performed for a client with a diagnosis of bladder cancer, and a Kock pouch is created
for urinary diversion. In preparing a discharge teaching plan for the client, the nurse should include
which instruction in the plan?

A. Dietary restrictions

B. Technique of catheterization

C. External pouch and application care

D. Proper administration of prophylactic antibiotics

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

A client being discharged home after renal transplantation has a risk for infection related to
immunosuppressive medication therapy. The nurse determines that the client needs further instruction
on measures to prevent and control infection if the client states that it is necessary to take which
action?

A. Take an oral temperature daily.

B. Use good hand washing technique.

C. Take all scheduled medications exactly as prescribed.

D. Monitor urine character and output at least 1 day each week.

D. Monitor urine character and output at least 1 day each week.

The client receiving immunosuppressive medication therapy must learn and use infection-control
methods for use at home. The client self-monitors urine output and its characteristics on a daily basis.
The client must learn proper hand washing technique and should take the temperature daily to detect
early infection. This is especially important because the client also takes corticosteroids, which mask
signs and symptoms of infection. All medications should be taken exactly as prescribed.

The nurse tests the urine of a client with acute kidney injury (AKI) with a multitest reagent strip. The
strip tests highly positive for proteinuria. The nurse plans care, knowing that this result is consistent with
which type of AKI?

A. Prerenal

B. Postrenal

C. Intrinsic

D. Atypical
C. Intrinsic
With intrinsic failure, there is a fixed specific gravity and the urine tests positive for proteinuria. In
prerenal failure, the specific gravity is high and there is very little or no proteinuria. In postrenal failure,
there is a fixed specific gravity and little or no proteinuria. There is no disorder known as atypical renal
failure.

A client with chronic kidney disease (CKD) is about to begin hemodialysis therapy. The client asks the
nurse about the frequency and scheduling of hemodialysis treatments. The nurse's response is based on
an understanding that which represents the typical schedule?

A. 5 hours of treatment 2 days per week

B. 2 hours of treatment 6 days per week

C. 3 to 4 hours of treatment 3 days per week

D. 2 to 3 hours of treatment 5 days per week

C. 3 to 4 hours of treatment 3 days per week

The typical schedule for hemodialysis is 3 to 4 hours of treatment 3 days per week. Individual
adjustments are made according to variables such as the size of the client, type of dialyzer, rate of blood
flow, personal client preferences, and other factors.

A client is about to begin hemodialysis. Which measure(s) should the nurse employ in the care of the
client? Select all that apply.

A. Using sterile technique for needle insertion

B. Using standard precautions in the care of the client

C. Giving the client a mask to wear during connection to the machine

D. Wearing full protective clothing such as goggles, mask, gloves, and apron

E. Covering the connection site with a bath blanket to enhance extremity warmth

A. Using sterile technique for needle insertion

B. Using standard precautions in the care of the client
C. Giving the client a mask to wear during connection to the machine
D. Wearing full protective clothing such as goggles, mask, gloves, and apron
Infection is a major concern with hemodialysis. For that reason, the use of sterile technique and the
application of a face mask for both nurse and client are extremely important. It also is imperative that
standard precautions be followed, which includes the use of goggles, mask, gloves, and an apron. The
connection site should not be covered; it should be visible so that the nurse can assess for bleeding,
ischemia, and infection at the site during the hemodialysis procedure.
A client is scheduled for surgical creation of an internal arteriovenous (AV) fistula on the following day.
The client says to the nurse, "I'll be so happy when the fistula is made tomorrow. This means I can have
that other hemodialysis catheter pulled right out." Which interpretation should the nurse make based
on the client's statement?

A. The client has an accurate understanding of the procedure and aftercare.

B. The client does not realize how painful removal of the dialysis catheter will be.

C. The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use.

D. The client is not aware that the alternative access site is left in place prophylactically for 2 months.

C. The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use.
An AV fistula is the internal creation of an arterial-to-venous anastomosis. This causes engorgement of
the vein, allowing both the artery and the vein to be easily cannulated for hemodialysis. Fistulas take 1
to 2 weeks to mature (engorgement) or develop before they can be used for dialysis, so the current
method of access must remain in place to be used during that time period.

A client with end-stage renal disease (ESRD) has the problem of ineffective coping. Which nursing
intervention would be potentially unsafe in working with this client?

A. Assess the client and family's coping patterns.

B. Explore the meaning of the illness with the client.

C. Set limits on mood swings and expressions of hostility.

D. Give the client information when the client is ready to listen.

C. Set limits on mood swings and expressions of hostility.

Clients with ESRD are likely to experience mood swings or express hostility, anger, and depression,
among other responses. The nurse should acknowledge the client's feelings, allow the client to express
those feelings, and be supportive. Options 1, 2, and 4 are helpful and appropriate interventions for the
client.

The nurse has administered a dose of meperidine hydrochloride (Demerol), 100 mg, to a client with
renal colic as treatment for pain. The nurse carefully monitors this client for which side effect of this
medication?

A. Bradycardia

B. Hypertension

C. Urinary retention
D. Increased respirations

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

The nurse is assessing the renal function of a client at risk for acute kidney injury. After noting the
amount of urine output and urine characteristics, the nurse proceeds to assess which as the best
indirect indicator of renal status?

A. Blood pressure

B. Apical heart rate

C. Jugular vein distention

D. Level of consciousness

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

A client has been diagnosed with polycystic kidney disease. On assessment of the client, the nurse will
observe for which as the most common manifestation of this disorder?

A. Headache

B. Hypotension

C. Flank pain and hematuria

D. Complaints of low pelvic pain

C. Flank pain and hematuria

The most common findings with polycystic kidney disease are hematuria and flank or lumbar pain that is
either colicky in nature or dull and aching. Other common findings include proteinuria, calculi, uremia,
and palpable kidney masses. Hypertension is another common finding and may be associated with
cardiomegaly and heart failure. The client may complain of a headache, but this is not a specific
assessment finding in polycystic kidney disease.

The nurse provides discharge instructions to a client after a prostatectomy. What is the priority
discharge instruction for this client?
A. Avoid driving a car for at least 1 week.

B. Increase fluid intake to at least 2.5 L/day.

C. Avoid lifting any objects greater than 30 pounds.

D. Contact the health care provider (HCP) if small clots are noticed in the urine.

B. Increase fluid intake to at least 2.5 L/day.

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

The nurse is teaching a client with nephrotic syndrome about managing the disorder. What should the
nurse instruct the client to adjust upward or downward according to the amount of edema present?

A. Salt intake

B. Water intake

C. Activity level

D. Use of diuretics

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

The nurse is caring for a client just after ureterolithotomy and is monitoring the drainage from the
ureteral catheter hourly. Suddenly, the catheter stops draining. The nurse assesses the client and
determines that which is the least likely cause of the problem?

A. Blood clots

B. Ureteral edema

C. Chemical sediment

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

A client with renal cell carcinoma of the left kidney is scheduled for nephrectomy. The right kidney
appears normal at this time. The client is anxious about whether dialysis will ultimately be a necessity.
The nurse should plan to use which information in discussions with the client to alleviate anxiety?

A. There is a strong likelihood that the client will need dialysis within 5 to 10 years.

B. There is absolutely no chance of needing dialysis because of the nature of the surgery.

C. One kidney is adequate to meet the needs of the body so long as it has normal function.

D. Dialysis could become likely, but it depends on how well the client complies with fluid restriction after
surgery.

C. One kidney is adequate to meet the needs of the body so long as it has normal function.

Fears about having only one functioning kidney are common in clients who must undergo nephrectomy
for renal cancer. These clients need emotional support and reassurance that the remaining kidney
should be able to fully meet the body's metabolic needs, so long as it has normal function. Therefore the
remaining options are incorrect.

A client with renal cancer is to undergo preoperative renal artery embolization. What should the nurse
tell the client regarding the primary benefit of this procedure?

A. This will reduce the time needed for surgery by at least half because it provides hemostasis.

B. This will cause the tumor to become tougher and easier to resect in surgery with the scalpel.

C. This will prevent the risk of pulmonary embolism by occluding the renal artery and its branches.

D. This will decrease the size of the tumor because its blood supply will be removed after placement of
an absorbable gelatin sponge.

D. This will decrease the size of the tumor because its blood supply will be removed after placement of
an absorbable gelatin sponge.
Renal artery embolization may be done instead of radiation therapy to shrink the kidney tumor by
cutting off its blood supply and impairing its overall vascularity. A secondary benefit is that it reduces the
risk of hemorrhage during surgery. This procedure can be accomplished in a number of ways, including
placement of an absorbable gelatin sponge (Gelfoam), a balloon, a metal coil, or any of various other
substances.
A client who is to have a cystectomy with creation of an ileal conduit asks the nurse why the bowel
needs to be cleansed before surgery if the bladder is being removed. The nurse would give the best
response using which piece of information?

A. All clients undergo bowel preparation with major surgery.

B. This will decrease the chance of postoperative paralytic ileus.

C. A portion of the bowel will be used to create the conduit for urinary diversion.

D. This will reduce the chance that the surgeon will nick the bowel during surgery.

C. A portion of the bowel will be used to create the conduit for urinary diversion.
The client scheduled for surgical creation of either an ileal conduit or a reservoir undergoes bowel
preparation the night before the procedure. Preparation can include intake of copious clear liquids,
laxatives, enemas, and antibiotics, depending on health care provider preference. This is done primarily
to prevent infection because a loop of bowel will be used to create the urinary diversion.

A client is diagnosed with epididymitis. The nurse checks the health care provider's prescriptions and
expects that which options will be prescribed? Select all that apply.

A. Sitz bath

B. Antibiotics

C. Scrotal elevation

D. Use of a heating pad

E. Bed rest with bathroom privileges

A. Sitz bath
B. Antibiotics
C. Scrotal elevation
E. Bed rest with bathroom privileges
Common interventions used in the treatment of epididymitis include bed rest with bathroom privileges,
elevation of the scrotum, ice packs, sitz baths, analgesics, and antibiotics. A heating pad would not be
used because direct application of heat would enhance blood flow to the area, thereby increasing the
swelling.

A client who is performing peritoneal dialysis at home calls the clinic and reports that the outflow from
the dialysis catheter seems to be decreasing in amount. The clinic nurse should ask which question first?

A. "Have you had any diarrhea?"

B. "Have you been constipated recently?"

C. "Have you had any abdominal discomfort?"

D. "Have you had an increased amount of flatulence?"

B. "Have you been constipated recently?"

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

At the beginning of the work shift, a nurse is assessing a client who has returned from the
postanesthesia care unit after transurethral resection of the prostate (TURP). The nurse should assess
for which color in the urinary drainage tubing that indicates proper irrigation and adequate functioning
of the device?

A. Pale pink

B. Dark pink

C. Bright red

D. Red with clots

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

The nurse is planning a teaching session with a client who has chronic kidney disease (CKD) about
managing the condition between dialysis treatments. The nurse should plan to include the instruction
that weight gain between dialysis treatments should be ideally no more than what value?

A. 5 to 6 kg

B. 2 to 4 kg

C. 1 to 1.5 kg

D. 0.5 to 1.0 kg

C. 1 to 1.5 kg
Limiting weight gain to 1 to 1.5 kg between dialysis treatments helps prevent the hypotension that
occurs with the removal of large volumes of fluid during dialysis. The nurse instructs the client in how to
manage daily fluid allotment to assist the client in staying within a low fluid intake range to prevent
excess weight gain. Options 1, 2, and 4 are incorrect.
A client undergoing hemodialysis begins to experience muscle cramping. What corrective action should
the hemodialysis nurse caring for the client take?

A. Administer hypotonic saline.

B. Increase the ultrafiltration rate.

C. Decrease the ultrafiltration rate.

D. Administer magnesium sulfate.

C. Decrease the ultrafiltration rate.

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

The nurse is receiving a client from the postanesthesia care unit who has had percutaneous
nephrolithotomy for calculi in the renal pelvis. The nurse anticipates that the client's care will most likely
involve monitoring which device?

A. Ureteral stent

B. Suprapubic tube

C. Nephrostomy tube

D. Jackson Pratt drain

C. Nephrostomy tube
A nephrostomy tube is put in place after percutaneous nephrolithotomy for calculi in the renal pelvis.
The client also may have a Foley catheter to drain urine produced by the other kidney. The nurse
monitors the drainage from each of these tubes and strains the urine to detect elimination of the
calculus fragments.

A client passes a urinary stone, and laboratory analysis of the stone indicates that it is composed of
calcium oxalate. On the basis of this analysis, which option should the nurse specifically include in the
dietary instructions?

A. Increase intake of dairy products.

B. Avoid citrus fruits and citrus juices.

C. Avoid green, leafy vegetables such as spinach.

D. Increase intake of meat, fish, plums, and cranberries.

C. Avoid green, leafy vegetables such as spinach.
Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb,
strawberries, chocolate, wheat bran, nuts, beets, and tea.

The nurse checks the serum myoglobin level for a client with a crush injury to the right lower leg
because the client is at risk for developing which type of acute kidney injury?

A. Prerenal

B. Intrarenal

C. Postrenal

D. Extrarenal

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

A nurse is preparing a plan of care for a client with chronic kidney disease and uremia. The nurse is
developing interventions to assist in promoting an increased dietary intake while at the same time
maintaining necessary dietary restrictions. Which action should the nurse include in the plan of care?

A. Increase the amount of protein in the diet.

B. Increase the amount of potassium in the daily diet.

C. Maintain a diet high in calories with frequent snacks.

D. Encourage the client to eat a large breakfast and smaller meals later in the day.

C. Maintain a diet high in calories with frequent snacks.

Uremia usually is accompanied by nausea, anorexia, and an unpleasant taste in the mouth. Most clients
experience more nausea and vomiting in the morning. Therefore to maintain optimal nutrition, it is best
for these clients to eat a diet that is high in calories with frequent snacks and a light breakfast in the
morning and larger meals later in the day. Dietary management usually is aimed at restricting protein,
sodium, and potassium.

A client who is performing peritoneal dialysis calls the nurse at the renal unit and reports the presence
of severe abdominal pain and diarrhea. The client also informs the nurse that the peritoneal dialysis
returns are brown-tinged in color. Which would the nurse suspect?

A. Infection
B. An intact catheter

C. Bowel perforation

D. Bladder perforation

C. Bowel perforation
Complications of a peritoneal catheter include infection, perforation of the bowel or bladder, and
bleeding. Brown-tinged returns suggest bowel perforation, which usually is accompanied by severe
abdominal pain and diarrhea. Cloudy or opaque returns suggest possible infection. Urine-colored
returns suggest possible bladder perforation. Option 2 is unrelated to the information provided in the
question.

A client with uric acid calculi is placed on a low-purine diet. The nurse instructs the client to restrict the
intake of which food?

A. Fish

B. Plum juice

C. Fruit juice

D. Cranberries

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

A nurse is developing a plan of care for a client with a diagnosis of nephrotic syndrome whose
glomerular filtration rate (GFR) is normal. Which interventions should be appropriate components of the
care plan? Select all that apply.

A. Monitor daily weight.

B. Maintain sodium restrictions.

C. Maintain a diet low in protein.

D. Monitor intake and output (I&O).

E. Maintain bed rest when edema is severe.

A. Monitor daily weight.

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

A nurse is reviewing the assessment findings for a client with a diagnosis of nephrotic syndrome. Which
would the nurse expect to note in this client?

A. Decreased serum lipids

B. Signs of fluid volume deficit

C. Decreased protein in the urine

D. Decreased serum albumin levels

D. Decreased serum albumin levels

Nephrotic syndrome describes a variety of signs and symptoms that accompany any condition that
markedly impairs filtration by glomerular capillary membranes and results in increased permeability to
protein. Hallmark signs and symptoms of this syndrome include increased serum lipids, edema,
increased excretion of protein in the urine, and decreased serum albumin levels.

A nurse is reviewing the urinalysis results for a client with glomerulonephritis. Which findings would the
nurse expect to note? Select all that apply.

A. Proteinuria

B. Hematuria

C. Positive ketones

D. A low specific gravity

E. A dark and smoky appearance of the urine

A. Proteinuria
B. Hematuria
E. A dark and smoky appearance of the urine
In the client with glomerulonephritis, characteristic findings in the urinalysis report are gross proteinuria
and hematuria. The specific gravity is elevated, and the urine may appear dark and smoky. Positive
ketones are not associated with this condition but may indicate a secondary problem.
An ambulatory care nurse is providing instructions to a client after a cystoscopy. Which statement by
the client indicates a need for further instruction?

A. "I should increase my fluid intake."

B. "I can apply heat to my lower abdomen."

C. "I may have some burning on urination for the next few days."

D. "If I notice any pink-tinged urine, I should contact the health care provider."

D. "If I notice any pink-tinged urine, I should contact the health care provider."
The client is instructed that pink-tinged urine and burning on urination are expected for 1 to 2 days after
the procedure. Increased fluid intake is encouraged. Application of heat to the lower abdomen,
administration of mild analgesics, and the use of sitz baths may relieve discomfort. The client also is
advised to avoid alcoholic beverages for 2 days after the test.

A nurse is providing instructions to a client who is scheduled for cystoscopy and possible biopsy and will
be receiving general anesthesia. Which instruction should the nurse provide to the client?

A. The procedure will take about 4 hours.

B. Intravenous fluids may be started on the day of the procedure.

C. Preprocedure sedatives are never administered with general anesthesia.

D. A full liquid breakfast only may be allowed on the day of the procedure.

B. Intravenous fluids may be started on the day of the procedure.

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

A nurse is performing an assessment on a client with acute kidney injury who is in the oliguric phase.
During this phase, the nurse understands that which manifestations are associated findings? Select all
that apply.

A. Increased serum creatinine level

B. A low and fixed specific gravity

C. Increased blood urea nitrogen (BUN) level

D. Urine osmolarity of approximately 300 mOsm/L

E. A urine output of 600 to 800 mL in a 24-hour period

A. Increased serum creatinine level

B. A low and fixed specific gravity
C. Increased blood urea nitrogen (BUN) level
D. Urine osmolarity of approximately 300 mOsm/L
During the oliguric phase of acute kidney injury, serum creatinine levels increase by approximately 1
mg/dL per day, and the BUN level increases by approximately 20 mg/dL per day. The specific gravity of
the urine is low and fixed, and the urine osmolarity approaches that of the client's serum level, or about
300 mOsm/L. Urine output is less than 100 mL in a 24-hour period.

A nurse instructor is evaluating a nursing student for knowledge regarding care of a client with acute
kidney injury. Which statement by the student demonstrates the need for further education about the
diuretic phase of acute kidney injury?

A. "The increase in urine output indicates the return of some renal function."

B. "The diuretic phase develops about 14 days after the initial insult and lasts about 10 days."

C. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour
period."

D. "The blood urea nitrogen (BUN) and creatinine levels will continue to rise during the first few days of
diuresis."

C. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour
period."
The diuretic phase of acute kidney injury is characterized by an increase in urine output of more than
1000 mL in a 24 hour period. This increase in urine output indicates the return of some renal function;
however, BUN and creatinine levels continue to rise during the first few days of diuresis. The diuretic
phase develops about 14 days after the initial insult and lasts about 10 days.

A client is experiencing a decrease in renal perfusion. The nurse plans care, knowing that the client could
benefit from greater endogenous production of which substance that dilates the renal arteries?

A. Serotonin

B. Dopamine

C. Epinephrine

D. Norepinephrine

B. Dopamine
Dopaminergic receptors are found in the renal blood vessels and in the nerves. When stimulated, they
dilate renal arteries and help modulate release of the neurotransmitter, dopamine. Renal artery dilation
helps to improve urine output by increasing blood flow through the kidneys. Serotonin is a local
hormone that is released from platelets after an injury; it constricts arterioles but dilates capillaries.
Epinephrine and norepinephrine affect the beta receptors in the body.

A nurse has provided dietary instructions to a client with renal calculi who must learn about the foods
that yield an alkaline residue in the urine. The nurse determines that the client has properly understood
the information presented when the client chooses which selections from a diet menu?

A. Spinach salad, milk, and a banana

B. Chicken, potatoes, and cranberries

C. Peanut butter sandwich, milk, and prunes

D. Linguini with shrimp, tossed salad, and a plum

B. Chicken, potatoes, and cranberries

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

The spouse of a client with acute kidney injury secondary to heart failure asks the nurse how a heart
problem can affect the kidneys. The nurse should base a response using what fact about the kidneys?

A. The kidneys get fatigued from having to filter too much fluid.

B. The kidneys can react adversely to moderate doses of furosemide (Lasix).

C. The kidneys will shut down easily if serum levels of digoxin (Lanoxin) are high.

D. The kidneys generally require and receive about 20% to 25% of the resting cardiac output.

D. The kidneys generally require and receive about 20% to 25% of the resting cardiac output.
Heart failure is referred to as a prerenal cause of acute kidney injury because heart failure results in
decreased blood flow to the kidneys. The kidneys normally receive about 20% to 25% of the cardiac
output and require adequate perfusion to function properly. With a significant or prolonged decrease in
blood supply, the kidneys can fail. Options 1 and 3 are incorrect. As for option 2, large doses of
furosemide resulting in severe dehydration may lead to decreased kidney perfusion, but moderate
doses of furosemide do not cause prerenal acute kidney injury, and furosemide may be used to treat
acute kidney injury.

A nurse measures the cardiac output of a client and finds it to be 6 L/min. Which amount should the
nurse calculate is the amount of blood circulating to the kidneys?

A. 100 to 300 mL/min

B. 500 to 1000 mL/min

C. 1200 to 1500 mL/min

D. 2000 to 2500 mL/min

C. 1200 to 1500 mL/min

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

A client is experiencing the syndrome of inappropriate antidiuretic hormone (ADH) secretion. When
explaining this disorder to the client and family, the nurse recalls that ADH works to reabsorb water in
which parts of the nephron?

A. The glomerulus and calices

B. The loop of Henle and the distal tubule

C. The distal tubule and the collecting duct

D. The proximal tubule and the loop of Henle

C. The distal tubule and the collecting duct

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

A nurse is caring for a client whose urine output was 25 mL for two consecutive hours. The nurse plans
care, knowing that which client-related factor would increase the amount of blood flow to the kidneys?

A. Physiological stress

B. Release of norepinephrine

C. Release of low levels of dopamine

D. Sympathetic nervous system stimulation

C. Release of low levels of dopamine

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

A client is being discharged to home while recovering from acute kidney injury (AKI). A reduction in
which substance indicates to the nurse that the client understands the dietary teaching?
A. Fats

B. Vitamins

C. Potassium

D. Carbohydrates

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

The nurse is working on a medical-surgical nursing unit and is caring for several clients with chronic
kidney disease. The nurse interprets that which client is best suited for peritoneal dialysis as a treatment
option?

A. A client with severe heart failure

B. A client with a history of ruptured diverticula

C. A client with a history of herniated lumbar disk

D. A client with a history of three previous abdominal surgeries

A. A client with severe heart failure

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

The nurse has provided instructions to a client with a urinary tract infection regarding foods and fluids to
consume that will acidify the urine. Which fluids should the nurse include in the client's teaching plan
that will aid in acidifying the urine? Select all that apply.

A. Milk
B. Prune juice
C. Apricot juice
D. Cranberry juice
E. Carbonated drinks
B. Prune juice
C. Apricot juice
D. Cranberry juice
Acidification of the urine inhibits multiplication of bacteria. Fluids that acidify the urine include prune,
apricot, cranberry, and plum juice. Carbonated drinks should be avoided because they increase urine
alkalinity. Two glasses of milk a day can make the urine more alkaline, which could aid in the
development of kidney stones.

Before providing care for a client in the late stages of chronic kidney disease (CKD), the nurse should
review the results of which most relevant laboratory study?

A. Urinalysis, hematocrit, hemoglobin

B. Culture and sensitivity testing, serum sodium

C. Urine specific gravity, intravenous pyelogram

D. Fasting blood glucose, serum potassium, serum calcium

D. Fasting blood glucose, serum potassium, serum calcium

Because of the potentially life-threatening outcomes associated with hyperglycemia, hyperkalemia, and
hypocalcemia, they are the most relevant to nursing management of the client with CKD. The diagnostic
tests in the remaining options may be helpful in diagnosing CKD or in monitoring treatment but are not
the most relevant. Additionally, decreased hematocrit and hemoglobin occur in CKD because of the
decreased level of erythropoietin. However, a decrease in hematocrit and hemoglobin may be reflective
of various health alterations.

Which findings noted in a client on continuous ambulatory peritoneal dialysis (CAPD) should be reported
to the health care provider (HCP)?

A. Cloudy yellow dialysate output

B. Client refusal to take the stool softener

C. Previous evening's dwell time of 8 hours

D. Peritoneal catheter site is not red, and the skin has grown around the cuff

A. Cloudy yellow dialysate output

CAPD is a form of peritoneal dialysis in which exchanges are completed four or five times daily.
Peritonitis is a major complication of this type of dialysis. Peritonitis can be recognized by cloudy
dialysate outflow, fever, abdominal guarding (board-like abdomen), abdominal pain, pain on inflow,
malaise, nausea, and vomiting. The client has the right to refuse medications, but it also is important for
the nurse to explain the importance of medications to the client. Typically the dwell time during the
night is for the entire time that the client sleeps, which could be around 7 to 9 hours. The peritoneal site
should have intact skin. The skin grows around the peritoneal catheter cuff, and this prevents tunnel
(around catheter) infections.

In performing a physical assessment of a client with chronic kidney disease (CKD), which finding should
the nurse anticipate to note?

A. Glycosuria

B. Polyphagia

C. Crackles auscultated in lungs

D. Blood pressure 98/58 mm Hg

C. Crackles auscultated in lungs

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

The client with a crush injury to the leg has a highly positive urine myoglobin level. The nurse should
assess this client carefully for signs and symptoms of which problem?

A. Brain attack

B. Respiratory failure

C. Myocardial infarction

D. Acute tubular necrosis

D. Acute tubular necrosis

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

A client diagnosed with polycystic kidney disease has been taught about the treatment plan for this
disease. The nurse should determine that the client needs additional teaching if the client states that
which is included in the treatment plan?

A. Genetic counseling
B. Sodium restriction

C. Increased water intake

D. Antihypertensive medications

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

A nurse is reviewing the list of components contained in the peritoneal dialysis solution with the client.
The client asks the nurse about the purpose of the glucose contained in the solution. The nurse should
base the response on knowing that which is the action of the glucose in the solution?

A. Decreases the risk of peritonitis

B. Prevents disequilibrium syndrome

C. Increases osmotic pressure to produce ultrafiltration

D. Prevents excess glucose from being removed from the client

C. Increases osmotic pressure to produce ultrafiltration

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

A client with benign prostatic hyperplasia undergoes a transurethral resection of the prostate.
Postoperatively the client is receiving continuous bladder irrigations. The nurse assesses the client for
manifestations of transurethral resection syndrome. Which assessment data would indicate the onset of
this syndrome?

A. Tachycardia and diarrhea

B. Bradycardia and confusion

C. Increased urinary output and anemia

D. Decreased urinary output and bladder spasms

B. Bradycardia and confusion

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

A client with a chronic kidney disease who is scheduled for hemodialysis this morning is due to receive a
daily dose of enalapril (Vasotec). When should the nurse plan to administer this medication?

A. During dialysis

B. Just before dialysis

C. The day after dialysis

D. On return from dialysis

D. On return from dialysis

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

A client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. Which
intervention is the priority nursing action?

A. Check the shunt for the presence of bruit and thrill.

B. Observe the site once as time permits during the shift.

C. Check the results of the prothrombin time as they are determined.

D. Ensure that small clamps are attached to the arteriovenous shunt dressing.

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

A nurse has taught the client with polycystic kidney disease about management of the disorder and
prevention and recognition of complications. The nurse should determine that the client understands
the instructions if the client states that which sign/symptom is not a cause for concern?

A. Burning on urination

B. A temperature of 100.6° F
C. New-onset shortness of breath

D. A blood pressure of 105/68 mm Hg

D. A blood pressure of 105/68 mm Hg

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

A nurse is caring for a client who has just returned from having a cystoscopy. The nurse should recognize
which as an abnormal assessment finding for this client?

A. The client reports bright red urine.

B. The client reports pink-tinged urine.

C. The client reports having urinary frequency.

D. The client complains of burning when urinating.

A. The client reports bright red urine.

The main purpose of a cystoscopy is to inspect the interior of the bladder with a tubular lighted scope
(cystoscope). Pink-tinged urine is a normal finding after this procedure, but bright red urine indicates
hemorrhaging and is not a normal finding.

A client with glomerulonephritis has developed acute kidney injury (AKI) as a complication. The nurse
would expect to note which abnormal finding documented on the client's medical record?

A. Bradycardia

B. Hypertension

C. Decreased cardiac output

D. Decreased central venous pressure

B. Hypertension
AKI caused by glomerulonephritis is classified as an intrinsic or intrarenal cause of renal failure. It is
commonly manifested by hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid
overload. AKI from a prerenal cause is characterized by decreased blood pressure, tachycardia,
decreased cardiac output, and decreased central venous pressure. Bradycardia is not part of the clinical
picture for any form of kidney failure.
A client has been diagnosed with pyelonephritis. The nurse interprets that which health problem has
placed the client at risk for this disorder?

A. Diabetes mellitus

B. Orthostatic hypotension

C. Coronary artery disease

D. Intravenous (IV) contrast medium

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

A client has chronic kidney disease (CKD) that does yet not require dialysis. Which comment to the
nurse, if made by the client, indicates the need for further teaching?

A. "I will reduce the sodium in my diet, and I can use salt substitutes to spice my food."

B. "The amount of fluid I can have every day depends on the amount of urine I put out."

C. "I will weigh myself on my bathroom scale every morning right after I have urinated."

D. "I should report a gain in weight, trouble with my breathing, or increased leg swelling."

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

A health care provider writes prescriptions for a client with chronic kidney disease (CKD). Which
prescription should the nurse question?

A. Insert a saline lock.

B. Obtain a daily weight.

C. Provide a high-protein diet.

D. Administer a calcium supplement with each meal.

C. Provide a high-protein diet.

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

The nurse is caring for a client with acute pyelonephritis. Which nursing intervention is most
important?
Increasing fluid intake to 3 L/day
The nurse is teaching a client with genital herpes. Education for this client should include an
explanation of:
the importance of informing his partner of the disease.
When a client with an indwelling urinary catheter insists on walking to the hospital lobby to visit
with family members, the nurse teaches him how to do this without compromising the catheter.
Which client action indicates an accurate understanding of this information?
When a client with an indwelling urinary catheter insists on walking to the hospital lobby to visit
with family members, the nurse teaches him how to do this without compromising the catheter.
Which client action indicates an accurate understanding of this information?
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(SELECT ALL THAT APPLY) The nurse is teaching a client how to
collect a 24-hour urine specimen for creatinine clearance. Which of the following directions
should the nurse give the client?
(2), "Discard the first voiding and record the time.", (4) "Refrigerate the urine sample or keep it
on ice.", (5) "At the end of 24 hours, void and save the urine."
A client is admitted with a diagnosis of acute renal failure. The nurse should monitor closely for:
drug toxicity.
The nurse is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a
client with a potassium level of 5.9 mEq/L. Correct administration and the effects of this enema
would include having the client:
retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have
diarrhea.
A client with dysuria is prescribed phenazopyridine (Pyridium). The nurse should advise the
client that his urine will:
appear orange.
A client with benign prostatic hyperplasia (BPH) doesn't respond to medical treatment and is
admitted to the facility for surgical intervention. Before providing preoperative and postoperative
instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done.
What is the most widely used procedure for treatment of BPH?
Transurethral resection of the prostate (TURP)
The red blood cell (RBC) production in a client with chronic renal failure (CRF) has decreased.
The nurse should monitor this client for:
fatigue and weakness.
The nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary
continence?
Encouraging intake of at least 2 L of fluid daily
A client with chronic renal failure who receives hemodialysis three times weekly has a
hemoglobin (Hb) level of 7 g/dl. The most therapeutic pharmacologic intervention would be to
administer:
epoetin alfa (Epogen)
Which steps should the nurse follow to insert a straight urinary catheter?
Prepare the client and the equipment, create a sterile field, put on gloves, clean the urinary
meatus, and insert the catheter until urine flows.
The nurse is reviewing the report of a client's routine urinalysis. Which value should the nurse
consider abnormal?
Urine pH of 3.0
Which of the following clinical findings would the nurse look for in a client with chronic renal
failure?
Uremia
A client with suspected renal insufficiency is scheduled for a comprehensive diagnostic workup.
After the nurse explains the diagnostic tests, the client asks which part of the kidney "does the
work." Which answer is correct?
The nephron
A client with decreased urine output refractory to fluid challenges is evaluated for renal failure.
Which condition may cause the intrinsic (intrarenal) form of acute renal failure?
Nephrotoxic injury secondary to use of contrast media
A client diagnosed with a sexually transmitted disease has been feeling poorly. A friend of the
client's who is employed by the hospital asks a nurse why her friend is hospitalized. How should
the nurse respond?
Explain that although she is a friend of the client, the nurse can't violate client confidentiality.
Which statement describes the therapeutic action of loop diuretics?
They block sodium reabsorption in the ascending loop and dilate renal vessels.
The nurse is completing an intake and output record for a client who is receiving continuous
bladder irrigation after transurethral resection of the prostate. How many milliliters of urine
should the nurse record as output for her shift if the client received 1,800 ml of normal saline
irrigating solution and the output in the urine drainage bag is 2,400 ml?
600
A client receiving total parental nutrition is prescribed a 24-hour urine test. When initiating a 24-
hour urine specimen, the collection time should:
start after a known voiding that empties the bladder.
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this
disorder increases the client's risk of:
water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
The physician prescribes norfloxacin (Noroxin), 400 mg by mouth twice daily, for a client with a
urinary tract infection (UTI). The client asks the nurse how long to continue taking the drug. For
an uncomplicated UTI, the usual duration of norfloxacin therapy is:
7 to 10 days.
The nurse is planning a group teaching session on the topic of urinary tract infection (UTI)
prevention. Which point would the nurse want to include?
Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.
A client who returns to the surgical floor after undergoing transurethral resection of the prostate
complains of pain. Which action should the nurse take first?
Check the client's medical record for postoperative orders.
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse
should reinforce which dietary instruction?
"Make sure to include carbohydrates in your diet."
A 25-year-old client comes to the emergency department with her clothes torn. She has visible
cuts, bruises, and profuse vaginal bleeding. A nurse suspects that this client has been raped.
What should the nurse do?
Collect forensic evidence.
A client with renal dysfunction of acute onset comes to the emergency department complaining
of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for
significant findings, the nurse should ask about:
recent streptococcal infection.
(SELECT ALL THAT APPLY) The nurse is collecting data on a client who has a urinary tract
infection (UTI). Which statements should the nurse expect the client to make?
(2) "I need to urinate frequently.", (3) "It burns when I urinate.", (5) "I need to urinate urgently."
A client requires hemodialysis. Which of the following drugs should be withheld before this
procedure?
Cardiac glycosides
A client comes to the emergency department complaining of severe pain in the right flank,
nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi).
When planning this client's care, the nurse should assign highest priority to which nursing
diagnosis?
Acute pain
Which of the following is an appropriate nursing diagnosis for a client with renal calculi?
Risk for infection
A stepfather brings a child with a fever to the emergency department. The child is crying, calling
for her mother, and attempting to get out of the stepfather's arms. Upon inspection, the nurse
notes that the child's underpants are stained with a bloodlike substance. Which action should the
nurse take?
Report the suspected abuse according to facility policy.
Four days after undergoing a right nephrectomy, a client develops a methicillin-resistant
Staphylococcus aureus infection in the surgical incision. A physician orders contact isolation and
dressing changes 3 times daily. How should the soiled dressing be handled during dressing
changes?
Discard the dressing in a biohazard bag located in the designated receptacle inside the client's
room.
A client with a history of heart failure is found to have a cystocele. When planning care for this
client, the nurse is likely to formulate which nursing diagnosis?
Stress urinary incontinence
During rounds, a client admitted with gross hematuria asks the nurse about the physician's
diagnosis. To facilitate effective communication, what should the nurse do?
Provide privacy for the conversation.
A client with an indwelling urinary catheter is suspected of having a urinary tract infection. The
nurse should collect a urine specimen for culture and sensitivity by:
wiping the self-sealing aspiration port or stopcock with antiseptic solution and aspirating urine
with a sterile needle and a sterile syringe.
A female client with a history of four urinary tract infections (UTIs) in the past 3 months comes
to the urology clinic complaining of burning and urinary urgency and frequency. A physician
makes the diagnosis of UTI. Which instruction should the nurse give the client to help prevent
recurring infections?
Wipe the perineal area from front to back.
A client with acute pyelonephritis is prescribed co-trimoxazole (Septra). Which finding best
demonstrates that the client has followed the prescribed regimen?
Bacteria are absent on urine culture.
A female client has just been diagnosed with condylomata acuminata (genital warts). What
information is appropriate to tell this client?
This condition puts her at a higher risk for cervical cancer; therefore, she should have a
Papanicolaou (Pap) smear annually.
A 25-year-old female client seeks care for a possible urinary tract infection (UTI). Her symptoms
include burning on urination and frequent, urgent voiding of small amounts of urine. She's
placed on trimethoprim-sulfamethoxazole (Bactrim) to treat the possible infection. Another
medication is prescribed to decrease the client's pain and frequency. Which of the following is
most likely the second medication prescribed?
Phenazopyridine (Pyridium)
A client tells a nurse that her ileoconduit appliance won't adhere to her skin. The nurse inspects
the site and notes that the area around the stoma is red, moist, and tender to touch. How should
the nurse intervene?
Consult the wound-ostomy nurse.
A client with bladder cancer has had his bladder removed and an ileal conduit created for urine
diversion. While changing this client's pouch, the nurse observes that the area around the stoma
is red, weeping, and painful. What should the nurse conclude?
The pouch faceplate doesn't fit the stoma.
The nurse is collecting data on a male client diagnosed with gonorrhea. Which symptom likely
prompted the client to seek medical attention?
Foul-smelling discharge from the penis
Two staff nurses on the urology unit are responsible for the unit schedule. The holidays are
nearing, and many staff members would like to take vacation days. Which method might fairly
solve the holiday staffing problem?
Poll the staff to find out their preferences.
A client with a genitourinary problem is being assessed in the emergency department. When
palpating the client's kidneys, the nurse should keep which anatomical fact in mind?
The left kidney usually is slightly higher than the right one.
A client diagnosed with renal calculi is experiencing severe pain despite having received pain
medication. A nurse pages a physician. Which intervention can the nurse perform while awaiting
the physician's response?
Perform nonpharmacologic pain interventions.
A nurse reviews a client's medical record and notes that a physician ordered an indwelling
urinary catheter due to client's urine retention. Which action should the nurse perform first?
Verify the client's identity.
A physician informs a client that her renal calculus is small enough that she should be able to
pass it without surgical intervention. Which action should the nurse take to help the client pass
the renal calculus?
Encourage the client to consume 3 to 4 liters of fluid a day.
The nurse is caring for a patient with acute renal failure. Rank in chronological order the phases
of acute renal failure. Use all the options.
(2) Initial insult, (3) Oliguric Phase, (4) Diuretic Phase, (1) recovery phase
Which of the following laboratory values supports a diagnosis of pyelonephritis?
Pyuria
A client reports experiencing vulvar pruritus. Which finding may indicate that the client has an
infection caused by Candida albicans?
Cottage cheese-like discharge
Discharge teaching has been performed for a client who is being discharged with an indwelling
urinary catheter. Which action by the client indicates that the teaching was successful?
The client holds the drainage bag below the level of the bladder.
After having a transurethral resection of the prostate (TURP), a client returns to the unit with a
three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding
suggests that the client's catheter is occluded?
The client reports bladder spasms and the urge to void.
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia.
Which finding signals a significant problem during this procedure?
White blood cell (WBC) count of 20,000/mm3
Which laboratory test is the most accurate indicator of a client's renal function?
Creatinine clearance
To treat a urinary tract infection (UTI), a client is prescribed sulfamethoxazole (Gantanol), 2 g
by mouth initially, and then 1 g by mouth three times daily. The nurse should teach the client that
sulfamethoxazole is most likely to cause which adverse effect?
Diarrhea
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most
important?
Limiting fluid intake
The nurse just received the shift report on her group of clients. Based on the information she
received, which client should she assess first?
A client who underwent a right nephrectomy yesterday and is complaining of pain
During a routine examination, the nurse notes that the client seems unusually anxious. Anxiety
can affect the genitourinary system by:
stimulating or hindering micturition.
A client with chronic renal failure must restrict her fluid intake to 500 ml daily. Despite having
reached the limit, the client is insisting that she have more fluid. Which intervention by a nurse is
appropriate?
Allow her to have a piece of hard candy.
A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After
hemodialysis, the nurse knows that the client is most likely to experience:
weight loss.
The nurse is monitoring the fluid intake and output of a female client recovering from an
exploratory laparotomy. Which nursing intervention would help the client avoid a urinary tract
infection (UTI)?
Maintaining a closed indwelling urinary catheter system and securing the catheter to the leg
The nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy.
In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis
generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the
client to:
notify the physician about cloudy or foul-smelling urine.
When a client returns from the operating room after undergoing a left nephrectomy, a nurse must
make sure that urine is draining through the client's indwelling urinary catheter. This assessment
is important for this client because it:
assesses function of the remaining kidney.
A 3-way indwelling urinary catheter is inserted for continuous bladder irrigation following a
transurethral resection of the prostate. In addition to inflating the balloon, the functions of the
three lumens include:
continuous inflow and outflow of irrigation solution.
A client comes to the outpatient department complaining of vaginal discharge, dysuria, and
genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders
diagnostic tests of the vaginal discharge. Which STD must be reported to the public health
department?
Gonorrhea
A client with a history of chronic cystitis comes to the outpatient clinic with signs and symptoms
of this disorder. To prevent cystitis from recurring, the nurse recommends maintaining an acid-
ash diet to acidify the urine, thereby decreasing the rate of bacterial multiplication. On an acid-
ash diet, the client must restrict which beverage?
Milk
A client who returned from a cystoscopic examination complains of pain while attempting to
void. Which intervention should a nurse suggest to ease the client's pain while attempting to
void?
Sit in a warm sitz bath.
A nurse's neighbor complains of severe right flank pain. She explains that it began during the
night, but she was able to take acetaminophen (Tylenol) and return to bed. When she awoke, the
pain increased in intensity. How should the nurse intervene?
Advise the neighbor to seek medical attention.
The nurse correctly identifies a urine sample with a pH of 5.2 as being which type of solution?
Acidic
A client with a urinary tract infection is prescribed co-trimoxazole (trimethoprim-
sulfamethoxazole). The nurse should provide which medication instruction?
"Drink at least eight 8-oz glasses of fluid daily."
A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should
provide which instruction?
"Increase your fluid intake to 2 to 3 L per day."
The nurse is caring for a male client with gonorrhea. The client asks how he can reduce his risk
of contracting another sexually transmitted disease (STD). The nurse should instruct the client to:
wear a condom every time he has sexual intercourse.
The client underwent a transurethral resection of the prostate gland 24 hours ago and has a
continuous bladder irrigation. Which of the following nursing interventions is appropriate?
Use aseptic technique when irrigating the catheter.
The nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output
should relate in which way?
Fluid intake should be approximately equal to the urine output.
A client is frustrated and embarrassed by urinary incontinence. Which of the following measures
should the nurse include in a bladder retraining program?
Assessing present elimination patterns
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test
results are consistent with CRF?
Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl
A client with a suspected diagnosis of renal cancer is ordered to undergo a renal biopsy to
confirm the diagnosis. The client informs a nurse that she will not sign the informed consent
form. Which action should the nurse take?
Notify a physician that the client refuses to give consent.
A client comes to the emergency department complaining of sudden onset of sharp, severe pain
in the lumbar region, which radiates around the side and toward the bladder. The client also
reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician
tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form
anywhere in the urinary tract. What is their most common formation site?
Kidney
A client in the short-procedure unit is recovering from renal angiography in which a femoral
puncture site was used. When providing postprocedure care, the nurse should:
check the client's pedal pulses frequently.
Which of the following is a function of antidiuretic hormone (ADH)?
Water reabsorption and urine concentration
A charge nurse in a long-term care facility is planning the nursing assignments for the oncoming
shift. Her staff consists of four nursing assistants and a licensed practical nurse (LPN). How
should she divide nursing care among the staff to adequately ensure safe, effective care?
The charge nurse performs treatments and supervises staff, the LPN administers medications and
assists with care, and the nursing assistants provide direct client care.
The nurse is inserting a urinary catheter into a client who is extremely anxious about the
procedure. The nurse can facilitate the insertion by asking the client to:
breathe deeply.
A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the
nurse assess first?
Cardiac rhythm
Which intervention might safely prevent constipation in a client who has end-stage ovarian
cancer and requires high doses of opioids to control pain?
Explaining the importance of increasing the intake of fiber and fluids
The nurse suspects that a client with a temperature of 103.6° F (39.8° C) and an elevated white
blood cell count is in the initial stage of sepsis. What is the most common cause of sepsis in
hospitalized clients?
Urinary tract infection (UTI)
A client with renal cancer who has not yet been informed of his diagnosis asks the nurse what his
test results showed. How should the nurse respond?
"It must be difficult for you not to know the results of your test."
Which factor can lead to the formation of renal calculi?
Alkaline urine
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit
after an exploratory laparotomy. Which data collection finding suggests that the client is
experiencing acute renal failure (ARF)?
Urine output of 400 ml/24 hours
Which statement describing urinary incontinence in the elderly is true?
Urinary incontinence isn't a disease.
When caring for a client with acute renal failure (ARF), the nurse expects the physician to adjust
the dosage or dosing schedule of certain drugs. Which drug would require such adjustment?
Gentamicin sulfate (Garamycin)
When performing a scrotal examination, the nurse finds a nodule. What should the nurse do
next?
Notify the physician.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which
nursing diagnosis is most appropriate for this client?
Risk for infection
The nurse is caring for a client in acute renal failure. The nurse should expect hypertonic
glucose, insulin infusions, and sodium bicarbonate to be used to treat:
hyperkalemia
A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects
one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include:
generalized edema, especially of the face and periorbital area.
A nurse-manager on the urology unit tells the staff that supplies have been disappearing at an
alarming rate. A staff nurse has been assigned to monitor supply use. Which method can best
help the nurse monitor supply use?
Compare charge slips for supplies used against the inventory left in the supply room every 24
hours.
A client develops acute renal failure (ARF) after receiving an I.V. nephrotoxic antibiotic.
Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk
for:
hyperkalemia.

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide
which instruction?

a) "Increase your fluid intake to 2 to 3 L per day."

b) "Apply an antibacterial dressing to the incision daily."
c) "Take your temperature every 4 hours."
d) "Be aware that your urine will be cherry-red for 5 to 7 days."

"Increase your fluid intake to 2 to 3 L per day."

The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal
calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature
every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours
after lithotripsy but should then disappear.

Ms. Simpson, age 72 years, is being seen in the clinic with a suspected bladder tumor. These tumors
occur more frequently in men than women and usually affect clients 50 years of age and older. Use of
tobacco products is the leading cause of bladder cancer. You are asking Ms. Simpson about symptoms
that she has had that brought her to the clinic. What is the most common first symptom of a malignant
tumor of the bladder?

a) Urgency
b) Fever
c) Painless hematuria
d) Dysuria

Painless hematuria

The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional
early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency. Painless
hematuria is the most common, however.

A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes
when I have to urinate I can't control it, and do not reach the bathroom in time." The nurse suspects
that the client is experiencing which type of incontinence?

a) Urge
b) Functional
c) Stress
d) Overflow
Urge

Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding
in time to reach a toilet. Stress incontinence occurs when the client has an involuntary loss of urine that
results from a sudden increase in intra-abdominal pressure. Overflow incontinence occurs when the
client experiences an involuntary loss of urine related to an overdistended bladder; the client voids small
amounts frequently and dribbles. Functional incontinence occurs when the client has function of the
lower urinary tract but cannot identify the need to void or ambulate to the toilet.

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Which of the following is a characteristic of a normal stoma?

a) Painful
b) Dry in appearance
c) Pink color
d) No bleeding when cleansing stoma

Pink color

Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because
it has no nerve endings. The area is vascular and may bleed when cleaned.

A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the
client about surgery and the postoperative period. The nurse informs the client that many members of
the health care team (including a mental health practitioner) will see him. A mental health practitioner
should be involved in the client's care to:

a) assess whether the client is a good candidate for surgery.

b) assess suicidal risk postoperatively.
c) evaluate the client's need for mental health intervention.
d) help the client cope with the anxiety associated with changes in body image.

help the client cope with the anxiety associated with changes in body image.

Many clients who undergo surgery for creation of an ileal conduit experience anxiety associated with
changes in body image. The mental health practitioner can help the client cope with these feelings of
anxiety. Mental health practitioners don't evaluate whether the client is a surgical candidate. None of
the evidence suggests that urinary diversion surgery, such as creation of an ileal conduit, places the
client at risk for suicide. Although evaluating the need for mental health intervention is always
important, this client displays no behavioral changes that suggest intervention is necessary at this time.

The nurse is teaching a patient how to perform self-catheterization. Which of the following directions
should the nurse include?
a) The catheterization should occur 4 to 6 hours and before bedtime.
b) The nurse uses nonsterile technique in the hospital setting.
c) The catheter is rinsed with sterile normal saline after soaking in a cleaning solution.
d) Peroxide is recommended for cleaning the urinary catheter.

The catheterization should occur 4 to 6 hours and before bedtime.

The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before
bedtime. The catheter is rinsed with tap water after soaking in a cleaning solution. Either antibacterial
soap or Betadine solution is recommended for cleaning urinary catheters at home. The nurse uses
sterile technique in the hospital setting.

Which of the following terms is used to refer to inflammation of the renal pelvis?

a) Urethritis
b) Cystitis
c) Interstitial nephritis
d) Pyelonephritis

Pyelonephritis

Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic. Cystitis is
inflammation of the urinary bladder. Urethritis is inflammation of the urethra. Interstitial nephritis is
inflammation of the kidney.

The nurse is caring for a client who is scheduled for the creation of an ileal conduit. Which statement by
the client provides evidence that client teaching was effective?

a) "My urine will be eliminated through a stoma."

b) "I will not need to worry about being incontinent of urine."
c) "A catheter will drain urine directly from my kidney."
d) "My urine will be eliminated with my feces."

"My urine will be eliminated through a stoma."

An ileal conduit is a non-continent urinary diversion whereby the ureters drain into an isolated section
of ileum. A stoma is created at one end of the ileum, exiting through the abdominal wall.

The nurse observes a client's uric acid level of 9.3 mg/dL. When teaching the client about ways to
decrease the uric acid level, which diet would the nurse suggest?

a) A diet high in fruits and vegetables

b) A low-purine diet
c) A diet high in calcium
d) A low-sodium diet
A low-purine diet

The nurse would suggest a low-purine diet. Foods to avoid are anchovies, animal organs and sardines.
The other options do not lower the uric acids levels.

The nurse is conducting a community education program on UTIs. The nurse determines that the
participants understand the teaching when they identify which of the following as a contributing factor
for UTIs in older adults?

a) Sporadic use of antimicrobial agents

b) Active lifestyle
c) Immunocompromise
d) Low incidence of chronic illness

Immunocompromise

Factors that contribute to UTIs in older adults include immunocompromise, high incidence of chronic
illness, immobility, and frequent use of antimicrobial agents.

Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse
would expect to provide the client with which type of diet?

a) High protein
b) Low oxalate
c) Low purine
d) High sodium

Low purine

A low-purine diet is used for uric acid stones, although the benefits are unknown. Clients with a history
of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate. Only
clients who have type II absorptive hypercalciuria—approximately half of the clients—need to limit
calcium intake. Usually, clients are told to increase their fluid intake significantly, consume a moderate
protein intake, and limit sodium. Avoiding excessive protein intake is associated with lower urinary
oxalate and lower uric acid levels. Reducing sodium intake can lower urinary calcium levels.

A group of students are reviewing information about disorders of the bladder and urethra. The students
demonstrate understanding of the material when they identify which of the following as a voiding
dysfunction?

a) Cystitis
b) Bladder stones
c) Urethral stricture
d) Urinary retention

Urinary retention
Urinary retention and urinary incontinence are voiding dysfunctions, temporary or permanent
alterations in the ability to urinate normally. Cystitis is an infectious disorder. Bladder stones and
urethral stricture are obstructive disorders.

The nurse is caring for a client with recurrent urinary tract infections. Which of the following body
structures would the nurse instruct as the most frequent cause of women's urinary tract infections?

a) The ureters
b) The rectum
c) The urethra
d) The bladder

The urethra

Because the urethra is short in women, ascending infections or microorganisms carried from the vagina
or rectum are common. Males have a longer urethra, causing the organisms travel farther to the
bladder. Although structures of the urinary system, the other options are where the client has bacteria
and microorganisms located. The ureters connect the bladder to kidney thus do not obtain bacteria, just
transmit when available.

The nurse is conducting a community education program on urinary incontinence. The nurse determines
that the participants understand the teaching when they identify which of the following as risk factors
for urinary incontinence?

a) Cesarean delivery
b) Sedatives
c) Body mass index (BMI) of 22
d) Swimming

Sedatives

Use of sedatives, diuretics, hypnotics, and opioids are risk factors for urinary incontinence. Additional
risk factors include high-impact exercises, a BMI greater than 40, and vaginal birth delivery.

A major goal when caring for a catheterized patient is to prevent infection. Select all the nursing actions
that apply.

a) Wash the perineal area with soap and water at least twice daily.
b) Disconnect the tubing to collect urine samples.
c) Empty the collection bag at least every 8 hours to reduce bacterial growth.
d) Irrigate the catheter every 24 hours.
e) Suspend the drainage bag off the floor.

• Empty the collection bag at least every 8 hours to reduce bacterial growth.
• Suspend the drainage bag off the floor.
• Wash the perineal area with soap and water at least twice daily.
Never disconnect the tubing to collect samples, irrigate, or ambulate the patient since this will allow
bacteria to enter the closed system. Drainage systems should have an aspiration or puncture port from
which a specimen can be obtained. The drainage system should not be disconnected. See Box 28-8 in
the text.

The nurse is obtaining a health history from a client describing urinary complications. Which assessment
finding is most suggestive of a malignant tumor of the bladder?

a) Incontinence
b) Hematuria
c) Dysuria
d) Frequency

Hematuria

The most common first symptom of a malignant tumor is hematuria. Most malignant tumors are
vascular; thus, abnormal bleeding can be a first sign of abnormality. The client then has symptoms of
incontinence (a later sign), dysuria and frequency.

A female patient visits her primary health care provider with a complaint of frequency of urination and
incontinence when she sneezes. The health care provider suspects the patient is experiencing cystitis.
The nurse knows that this is most likely due to which of the following?

a) Disturbance in the normal bacterial flora of the vagina

b) Dysfunction of the bladder neck or urethra.
c) Reflux of urine from the urethra into the bladder
d) Interruption in the protective effect of glycosaminoglycan

Reflux of urine from the urethra into the bladder

With coughing, sneezing, or straining, the bladder pressure increases, which may force urine from the
bladder into the urethra. When the pressure returns to normal, the urine flows back into the bladder,
bringing into the bladder bacteria from the anterior portions of the urethra. See Figure 28-1 in the text.

Sympathomimetics have which of the following effects on the body?

a) Constriction of pupils
b) Decrease of heart rate
c) Relaxation of bladder wall
d) Constriction of bronchioles

Relaxation of bladder wall

Sympathomimetics mimic the sympathetic nervous system, causing increased heart rate and
contractility, dilation of bronchioles and pupils, and bladder wall relaxation.
Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply.

a) Deficient knowledge: management of urinary diversion

b) Urinary retention
c) Risk for impaired skin integrity
d) Disturbed body image
e) Chronic pain

• Deficient knowledge: management of urinary diversion

• Disturbed body image
• Risk for impaired skin integrity

Deficient knowledge, disturbed body image, and risk for impaired skin integrity are expected problems
for the client with a new ileal conduit. Urinary retention and chronic pain are not expected client
problems.

Which of the following is the most common symptom of bladder cancer?

a) Painless gross hematuria

b) Altered voiding
c) Back pain
d) Pelvic pain

Painless gross hematuria

Painless gross hematuria is the most common symptom of bladder cancer. Pelvic and back pain may
occur with metastasis. Any alteration in voiding or change in the urine may indicate cancer of the
bladder.

The nurse is caring for a postoperative client who has a Kock pouch. Nursing assessment findings reveal
abdominal pain, absence of bowel sounds, fever, tachycardia, and tachypnea. The nurse suspects which
of the following?

a) Stoma ischemia
b) Stoma retraction
c) Peritonitis
d) Postoperative pneumonia

Peritonitis

Clinical manifestations of peritonitis include abdominal pain and distention, absence of bowel sounds,
nausea and vomiting, fever, changes in vital signs.

Which of the following medications may be ordered to relieve discomfort associated with a UTI?

a) Nitrofurantoin (Furadantin)
b) Levofloxacin (Levaquin)
c) Phenazopyridine (Pyridium)
d) Ciprofloxacin (Cipro)

Phenazopyridine (Pyridium)

Pyridium is a urinary analgesic ordered to relieve discomfort associated with UTIs. Furadantin, Cipro,
and Levaquin are antibiotics.

A nurse has been asked to speak to a local women's group about preventing cystitis. Which of the
following would the nurse include in the presentation?

a) Importance of urinating every 4 to 6 hours while awake

b) Suggestion to take tub baths instead of showers
c) Need to urinate after engaging in sexual intercourse
d) Need to wear underwear made from synthetic material

Need to urinate after engaging in sexual intercourse

Measures to prevent cystitis include voiding after sexual intercourse, wearing cotton underwear,
urinating every 2 to 3 hours while awake, and taking showers instead of tub baths.

The nurse is conducting a history and assessment related to a patient's incontinence. Which of the
following should the nurse include in the assessment before beginning a bladder training program?

a) History of allergies
b) Occupational history
c) Medication usage
d) Smoking habits

Medication usage

It is essential to assess the patient's physical and environmental conditions before beginning a bladder
training program, because the patient may not be able to reach the bathroom in time. During the
bladder training program, a change in environment may be an effective suggestion for the patient. It is
not so essential to assess the patient's history of allergy, occupation, and smoking habits before
beginning a bladder training program.

Patricia O'Connor, a 17-year-old high school student, is returning to the medical-surgical unit where you
practice nursing from surgery. She has just undergone an appendectomy. She reports the need to
urinate and cannot do so. What is your response to her situation as ordered by the physician?

a) Intermittent catheterization
b) Clean intermittent catheterization
c) Indwelling catheterization
d) All options are correct.
Intermittent catheterization

Acute retention that is likely to resolve quickly (e.g., after anesthesia) probably will be treated by
intermittent catheterization.

A client presents at the clinic with complaints of urinary retention. What question should the nurse ask
to obtain additional information about the client's complaint?

a) "How much fluid are you drinking?"

b) "Do you get up at night to urinate?"
c) "When did you last urinate?"
d) "Have you had a fever and chills?"

"When did you last urinate?"

The nurse needs to determine the last time the client voided.

The nurse is caring for a client diagnosed with bladder cancer and requiring a cystectomy. The nurse
overhears the physician instructing the client on the presence of a stoma with temporary pouch. In
gathering information for the client, which urinary diversion would the nurse select?

a) Ureterosigmoidostomy
b) Ileal conduit
c) Kock Pouch
d) Indiana Pouch

Ileal conduit

When the physician is discussing a stoma, the nurse recognizes that the client will have an ileal conduit
which is a cetaceous urinary diversion. Both the Kock Pouch and Indiana Pouch are continent urinary
diversions. The ureterosigmoidostomy connects with the rectum for urinary drainage.

A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most
important?

a) Encouraging the client to drink cranberry juice to acidify the urine

b) Administering a sitz bath twice per day
c) Using an indwelling urinary catheter to measure urine output accurately
d) Increasing fluid intake to 3 L/day

Increasing fluid intake to 3 L/day

Acute pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both
kidneys. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. Pyelonephritis
may result from procedures that involve the use of instruments (such as catheterization, cystoscopy,
and urologic surgery) or from hematogenic infection. The most important nursing intervention is to
increase fluid intake to 3 L/day. Doing so helps empty the bladder of contaminated urine and prevents
calculus formation. Administering a sitz bath would increase the likelihood of fecal contamination. Using
an indwelling urinary catheter could cause further contamination. Encouraging the client to drink
cranberry juice to acidify urine is helpful but isn't the most important intervention.

If an indwelling catheter is necessary, the nursing interventions that should be implemented to prevent
infection include

a) placing the catheter bag on the patient's abdomen when moving the patient.
b) using sterile technique to disconnect the catheter from tubing to obtain urine specimens.
c) using clean technique during insertion.
d) performing meticulous perineal care daily with soap and water.

performing meticulous perineal care daily with soap and water.

Cleanliness of the area will reduce potential for infection. Strict aseptic technique must be used during
insertion of a urinary bladder catheter. The nurse must maintain a closed system and use the catheter's
port to obtain specimens. The catheter bag must never be placed on the patient's abdomen unless it is
clamped because it may cause backflow of urine from the tubing into the bladder.

Behavioral interventions for urinary incontinence can be coordinated by a nurse. A comprehensive

program that incorporates timed voiding and urinary urge inhibition is referred to as:

a) Voiding at given intervals.

b) Bladder retaining
c) Interval voiding
d) Prompted voiding

Bladder retaining

Bladder retraining includes a timed voiding schedule and urinary urge inhibition exercises. These
exercises involve delaying voiding to help the patient stay dry for a set period of time. When one time
interval is reached, another is set. The time is usually increased by 10 to 15 minutes, until an acceptable
voiding interval is achieved.

A nurse who is taking care of a patient with a spinal cord injury documents the frequency of reflex
incontinence. The nurse understands that this is most likely due to:

a) A stricture or tumor in the bladder.

b) Loss of motor control of the detrusor muscle.
c) Compromised ligament and pelvic floor support of the urethra.
d) Uninhibited detrusor contractions.

Loss of motor control of the detrusor muscle.

Spinal cord injury patients commonly experience reflex incontinence because they lack neurologically
mediated motor control of the detrusor and the sensory awareness of the urge to void. These patients
also experience hyperreflexia in the absence of normal sensations associated with voiding.
The nurse recognizes that urinalysis results that most likely indicate a urinary tract infection include:

a) proteinuria
b) RBC 3
c) WBC 50
d) glucose trace

WBC 50

Increased white blood cell occurs in all clients with a UTI and indicates an infectious process is occurring.

The most common presenting objective symptoms of a urinary tract infection in older adults, especially
in those with dementia, include?

a) Hematuria
b) Change in cognitive functioning
c) Back pain
d) Incontinence

Change in cognitive functioning

The most common objective finding is a change in cognitive functioning, especially in those with
dementia, because these patients usually exhibit even more profound cognitive changes with the onset
of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective
symptoms.

The nurse is educating a female patient with a UTI on the pharmacologic regimen for treatment. What is
important for the nurse to instruct the patient to do?

a) Take the antibiotic for 3 days as prescribed.

b) Understand that if the infection reoccurs, the dose will be higher next time.
c) Be sure to take the medication with grapefruit juice.
d) Take the antibiotic as well as an antifungal for the yeast infection she will probably have.

Take the antibiotic for 3 days as prescribed.

The trend is toward a shortened course of antibiotic therapy for uncomplicated UTIs, because most
cases are cured after 3 days of treatment. Regardless of the regimen prescribed, the patient is instructed
to take all doses prescribed, even if relief of symptoms occurs promptly. Although brief pharmacologic
treatment of UTIs for 3 days is usually adequate in women, infection recurs in about 20% of women
treated for uncomplicated UTIs.

Which of the following would be included in a teaching plan for a patient diagnosed with a urinary tract
infection?

a) Drink liberal amount of fluids

b) Void every 4 to 6 hours
c) Use tub baths as opposed to showers
d) Drink coffee or tea to increase diuresis

Drink liberal amount of fluids

Patients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3
hours. Coffee and tea are urinary irritants. The patient should shower instead of bathe in a tub because
bacteria in the bath water may enter the urethra.

Which of the following is a factor contributing to UTI in older adults?

a) Immunocompromise
b) Active lifestyle
c) Sporadic use of antimicrobial agents
d) Low incidence of chronic illness

Immunocompromise

Factors that contribute to urinary tract infection in older adults include immunocompromise, high
incidence of chronic illness, immobility, and frequent use of antimicrobial agents.

A 32-year-old client has a history of neurogenic bladder and presents with fever, burning, and
suprapubic pain. What would you suspect is the problem?

a) Urethral strictures
b) Urinary incontinence
c) Urinary tract infection
d) Urinary retention

Urinary tract infection

Signs of a bladder infection include fever, chills, and suprapubic pain.

A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line fluoroquinolone
antibacterial agent for UTIs has been found to be significantly effective?

a) Cipro
b) Bactrim
c) Macrodantin
d) Septra

Cipro

Ciprofloxacin (Cipro) is a fluoroquinolone used to treat UTIs. Co-trimoxazole (Bactrim, Septra) is a

trimethoprim-sulfamethoxazole combination medication. Nitrofurantoin (Macrodantin, Furadantin) is
an anti-infective urinary tract medication.
The nurse is assisting in the development of a protocol for bladder retraining following removal of an
indwelling catheter. Which of the following should the nurse include?

a) Implementing a 2- to 3-hour voiding schedule

b) Avoiding drinking fluids for 6 hours
c) Performing straight catheterization every 4 hours
d) Encouraging voiding immediately after catheter removal

Implementing a 2- to 3-hour voiding schedule

Immediately after the removal of the indwelling catheter, the patient is placed on a voiding schedule,
usually 2 to 3 hours. At the given time interval, the patient is instructed to void. If bladder ultrasound
scanning shows 100 mL or more of urine remaining in the bladder after voiding, straight catheterization
may be performed for complete bladder emptying. Immediate voiding is not usually encouraged.

The nurse is caring for an older patient whose chart reveals that the patient has a reversible cause of
urinary incontinence. The nurse creates a plan of care for which of the following conditions?

a) Constipation
b) Asthma
c) Bladder cancer
d) Decreased progesterone levels

Constipation

Constipation is a reversible cause of urinary incontinence in the older adult. Other reversible causes
include acute urinary tract infection, infection elsewhere in the body, decreased fluid intake, a change in
a chronic disease pattern, and decreased estrogen levels in the menopausal woman. The other answers
do not apply.

A patient undergoes surgery for removing a malignant tumor, followed by a urinary diversion procedure.
The nurse's postoperative plan of care should include which of the following?

a) Determine the patient's ability to manage stoma care.

b) Suggest a visit to a local ostomy group.
c) Maintain skin and stomal integrity.
d) Show pictures and drawings of placement of the stoma.

Maintain skin and stomal integrity.

The most important postoperative nursing management is to maintain skin and stomal integrity to avoid
further complications, such as skin infections and urinary odor. Determining the patient's ability to
manage stoma care, showing photographs, and suggesting a visit to a local ostomy group would be a
part of the preoperative procedure.

A client is suspected of having interstitial cystitis. Which diagnostic test would the nurse anticipate as
being used to confirm the diagnosis?
a) Bladder biopsy
b) Voiding cystourethrogram
c) Urine culture
d) Cystoscopy

Bladder biopsy

A biopsy of the bladder mucosa which reveals an inflammatory process with scarring and hemorrhagic
areas confirms the diagnosis. A cystoscopy would reveal a markedly inflamed bladder with pinpoint
hemorrhage and a bladder capacity that is smaller than normal. A voiding cystourethrogram
demonstrates a small bladder capacity. Urine culture would be negative.

Which finding is an early indicator of bladder cancer?

a) Nocturia
b) Occasional polyuria
c) Painless hematuria
d) Dysuria

Painless hematuria

Initially, as cancer cells destroy normal bladder tissue, bleeding occurs and causes painless hematuria.
(Pain is a late symptom of bladder cancer.) Occasional polyuria may occur with diabetes mellitus or
increased alcohol or caffeine intake. Nocturia commonly accompanies benign prostatic hypertrophy.
Dysuria may indicate a urinary tract infection.

The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom
with little notice. When the nurse is documenting these symptoms, which medical term will the nurse
document?

a) Urinary stasis
b) Urinary urgency
c) Urinary incontinence
d) Urinary frequency

Urinary urgency

The nurse would document urinary urgency. Urinary frequency is urinating more frequently than normal
often times due to inadequate emptying of the bladder. Urinary incontinence is the involuntary loss of
urine. Urinary stasis is a stoppage or diminution of flow.

A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor
of the bladder. Which finding would the nurse identify as the most common initial symptom?

a) Urinary retention
b) Painless hematuria
c) Frequency
d) Fever

Painless hematuria

The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional
early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency. Later
symptoms are related to metastases and include pelvic pain, urinary retention (if the tumor blocks the
bladder outlet), and urinary frequency from the tumor occupying bladder space.

The nurse is educating a patient with urolithiasis about preventative measures to avoid another
occurrence. What should the patient be encouraged to do?

a) Add calcium supplements to the diet to replace losses to renal calculi.

b) Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be
strengthened to help propel calculi.
c) Limit voiding to every 6 to 8 hours so that increased volume can increase hydrostatic pressure, which
will help push stones along the urinary system.
d) Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help
prevent additional stone formation.

Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent
additional stone formation.

A patient who has shown a tendency to form stones should drink enough fluid to excrete greater than
2,000 mL (preferably 3,000 to 4,000 mL) of urine every 24 hours (Meschi et al., 2011).

Which of the following accounts for the majority of ureteral injuries?

a) Sports injuries
b) Unintentional injuries
c) Gunshot wounds
d) Knife wounds

Gunshot wounds

Gunshot wounds account for 95% of ureteral injuries, which may range from contusions to complete
transection. Unintentional injury to the ureter may occur during gynecologic or urologic surgery. Knife
wounds and sports injuries do not account for the majority of ureteral injuries.

The nurse is assisting in the transport of a client with an indwelling catheter to the diagnostic studies
unit. Which action, made by the nursing assistant, would require instruction?

a) The nursing assistant places the drainage bag on the lower area of the wheelchair for transport.
b) The nursing assistant places the drainage bag on the client's abdomen for transport.
c) The nursing assistant holds the drainage bag while the client moves to the wheelchair.
d) The nursing assistant keeps the catheter and drainage bag together when moving the client.
The nursing assistant places the drainage bag on the client's abdomen for transport.

The nurse would instruct the nursing assistant to maintain the drainage bag lower than the genital
region to avoid a backflow of urine into the bladder. The nursing assistant is correct to move the
catheter and drainage bag with the client to not put tension on the catheter, place the drainage bag on
the lower area of the wheelchair, and hold the drainage bag while the client is in the process of moving.

A male patient, who is 82 years of age, suffers from urinary incontinence. Which of the following factors
should the nurse assess before beginning a bladder training program for the patient?

a) Smoking habits
b) Physical and environmental conditions
c) Occupational history
d) History of allergies

Physical and environmental conditions

It is essential to assess the patient's physical and environmental conditions before beginning a bladder
training program, because the patient may not be able to reach the bathroom in time. During the
bladder training program, a change in environment may be an effective suggestion for the patient. It is
not so essential to assess the patient's history of allergy, occupation, and smoking habits before
beginning a bladder training program.

The nurse is employed in an urologist office. Which classification of medication is anticipated for clients
having difficulty with urinary incontinence?

a) Diuretics
b) Anticholinergic
c) Cholinergic
d) Anticonvulsant

Anticholinergic

Pharmacologic agents that can improve bladder retention, emptying, and control include anticholinergic
drugs. In this classification are medications such as Detrol, Ditropan, and Urecholine. Diuretics eliminate
fluid from the body but do not affect the muscles of urinary elimination. Anticonvulsant and cholinergic
medications also do not directly help with control.

When describing the types of bladder tumors that may occur, which type would the nurse identify as
most common?

a) Squamous cell carcinoma

b) Adenocarcinoma
c) Transitional cell carcinoma
d) Papillary carcinoma
Transitional cell carcinoma

The most common type of bladder tumor is a transitional cell carcinoma which develops in the bladder's
epithelial lining. The tumors are classified as papillary or nonpapillary. Papillary lesions are superficial
and extend outward from the mucosal layer. Nonpapillary tumors are solid growths that grow inward,
deep into the bladder wall. This type is more likely to metastasize, usually to the lymph nodes, liver,
lungs, and bone. Other types include squamous cell carcinoma and adenocarcinoma.

Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis?

a) Risk for fluid volume excess

b) Risk for deficient knowledge: self-catherization
c) Risk for altered urinary elimination
d) Risk for infection

Risk for infection

Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client
would be at risk for infection.

The nurse working with a patient after an ileal conduit notices that the pouching system is leaking small
amounts of urine. The appropriate nursing intervention is which of the following?

a) Empty the pouch.

b) Secure/patch it with tape.
c) Secure/patch with barrier paste.
d) Change wafer and pouch.

Change wafer and pouch.

Whenever the nurse notes a leaking pouching system, the nurse should change the wafer and pouch.
Attempting to secure or patch the leak with tape and/or barrier paste will trap urine under the barrier or
faceplate, which will compromise peristomal skin integrity. Emptying the pouch will not rectify the
leaking.

The nurse caring for a patient after urinary diversion surgery monitors the patient closely for peritonitis
by assessing for which of the following? Select all that apply.

a) Hyperactive bowel sounds

b) Muscle flaccidity
c) Leukocytosis
d) Abdominal distention

• Leukocytosis
• Abdominal distention

The nurse should monitor the patient for the following signs and symptoms of peritonitis: leukocytosis,
abdominal distention, absence of bowel sounds, fever, muscle rigidity, guarding, and nausea and
vomiting.

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include
in a bladder retraining program?

a) Establishing a predetermined fluid intake pattern for the client

b) Assessing present voiding patterns
c) Restricting fluid intake to reduce the need to void
d) Encouraging the client to increase the time between voidings

Assessing present voiding patterns

The guidelines for initiating bladder retraining include assessing the client's present intake patterns,
voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce
or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding
schedule should be established after assessment.

The nurse is giving discharge instructions to the client with uric acid renal calculi. Which statement by
the client indicates the client understands the prescribed diet?

a) "I will eliminate milk and other dairy products from my diet."
b) "I should limit my intake of meat and fish."
c) "I should avoid raw fruits and vegetables."
d) "Chocolate, spinach, and strawberries are not allowed."

"I should limit my intake of meat and fish."

A low-purine diet is prescribed for the client with uric acid renal calculi. Organ meats, shellfish,
anchovies, asparagus, and mushrooms are foods high in purine.

After teaching a group of students about the types of urinary incontinence and possible causes, the
instructor determines that the student have understood the material when they identify which of the
following as a cause of stress incontinence?

a) Obstruction due to fecal impaction or enlarged prostate

b) Increased urine production due to metabolic conditions
c) Decreased pelvic muscle tone due to multiple pregnancies
d) Bladder irritation related to urinary tract infections

Decreased pelvic muscle tone due to multiple pregnancies

Stress incontinence is due to decreased pelvic muscle tone, which is associated with multiple
pregnancies, obstetric injuries, obesity, menopause, or pelvic disease. Transient incontinence is due to
increased urine production related to metabolic conditions. Urge incontinence is due to bladder
irritation related to urinary tract infections, bladder tumors, radiation therapy, enlarged prostate, or
neurologic dysfunction. Overflow incontinence is due to obstruction from fecal impaction or enlarged
prostate.

A client is prescribed amitriptyline, an antidepressant for incontinence. The nurse understands that this
drug is an effective treatment because it:

a) Increases bladder neck resistance.

b) Decreases involuntary bladder contractions.
c) Reduces bladder spasticity.
d) Increases contraction of the detrusor muscle.

Increases bladder neck resistance.

Some tricyclic antidepressant medications (amitriptyline, nortriptyline, and amoxapine) are useful in
treating incontinence because they decrease bladder contractions and increase bladder neck resistance.
Anticholinergic drugs such as oxybutynin chloride (Ditropan), reduce bladder spasticity and involuntary
bladder contractions. Bethanechol (Urecholine) helps to increase contraction of the detrusor muscle,
which assists with emptying of the bladder.

An ileal conduit is created for a client after a radical cystectomy. Which of the following would the nurse
expect to include in the client's plan of care?

a) Exercises to promote sphincter control

b) Application of an ostomy pouch
c) Irrigating the urinary diversion
d) Intermittent catheterizations

Application of an ostomy pouch

An ileal conduit involves care of a urinary stoma, much like that of a fecal stoma, including the
application of an ostomy pouch, skin protection, and stoma care. Intermittent catheterizations and
irrigations are appropriate for a continent urinary diverse such as a Kock or Indiana pouch. Exercises to
promote sphincter control are appropriate for an ureterosigmoidoscopy.

James Roth, a 63-year-old accountant, is a client on the hospital unit where you practice nursing. Mr.
Roth has developed urinary incontinence and is beginning bladder training to regain control over his
urine elimination. Why is the catheter being clamped and unclamped?

a) To prevent bladder distention

b) To promote normal bladder function
c) To prevent urinary retention
d) To promote urine production

To promote normal bladder function

The clamping and unclamping of the catheter begins to reestablish normal bladder function and
capacity.
A patient is admitted to a hospital with a diagnosis of spastic, neurogenic bladder. The nurse is aware
that the pathophysiology of this condition is primarily due to which of the following occurrences?

a) Inability of the bladder muscle to contract forcefully

b) Presence of a lower motor neuron lesion
c) Bladder distended until overflow incontinence occurs
d) Patient's inability to exert motor control

Patient's inability to exert motor control

Neurogenic bladder dysfunction results from a lesion of the nervous system that results in urinary
incontinence. Spastic bladder is caused by any spinal cord lesion above the voiding reflex. There is a loss
of conscious sensation and control. A spastic bladder empties on reflex.

Which of the following is a strategy to promote urinary continence?

a) Implement a low fiber diet

b) Take diuretics after 4 PM
c) Use caffeine in moderation
d) Void regularly, 5 to 8 times a day

Void regularly, 5 to 8 times a day

Strategies to promote urinary continence include increasing awareness of the amount and timing of all
fluid intake; avoid taking diuretics after 4 PM; avoiding bladder irritants, such as caffeine, alcohol, and
aspartame (NutraSweet); taking steps to avoid constipation by drinking adequate fluids, eating a well-
balanced diet high in fiber, exercising regularly, and taking stool softeners if recommended; and voiding
regularly, 5 to 8 times a day (about every 2 to 3 hours).

Which type of incontinency refers to the involuntary loss of urine due to medications?

a) Overflow
b) Urge
c) Iatrogenic
d) Reflex

Iatrogenic

Iatrogenic incontinence is the involuntary loss of urine due to medications. Reflex incontinence is the
involuntary loss of urine due to hyperreflexia in the absence of normal sensations usually associated
with voiding. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that
cannot be suppressed. Overflow incontinence is the involuntary loss of urine associated with
overdistention of the bladder.

A patient who has been treated with uric acid for stones is being discharged from the hospital. What
type of diet does the nurse discuss with the patient?
a) Low-calcium diet
b) Low-phosphorus diet
c) Low-purine diet
d) High-protein diet

Low-purine diet

For uric acid stones, the patient is placed on a low-purine diet to reduce the excretion of uric acid in the
urine. Foods high in purine (shellfish, anchovies, asparagus, mushrooms, and organ meats) are avoided,
and other proteins may be limited.

A 64-year-old man is seeing his urologist for an annual check-up, post prostatectomy. The health care
provider is concerned with the symptom he finds because it is considered diagnostic for bladder cancer.
Which of the following signs/symptoms is diagnostic for bladder cancer?

a) Deep flank and abdominal pain

b) Muscle spasm and abdominal rigidity over the flank
c) Painless, gross hematuria
d) Decreasing kidney function associated with fever and hematuria

Painless, gross hematuria

Although flank pain may occur, the painless, gross hematuria is characteristic of bladder cancer.

The nurse is evaluating the effectiveness of discharge teaching for a client with an oxalate urinary stone.
Which statement by the client indicates the need for further teaching by the nurse? Select all that apply.

a) "I will never have another urinary stone again."

b) "Tylenol is best to control my pain."
c) "I'm so glad I don't have to make any changes in my diet."
d) "I need to drink eight to ten glasses of water every day."
e) "I need to take allopurinol."

• "I'm so glad I don't have to make any changes in my diet."

• "Tylenol is best to control my pain."
• "I will never have another urinary stone again."
• "I need to take allopurinol."

Nonsteroidal anti-inflammatory drugs are used to treat renal stone pain. Oxalate-containing foods
should be avoided. Fluid intake should total 2 to 3 liters, if not contraindicated. Allopurinol (Zyloprim) is
prescribed for uric acid stones. Recurrence of stones occurs in about half of individuals.

When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family
members, the nurse teaches him how to do this without compromising the catheter. Which client action
indicates an accurate understanding of this information?

a) The client keeps the drainage bag below the bladder at all times.
b) The client loops the drainage tubing below its point of entry into the drainage bag.
c) The client sets the drainage bag on the floor while sitting down.
d) The client clamps the catheter drainage tubing while visiting with the family.

The client keeps the drainage bag below the bladder at all times.

To maintain effective drainage, the client should keep the drainage bag below the bladder; doing so
allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldn't lay the
drainage bag on the floor because the bag could become grossly contaminated. The client shouldn't
clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the
client may loop the drainage tubing above — not below — its point of entry into the drainage bag.

A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which
statement indicates the client understands the teaching about preventing UTIs?

a) "I should wipe from back to front."

b) "I should limit my fluid intake to limit my trips to the bathroom."
c) "I should take a tub bath at least 3 times per week."
d) "I should take at least 1,000 mg of vitamin C each day."

"I should take at least 1,000 mg of vitamin C each day."

The client demonstrates understanding of teaching when she states that she should take vitamin C each
day. Increasing vitamin C intake to at least 1,000 mg per day helps acidify the urine, decreasing the
amount of bacteria that can grow. The client should wipe from front to back to avoid introducing
bacteria from the anal area into the urethra. The client should shower, not bathe, to minimize the
amount of bacteria that can enter the urethra. The client should increase her fluid intake, and void every
2 to 3 hours and completely empty her bladder. Holding urine in the bladder can cause the bladder to
become distended, which places the client at further risk for UTI.

The nurse is participating in a bladder retraining program for a patient who had an indwelling catheter
for 2 weeks. The nurse knows that, during this process, straight catheterization, after catheter-free
intervals, can be discontinued when residual urine is:

a) <100 mL
b) 400 mL
c) 200 mL
d) 500 mL

<100 mL

Residual urine greater than 100 mL is considered diagnostic of urinary retention. Refer to Box 28-9 in the
text.

The nurse, in assessing a patient's newly created stoma, observes that the stoma color is now dark
purple. The appropriate nursing intervention is to do which of the following?
a) Remove the urinary stents.
b) Apply Karaya powder.
c) Change the pouching system.
d) Contact the physician.

Contact the physician.

The appropriate nursing intervention when a newly created stoma is dark purple is to notify the
physician. The physician or wound, ostomy, and continence (WOC) nurse will assess the stoma to
determine if it the stoma has superficial ischemia or if it is necrotic.

A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following
instructions would the nurse give the client?

a) "This will kill the organism causing the infection."

b) "This medication should be taken at bedtime."
c) "This medication will prevent re-infection."
d) "This medication will relieve your pain."

"This medication will relieve your pain."

Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain
associated with UTIs.

A client comes to the emergency department complaining of severe pain in the right flank, nausea, and
vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this
client's care, the nurse should assign the highest priority to which nursing diagnosis?

a) Impaired urinary elimination

b) Imbalanced nutrition: Less than body requirements
c) Acute pain
d) Risk for infection

Acute pain

Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes
increasingly anxious. Therefore, the nursing diagnosis of Acute pain takes highest priority. Diagnoses of
Risk for infection and Impaired urinary elimination are appropriate when the client's pain is controlled. A
diagnosis of Imbalanced nutrition: Less than body requirements isn't pertinent at this time.

Which of the following is the procedure of choice for men with recurrent or complicated UTIs?

a) CT scan
b) MRI
c) IV urogram
d) Transrectal ultrasonography
Transrectal ultrasonography

A transrectal ultrasonography is the procedure of choice for men with recurrent or complicated UTIs.

The nurse advises the patient with chronic pyelonephritis that he should:

a) Decrease his sodium intake to prevent fluid retention.

b) Decrease his intake of calcium rich foods to prevent kidney stones.
c) Limit his fluid intake to 1.5 L/day to minimize bladder fullness, which could cause backward pressure
on the kidneys.
d) Increase fluids to 3 to 4 L/24 hours to dilute the urine.

Increase fluids to 3 to 4 L/24 hours to dilute the urine.

Unless contraindicated, fluids should be increased to dilute the urine, decrease burning on urination,
and prevent dehydration. A balanced diet would be recommended but there is no need to restrict
sodium or calcium.

A woman comes to her health care provider's office with signs and symptoms of kidney stones. Which of
the following should be the primary medical management goal?

a) Determine the stone type.

b) Relieve any obstruction.
c) Relieve the pain.
d) Prevent nephron destruction.

Relieve the pain.

The immediate objective is to relieve pain, which can be incapacitating depending

A nurse is describing the renal system to a client with a kidney disorder. Which structure would
the nurse identify as emptying into the ureters?
Renal pelvis

The renal pelvis empties into the ureter which carries urine to the bladder for storage. The
nephron consists of the glomerulus, afferent arteriole, efferent arteriole, Bowman's capsule, distal
and proximal convoluted tubules, the loop of Henle, and collecting tubule. The nephron is
located in the cortex and carries out the functions of the kidney. The parenchyma is made up of
the cortex and medulla.
Which of the following terms refers to casts in the urine?
Cylindruria

Casts may be identified through microscopic examination of the urine sediment after
centrifuging. Crystalluria is the term used to refer to crystals in the urine. Pyuria is the term used
to refer to pus in the urine. Bacteriuria refers to a bacterial count higher than 100,000 colonies
per mL in the urine.
The client presents with nausea and vomiting, absent bowel sounds, and colicky flank pain. The
nurse interprets these findings as consistent with:
Ureteral colic
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Which of the following is used to identify vesicoureteral reflux?
Voiding cystourethrography

A voiding cystourethrography is used as a diagnostic tool to identify vesicoureteral reflux. An IV

urography may be used as the initial assessment of various suspected urologic problems,
especially lesions in the kidneys and ureters, and it provides an approximate estimate of renal
function. Renal angiography is used to evaluate renal blood flow, to differentiate renal cysts from
tumors, to evaluate hypertension, and preoperatively for renal transplantation.
Serum sodium plays a major role in maintaining fluid and electrolyte balance. Choose all the
correct statements that apply.
Aldosterone causes renal reabsorption of sodium.
Angiotensin II controls the release of aldosterone.
Renin, an enzyme released by the kidneys, activates the RAS system to ensure adequate
filtration.
A patient presents to the ED complaining of left flank pain and lower abdominal pain. The pain
is severe, sharp, stabbing, and colicky in nature. The patient has also experienced nausea and
emesis. The nurse suspects the patient is experiencing which of the following?
Ureteral stones
A patient is being seen in the clinic for possible kidney disease. What major sensitive indicator
of kidney disease does the nurse anticipate the patient will be tested for?

a) Creatinine clearance level

b) Uric acid level
c) Blood urea nitrogen level
d) Serum potassium level
Creatinine clearance level

Creatinine is an endogenous waste product of skeletal muscle that is filtered at the glomerulus,
passed through the tubules with minimal change, and excreted in the urine. Hence, creatinine
clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma
filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of
renal function. As renal function declines, both creatinine clearance and renal clearance (the
ability to excrete solutes) decrease.
An appropriate nursing intervention for the client following a nuclear scan of the kidney is to:

a) Apply moist heat to the flank area.

b) Encourage high fluid intake.
c) Strain all urine for 48 hours.
d) Monitor for hematuria.
Encourage high fluid intake.

A nuclear scan of the kidney involves the IV administration of a radioisotope. Fluid intake is
encouraged to flush the urinary tract to promote excretion of the isotope. Monitoring for
hematuria, applying heat, and straining urine do not address the potential renal complications
associated with the radioisotope.
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the
following would the nurse expect to find?

a) Decreased potassium
b) Increased serum albumin
c) Decreased blood urea nitrogen (BUN)
d) Increased serum creatinine
Increased serum creatinine

In clients with renal disease, the serum creatinine level would be increased. The BUN also would
be increased, serum albumin would be decreased, and potassium would likely be increased.
The nurse is providing care to a client who has had a renal (kidney) biopsy. The nurse would
need to be alert for signs and symptoms of which of the following?

a) Infection
b) Dehydration
c) Allergic reaction
d) Bleeding
Bleeding

Renal biopsy carries the risk of postprocedure bleeding because the kidneys receive up to 25% of
the cardiac output each minute. Therefore, the nurse would need to be alert for signs and
symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater.
Dehydration and allergic reaction are not associated with a renal biopsy.
A client has undergone diagnostic testing that involved the insertion of a lighted tube with a
telescopic lens. The nurse identifies this test as which of the following?

a) Excretory urogram
b) Cystoscopy
c) Intravenous pyelography
d) Renal angiography
Cystoscopy

Cystoscopy is the visual examination of the inside of the bladder using an instrument called a
cystoscope, a lighted tube with a telescopic lens. Renal angiography involves the passage of a
catheter up the femoral artery into the aorta to the level of the renal vessels. Intravenous
pyelography or excretory urography is a radiologic study that involves the use of a contrast
medium to evaluate the kidneys' ability to excrete it.
Approximately what percentage of blood passing through the glomeruli is filtered into the
nephron?

a) 10
b) 30
c) 20
d) 40
20

Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into
the nephron, amounting to about 180 liters per day of filtrate.
The nurse is providing instructions to the client prior to an intravenous pyelogram. Which
statement by the client indicates teaching was effective?

a) "I will feel a warm sensation as the dye is injected."

b) "I will need to drink all of the dye as quickly as possible."
c) "I should remove all jewelry before the test."
d) "I should let the staff know if I feel claustrophobic."
"I will feel a warm sensation as the dye is injected."

A contrast agent is injected into the client for an intravenous pyelogram. The client may
experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast
infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not
expected.
The nurse is completing a full exam of the renal system. Which assessment finding best
documents the need to offer the use of the bathroom?

a) The ingestion of 8 oz of water

b) A dull sound when percussing over the bladder
c) Tenderness over the kidneys
d) Bruits noted over the abdominal area
A dull sound when percussing over the bladder

A dull sound when percussing over the bladder indicates a full bladder. Because the bladder is
full, the nurse would offer for the client to use the bathroom. Tenderness over the kidney can
indicate an infection or stones. Bruits are an abnormal vascular sound that does not indicate the
need to use the bathroom. Ingesting water does not mean that the client has to void at this time.
A 24-year-old patient was admitted to the emergency room after a water skiing accident. The X-
rays revealed two fractured vertebrae, T-12 and L1. Based on this information, the nurse would
know to perform which of the following actions?

a) Keep the patient on bed rest for 72 hours.

b) Apply moist heat, every 4 hours for the first 48 hours to aid healing.
c) Place a bed board under the mattress to add support.
d) Check the patient's urine for hematuria.
Check the patient's urine for hematuria.

The kidneys are located from the 12th thoracic vertebrae to the third lumbar vertebrae.
Therefore, the accident may have caused blunt force trauma damage to the kidneys. Ice is always
applied for the first 24 hours, then heat, if not contraindicated. Activity will be restricted but bed
rest is not necessary.
Retention of which electrolyte is the most life-threatening effect of renal failure?

a) Sodium
b) Potassium
c) Phosphorous
d) Calcium
Potassium

Retention of potassium is the most life-threatening effect of renal failure.

The nurse is caring for a patient following a cystoscopic examination. Following the procedure,
the nurse informs the patient that which of the following may occur?

a) Blood-tinged urine
b) Diarrhea
c) Nausea and emesis
d) Severe abdominal pain
Blood-tinged urine

Postprocedural management is directed at relieving any discomfort resulting from the

examination. Some burning on voiding, blood-tinged urine, and urinary frequency from trauma
to the mucous membranes can be expected. Moist heat to the lower abdomen and warm sitz
baths are helpful in relieving pain and relaxing the muscles. Not eating and diarrhea are not
expected following a cystoscopic examination. The patient should not experience severe
abdominal pain.
A 30-year-old male patient presents to the clinic for an employment physical. The nurse notes
protein in the patient's urine. The nurse understands that transient proteinuria can be caused by
which of the following? Select all that apply.

a) NSAIDs
b) Strenuous exercise
c) Prolonged standing
d) Diabetes mellitus
e) Fever
• Strenuous exercise
• Prolonged standing
• Fever

Proteinuria may be a benign finding, or it may signify serious disease. Common benign causes of
transient proteinuria are fever, strenuous exercise, and prolonged standing. Causes of persistent
proteinuria include glomerular diseases, malignancies, collagen diseases, diabetes, preeclampsia,
hypothyroidism, heart failure, exposure to heavy metals, and use of medications, such as drugs,
NSAIDs, and angiotensin-converting enzyme (ACE) inhibitors.
A client is scheduled for a renal angiography. Which of the following would be appropriate
before the test?

a) Evaluate the client for periorbital edema.

b) Monitor the client for signs of electrolyte and water imbalance.
c) Monitor the client for an allergy to iodine contrast material.
d) Assess the client's mental changes.
Monitor the client for an allergy to iodine contrast material.

A renal angiography procedure will be contraindicated if the client is allergic to iodine contrast
material. Therefore, it is important for the nurse to monitor the client for an allergy to iodine
contrast material. The nurse monitors the client for the signs of electrolyte and water imbalance,
mental changes, and periorbital edema at any time regardless of the test being done.
Which term best describes a total urine output of less than 500 mL in 24 hours?

a) Oliguria
b) Dysuria
c) Nocturia
d) Polyuria
Oliguria

Oliguria is a urine output of less than 400 mL in 24 hours. Polyuria is increased urine output.
Nocturia is awakening at night to urinate. Dysuria is painful or difficult urination.
A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient
complains of severe pain in the back, arms, and shoulders. Which of the following appropriate
nursing interventions should be offered by the nurse?

a) Asses the patient's back and shoulder areas for signs of internal bleeding.
b) Distract the patient's attention from the pain.
c) Provide analgesics to the patient.
d) Enable the patient to sit up and ambulate.
Asses the patient's back and shoulder areas for signs of internal bleeding.

After a renal biopsy, the patient is on bed rest. The nurse observes the urine for signs of
hematuria. It is important to assess the dressing frequently for signs of bleeding, monitor vital
signs, and evaluate the type and severity of pain. Severe pain in the back, shoulder, or abdomen
may indicate bleeding. In such a case, the nurse should notify the physician about these signs and
symptoms. The nurse should also assess the client for difficulty voiding and encourage adequate
fluid intake. Distracting the patient's attention, helping the patient to sit up or ambulate, and
providing analgesics may only aggravate the patient's pain and, therefore, should not be
performed by the nurse.
A client presents to the emergency department complaining of a dull, constant ache along the
right costovertebral angle along with nausea and vomiting. The most likely cause of the client's
symptoms is:

a) interstitial cystitis.
b) an overdistended bladder.
c) acute prostatitis.
d) renal calculi.
renal calculi.

Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may
also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended
bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's
intense with voiding. The client also complains of urinary urgency and straining to void. The
client with acute prostatitis presents with a feeling of fullness in the perineum and vague back
pain, along with frequency, urgency, and dysuria.
When the bladder contains 300 mL or more of urine, this is referred to as

a) functional capacity
b) anuria.
c) specific gravity
d) renal clearance
functional capacity

A marked sense of fullness and discomfort with a strong desire to void usually occurs when the
bladder contains 350 mL or more of urine, referred to as the "functional capacity." Anuria is a
total urine output of less than 50 mL in 24 hours. Specific gravity reflects the weight of particles
dissolved in the urine. Renal clearance refers to the ability of the kidneys to clear solutes from
the plasma.
Which nursing assessment finding indicates the client has not met expected outcomes?

a) The client consumes 75% of lunch following an intravenous pyelogram.

b) The client has blood-tinged urine following brush biopsy.
c) The client reports a pain rating of 3 two hours post-kidney biopsy.
d) The client voids 75 cc four hours post cystoscopy.
The client voids 75 cc four hours post cystoscopy.

Urinary retention is an undesirable outcome following cystoscopy. A pain rating of 3 is an

achieveable and expected outcome following kidney biopsy. Blood-tinged urine is an expected
finding following cystoscopy due to trauma of the procedure. A client would be expected to eat
and retain a meal following an intravenous pyelogram.
The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical
manifestations would the nurse expect to find?

a) Pain after voiding

b) Suprapubic pain
c) Costovertebal angle tenderness
d) Perineal pain
Costovertebal angle tenderness

Acute pyelonephritiis is characterized by costovertebal angle tenderness. Suprapubic pain is

suggestive of bladder distention or infection. Urethral trauma and irritation of the bladder neck
can cause pain after voiding. Perineal pain is experienced by male clients with prostate cancer or
prostatitis.
A 42-year-old client is being seen by a urologist in the group where you practice nursing. She is
experiencing some secretion abnormalities, for which diagnostics are being performed. Which of
the following substances are typically reabsorbed and not secreted in urine?

a) Potassium
b) Glucose
c) Creatinine
d) Chloride
Glucose

Amino acids and glucose typically are reabsorbed and not excreted in the urine. The filtrate that
is secreted as urine usually contains water, sodium, chloride, bicarbonate, potassium, urea,
creatinine, and uric acid.
The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would
the client assess for an allergy to shellfish?

a) Bladder ultrasonography
b) Computed tomography with contrast
c) Cystoscopy
d) Radiography
Computed tomography with contrast

The nurse is correct to assess for an allergy to shellfish most times when a contrast medium is
ordered. The other options do not necessarily have a contrast medium.
A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the
procedure?

a) With the first specimen voided after 8:00 am

b) After discarding the 8:00 am specimen
c) At 8:00 am, with or without a specimen
d) 6 hours after the urine is discarded
After discarding the 8:00 am specimen

A 24-hour collection of urine is the primary test of renal clearance used to evaluate how well the
kidney performs this important excretory function. The client is initially instructed to void and
discard the urine. The collection bottle is marked with the time the client voided. Thereafter, all
the urine is collected for the entire 24 hours. The last urine is voided at the same time the test
originally began.
The nurse is reviewing the results of renal function studies of a patient. The nurse understands
that which of the following is a normal BUN-to-creatinine ratio?

a) 10:1
b) 8:1
c) 4:1
d) 6:1
10:1

A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect.
The nurse is caring for a patient complaining of orange-colored urine. The nurse suspects which
of the following as the cause of the urine discoloration?

a) Pyridium (phenazopyridium HCl)

b) Phenytoin (Dilantin)
c) Infection
d) Metronidazole (Flagyl)
Pyridium (phenazopyridium HCl)

Orange to amber-colored urine is caused by concentrated urine due to dehydration, fever, bile,
excess bilirubin or carotene, and the medications Pyridium (phenazopyridium HCl) and
nitrofurantoin (Furadantin). Infection would cause yellow to milky white urine. Phenytoin
(Dilantin) would cause the urine to become pink to red in color. Metronidazole (Flagyl) would
cause the urine to become brown to black in color.
The nurse is preparing a patient for a nuclear scan of the kidneys. Following the procedure, the
nurse will instruct the patient to complete which of the following?

a) Carefully handle urine as it is radioactive.

b) Maintain bed rest for 2 hours.
c) Drink liberal amounts of fluids.
d) Notify the health care team if bloody urine is noted.
Drink liberal amounts of fluids.

After the procedure is completed, the patient is encouraged to drink fluids to promote excretion
of the radioisotope by the kidneys. The remaining instructions are not associated with a nuclear
scan.
A nurse measures a patient's urinary output every 8 hours. The nurse weighs the importance of
these results by comparing the normal 24-hour urinary output with the patient's condition and
medication. The normal 24-hour output should be:

a) 1 to 2 L/day
b) 3.5 to 4 L/day
c) 0.4 to 0.8 L/day
d) 2.5 to 3 L/day
1 to 2 L/day

The normal output of urine every 24 hours is 800 to 1,500 mL. Refer to Table 26-1 in the text.
The significance of the 24-hour result will depend on the patient's medical condition.
A client has a full bladder. Which sound would the nurse expect to hear on percussion?

a) Resonance
b) Dullness
c) Tympany
d) Flatness
Dullness

Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance
is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very
dense tissue, such as the bone or muscle.
Which of the following does the nurse recognize is the best clinical measure of renal function?

a) Volume of urine output

b) Creatinine clearance
c) Urine-specific gravity
d) Circulating ADH levels
Creatinine clearance

Creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of
plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best
approximation of renal function. As renal function declines, both creatinine clearance and renal
clearance (the ability to excrete solutes) decreases.
A patient who complains of a dull, continuous pain in the suprapubic area that occurs with and at
the end of voiding would most likely be diagnosed with which of the following?

a) A kidney stone
b) Interstitial cystitis
c) Prostatic cancer
d) Acute pyelonephritis
Interstitial cystitis

Pain over the suprapubic area is most likely related to the bladder. Pain intensity would increase
with fullness. Pain at the end of voiding is one of the symptoms associated with interstitial
cystitis.
Which nursing assessment finding indicates the client with renal dysfunction has not met
expected outcomes?

a) Client reports increasing fatigue.

b) Urine output is 100 ml/hr.
c) Client rates pain at a 3 on a scale of 0 to 10.
d) Client denies frequency and urgency.
Client reports increasing fatigue.

Fatigue, shortness of breath, and exercise intolerance are consistent with unexplained anemia,
which can be secondary to gradual renal dysfunction.
Which of the following hormones is secreted by the juxtaglomerular apparatus?

a) Aldosterone
b) Calcitonin
c) Renin
d) Antidiuretic hormone (ADH)
Renin

Renin is a hormone directly involved in the control of arterial blood pressure; it is essential for
proper functioning of the glomerulus. ADH, also known as vasopressin, plays a key role in the
regulation of extracellular fluid by excreting or retaining water. Calcitonin regulates calcium and
phosphorous metabolism.
When fluid intake is normal, the specific gravity of urine should be which of the following?

a) >1.025.
b) 1.000.
c) <1.010.
d) 1.010 to 1.025.
1.010 to 1.025.

Urine specific gravity is a measurement of the kidney's ability to concentrate urine. The specific
gravity of water is 1.000. A urine specific gravity of <1.010 may indicate overhydration. A urine
specific gravity >1.025 may indicate dehydration.
After undergoing renal arteriogram, in which the left groin was accessed, a client complains of
left calf pain. Which intervention should the nurse perform first?

a) Exercise the leg and foot.

b) Assess for anaphylaxis.
c) Place cool compresses on the calf.
d) Assess peripheral pulses in the left leg.
Assess peripheral pulses in the left leg.

The nurse should begin by assessing peripheral pulses in the left leg to determine if blood flow
was interrupted by the procedure. The client may also have thrombophlebitis. Cool compresses
aren't used to relieve pain and inflammation in thrombophlebitis. The leg should remain straight
after the procedure. Calf pain isn't a symptom of anaphylaxis.
A client is scheduled for a renal ultrasound. Which of the following would the nurse include
when explaining this procedure to the client?

a) "You don't need to do any fasting before this noninvasive test."

b) "You'll have a pressure dressing on your groin after the test."
c) "A contrast medium will be used to help see the structures better."
d) "An x-ray will be done to view your kidneys, ureters, and bladder."
"You don't need to do any fasting before this noninvasive test."

Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and
adjacent tissues. It is not invasive, does not require the injection of a radiopaque dye, and does
not require fasting or bowel preparation. An x-ray of the abdomen to view the kidneys, ureters,
and bladder is called a KUB. A contrast medium is used for computed tomography of the
abdomen and pelvis. A pressure dressing is applied to the groin after a renal arteriogram.
The term used to describe painful or difficult urination is which of the following?

a) Oliguria
b) Anuria
c) Nocturia
d) Dysuria
Dysuria

Dysuria refers to painful or difficult urination. Oliguria is urine output less than 0.5 mL/kg/hr.
Anuria is used to describe total urine output of less than 50 mL in 24 hours. Nocturia refers to
awakening at night to urinate.
A client is prescribed flavoxate (Urispas) following cystoscopy. Which of the following
instructions would the nurse give the client?

a) "This medication will relieve your pain."

b) "This medication will treat the blood in your urine."
c) "This medication prevents infection in your urinary tract"
d) "This medication prevents urinary incontinence."
"This medication will relieve your pain."

Flavoxate (Urispas) is a antispasmodic agent used for the treatment of burning and pain of the
urinary tract.
The term used to describe total urine output of less than 400 mL in 24 hours is

a) oliguria.
b) dysuria.
c) anuria.
d) nocturia.
oliguria.

Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine
output of less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Dysuria
refers to painful or difficult urination.
The nurse is caring for a patient with a medical history of sickle cell anemia. The nurse
understands this predisposes the patient to which of the following possible renal or urologic
disorders?

a) Kidney stone formation

b) Neurogenic bladder
c) Proteinuria
d) Chronic kidney disease
Chronic kidney disease

A medical history of sickle cell anemia predisposes the patient to the development of chronic
kidney disease. The other disorders are not associated with the development of sickle cell
anemia.
The most frequent reason for admission to skilled care facilities includes which of the following?

a) Stroke
b) Urinary incontinence
c) Congestive heart failure
d) Myocardial infarction
Urinary incontinence

Urinary incontinence is the most common reason for admission to skilled nursing facilities.
A patient is scheduled for a test with contrast to determine kidney function. What statement
made by the patient should the nurse inform the physician about prior to testing?

a) "I have had a test similar to this one in the past."

b) "I take medication to help me sleep at night."
c) "I am allergic to shrimp."
d) "I don't like needles."
"I am allergic to shrimp."

The nurse should obtain the patient's allergy history with emphasis on allergy to iodine, shellfish,
and other seafood, because many contrast agents contain iodine.
The nurse is aware, when caring for patients with renal disease, that which of the following
substances, made in the glomeruli, directly controls blood pressure?

a) Renin
b) Vasopressin
c) Cortisol
d) Albumin
Renin

Renin is directly involved in the control of arterial blood pressure. It is also essential for the
proper functioning of the glomerulus and management of the body's renin-angiotensin system
(RAS).
Following a voiding cystogram, the client has a nursing diagnosis of risk for infection related to
the introduction of bacterial following manipulation of the urinary tract. An appropriate nursing
intervention for the client is to:

a) Encourage high fluid intake.

b) Apply moist heat to the flank area.
c) Monitor for hematuria.
d) Strain all urine for 48 hours.
Encourage high fluid intake.

A voiding cystogram involves the insertion of a urinary catheter, which can result in the
introduction of microorganism into the urinary tract. Fluid intake is encouraged to flush the
urinary tract and promote removal of microorganisms. Monitoring for hematuria, applying heat,
and straining urine do not address the nursing diagnosis of risk for infection.
The nurse reviews a client's history and notes that the client has a history of
hyperparathyroidism. The nurse would identify that this client most likely would be at risk for
which of the following?

a) Neurogenic bladder
b) Kidney stones
c) Fistula
d) Chronic renal failure
Kidney stones

A client with hyperparathyroidism is at risk for kidney stones. The client with diabetes mellitus
is a risk factor for developing chronic renal failure and neurogenic bladder. A client with
radiation to the pelvis is at risk for urinary tract fistula.
A client in a short-procedure unit is recovering from renal angiography in which a femoral
puncture site was used. When providing postprocedure care, the nurse should:

a) check the client's pedal pulses frequently.

b) remove the dressing on the puncture site after vital signs stabilize.
c) keep the client's knee on the affected side bent for 6 hours.
d) apply pressure to the puncture site for 30 minutes.
check the client's pedal pulses frequently.

After renal angiography involving a femoral puncture site, the nurse should check the client's
pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The
nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the
puncture site frequently for fresh bleeding. The client should be kept on bed rest for several
hours so the puncture site can seal completely. Keeping the client's knee bent is unnecessary. By
the time the client returns to the short-procedure unit, manual pressure over the puncture site is
no longer needed because a pressure dressing is in place. The nurse should leave this dressing in
place for several hours — and only remove it if instructed to do so.
The nurse is caring for a client who is brought to the emergency department after being found
unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a
urine specific gravity is ordered. Which relation between the client's symptoms and urine
specific gravity is anticipated?

a) The specific gravity will be high.

b) The specific gravity will be inversely proportional
c) The specific gravity will be low
d) The specific gravity will equal to one
The specific gravity will be high.

The nurse assesses all of the data to make an informed decision on client status. On a hot day, the
client found outside will be perspiring. When dehydration occurs, a client will have low urine
output and increased specific gravity of urine. Normal specific gravity is inversely proportional.
The density of distilled water is one. A low specific gravity is noted in a client with high fluid
intake and who is not losing systemic fluid.
The nephrons are the functional units of the kidney, responsible for the initial formation of urine.
The nurse knows that damage to the area of the kidney where the nephrons are located will affect
urine formation. Identify that area.

a) Renal papilla
b) Renal medulla
c) Renal pelvis
d) Renal cortex
Renal cortex

The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to
20% are located deeper in the cortex.
A nurse is assisting the physician conducting a cystogram. The client has an intravenous (IV)
infusion of D5W at 40 ml/hr. The physician inserts a urinary catheter into the bladder and instills
a total of 350 ml of a contrast agent. The nurse empties 500 ml from the urinary catheter
drainage bag at the conclusion of the procedure. How many milliliters does the nurse record as
urine?
150

The urinary drainage bag contains both the contrast agent and urine at the conclusion of the
procedure. Total contents (500 ml) in the drainage bag consist of 350 ml of contrast agent and
150 ml of urine.
A female patient presents to the health clinical for a routine physical examination. The nurse
observes that the patient's urine is bright yellow in color. Which of the following questions is
most appropriate for the nurse to ask the patient?

a) "Do you take phenytoin (Dilantin) daily?"

b) "Do you take multiple vitamin preparations?"
c) "Have you noticed any vaginal bleeding?"
d) "Have you had a recent urinary tract infection?"
"Do you take multiple vitamin preparations?"

Urine that is bright yellow is an anticipated abnormal finding in the patient taking a multiple
vitamin preparation. Urine that is orange may be caused by intake of Dilantin or other
medications. Orange- to amber-colored urine may also indicate concentrated urine due to
dehydration or fever. Urine that is pink to red may indicate lower urinary tract bleeding. Yellow
to milky white urine may indicate infection, pyuria, or, in the female patient, the use of vaginal
creams.
A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to
shellfish or iodine, she finds no allergies recorded. The client is unable to provide the
information. During the procedure, the nurse should be alert for which finding that may indicate
an allergic reaction to the dye used during the arteriogram?

a) Unusually smooth skin

b) Pruritus
c) Increased alertness
d) Hypoventilation
Pruritus

The nurse should be alert for pruritus and urticaria, which may indicate a mild anaphylactic
reaction to the arteriogram dye. Decreased (not increased) alertness may occur as well as
dyspnea (not hypoventilation). Unusually smooth skin isn't a sign of anaphylaxis.
A group of students is reviewing for a test on the urinary and renal system. The students
demonstrate understanding of the information when they identify which of the following as part
of the upper urinary tract?

a) Ureters
b) Pelvic floor muscles
c) Bladder
d) Urethra
Ureters

The upper urinary tract is composed of the kidneys, renal pelvis, and ureters. The lower urinary
tract consists of the bladder, urethra, and pelvic floor muscles.
Renal function results may be within normal limits until the GFR is reduced to less than which
percentage of normal?

a) 20%
b) 40%
c) 50%
d) 30%
50%

Renal function test results may be within normal limits until the GFR is reduced to less than 50%
of normal. Renal function can be assessed most accurately if several tests are performed and their
results are analyzed together. Common tests of renal function include renal concentration tests,
creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein
metabolism) levels.
The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of
dehydration of the client is:

a) Specific gravity 1.035

b) Creatinine 0.7 mg/dL
c) Bright yellow urine
d) Protein 15 mg/dL
Specific gravity 1.035

Specific gravity is reflective of hydration status. A concentrated specific gravity, such as 1.035,
is suggestive of dehydration. Bright yellow urine suggests ingestion of mulitiple vitamins.
Proteinuria can be benign or be caused by conditions which alter kidney function. Creatinine
measures the ability of the kidney to filter the blood. A level of 0.7 is within normal limits.
The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of
dehydration of the client is:

a) Specific gravity 1.035

b) Creatinine 0.7 mg/dL
c) Bright yellow urine
d) Protein 15 mg/dL
Specific gravity 1.035
A 76-year-old client is visiting the urologist because of an increasingly troublesome need to
urinate several times through the night. After checking his prostate (which was within normal
limits), the physician prescribes limiting fluid intake after the evening meal. What is another
important intervention to keep the client safe?
Increase fluid intake throughout the day

Older persons may need to drink more fluids throughout the day to allow for limiting their intake
after the evening meal. Urine formation increases during the night, when leg elevation promotes
blood return to the heart and kidneys, and may interrupt sleep patterns. Salt is secreted. Filtrate
that is secreted as urine usually contains sodium and chloride. Protein molecules, except for
periodic small amounts of globulins and albumin, also are reabsorbed.
The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain
on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe
assessment, at which specific location would the nurse assess the client's kidneys for tenderness?
The cost vertebral angle
A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse
most likely suspect?
Infection

Frequency, urgency, and dysuria are commonly associated with urinary tract infection.
A client with a genitourinary problem is being examined in the emergency department. When
palpating the client's kidneys, the nurse should keep in mind which anatomic fact?
The left kidney usually is slightly higher than the right one

The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each
kidney. The average kidney measures approximately 11 cm (4??) long, 5 to 5.8 cm (2? to 2¼?)
wide, and 2.5 cm (1?) thick. The kidneys are located retroperitoneally, in the posterior aspect of
the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd
lumbar vertebrae.
Which of the following urine characteristics would the nurse anticipate when caring for a client
whose lab work reveals a high urine specific gravity related to dehydration?
Dark amber urine
Explanation:

Concentrated urine (one with a high specific gravity) is a dark amber color due to the solutes in
the urine. Clear or yellow urine indicates a flushing of the urinary system. Red urine indicates hematuria.
A turbid urine may indicate bacteriuria.