Adult Health - Renal & Urinary

A client with acute kidney injury has a serum potassium level of 6.0 mEq/L. The nurse should plan which action as a priority? 
1. Check the sodium level. 
2. Place the client on a cardiac monitor. 
3. Encourage increased vegetables in the diet. 
4. Allow an extra 500 mL of fluid intake to dilute the electrolyte concentration.

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

A client is admitted to the emergency department following a motor vehicle accident. The client was wearing a lap seat belt when the accident occurred and now the client has hematuria and lower abdominal pain. To assess further whether the pain is caused by bladder trauma, the nurse should ask the client if the pain is referred to which area? 
1. Hip 
2. Shoulder 
3. Umbilicus 
4. Costovertebral angle

A client is admitted to the emergency department following a fall from a horse and the health care provider (HCP) prescribes insertion of a Foley catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? 
1. Notify the HCP. 
2. Use a small-sized catheter. 
3. Administer pain medication before inserting the catheter. 
4. Use extra povidone-iodine solution in cleansing the meatus.

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

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

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

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

The nurse is collecting data from a client who has a history of benign prostatic hyperplasia. To determine whether the client currently is experiencing this condition, the nurse should ask the client about the presence of whichearly symptom? 
1. Nocturia 
2. Urinary retention 
3. Urge incontinence 
4. Decreased force in the stream of urine

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 
1. Check the level of the drainage bag. 
2. Reposition the client to his or her side. 
3. Contact the health care provider (HCP). 
4. Place the client in good body alignment. 
5. Check the peritoneal dialysis system for kinks. 
6. Increase the flow rate of the peritoneal dialysis solution.

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

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

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 100.2° F. Which nursing action is most appropriate? 1. Encourage fluids. 
2. Notify the health care provider. 
3. Continue to monitor vital signs. 
4. Monitor the site of the shunt for infection.

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

A client newly diagnosed with chronic kidney disease has just been started on peritoneal dialysis. During the infusion of the dialysate, the client complains of abdominal pain. Which action by the nurse is most appropriate? 
1. Stop the dialysis. 
2. Slow the infusion. 
3. Decrease the amount to be infused. 
4. Explain that the pain will subside after the first few exchanges.

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? 
1. Infection 
2. Hyperglycemia 
3. Hypophosphatemia 
4. Disequilibrium syndrome

A week after kidney transplantation, a client develops a temperature of 101° F, the blood pressure is elevated, and the kidney is tender. The x-ray indicates that the transplanted kidney is enlarged. Based on these assessment findings, the nurse suspects which complication? 
1. Acute rejection 
2. Kidney infection 
3. Chronic rejection 
4. Kidney obstruction

A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the health care provider (HCP)? 
1. Red bloody urine 
2. Pain related to bladder spasms 
3. Urinary output of 200 mL higher than intake 
4. Blood pressure, 90/50 mm Hg; pulse, 130 beats/minute

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

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

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

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? 
1. Bradycardia 
2. Hypertension 
3. Decreased cardiac output 
4. Decreased central venous pressure

A client newly diagnosed with chronic kidney disease (CKD) has many learning needs regarding the disease. The nurse prepares a teaching plan to help the client adapt to the disease. The nurse recognizes that which client characteristic or factor is least likely to interfere with the client's ability to learn? 
1. Anxiety 
2. Memory deficits 
3. Presence of family 
4. Short attention span

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? 
1. Potassium 
2. Creatinine 
3. Phosphorus 
4. Red blood cell (RBC) count

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

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? 
1. Constipation 
2. Dehydration 
3. Inability to tolerate activity 
4. Impaired physical mobility

The nurse is working with a client newly diagnosed with chronic kidney disease (CKD) to set up a schedule for hemodialysis. The client states, "This is impossible! How can I even think about leading a normal life again if this is what I'm going to have to do?" The nurse determines that the client is exhibiting which problem? 
1. Anger 
2. Projection 
3. Depression 
4. Withdrawal

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? 
1. The client washes hands at least once per day. 
2. The client's temperature remains lower than 101° F. 
3. The client avoids blood pressure (BP) measurement in the left arm. 
4. The client's white blood cell (WBC) count remains within normal limits.

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

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

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

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

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? 
1. Hypoglycemia 
2. Diabetes mellitus 
3. Coronary artery disease 
4. Orthostatic hypotension

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? 
1. Prevents ulcers. 
2. Prevents constipation. 
3. Promotes the elimination of potassium from the body. 
4. Combines with phosphorus and helps eliminate phosphates from the body.

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. 
1. "Sterile dialysate must be used." 
2. "Dialysate contains metabolic waste products." 
3. "Heparin sodium is administered during dialysis." 
4. "Dialysis cleanses the blood of accumulated waste products." 
5. "Warming the dialysate increases the efficiency of diffusion."

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? 
1. Apnea 
2. Kussmaul's respirations 
3. Decreased respirations 
4. Cheyne-Stokes respirations

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? 
1. Prevent fluid overload. 
2. Prevent loss of electrolytes. 
3. Promote the excretion of wastes. 
4. Reduce the urine specific gravity.

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

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

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? 
1. Dietary restrictions 
2. Technique of catheterization 
3. External pouch and application care 
4. Proper administration of prophylactic antibiotics

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

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? 
1. Take an oral temperature daily. 
2. Use good hand washing technique. 
3. Take all scheduled medications exactly as prescribed. 
4. Monitor urine character and output at least 1 day each week.

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

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? 
1. Prerenal 
2. Postrenal 
3. Intrinsic 
4. Atypical

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? 
1. 5 hours of treatment 2 days per week 
2. 2 hours of treatment 6 days per week 
3. 3 to 4 hours of treatment 3 days per week 
4. 2 to 3 hours of treatment 5 days per week

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

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

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

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? 
1. Assess the client and family's coping patterns. 
2. Explore the meaning of the illness with the client. 
3. Set limits on mood swings and expressions of hostility. 
4. Give the client information when the client is ready to listen.

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? 
1. Bradycardia 
2. Hypertension 
3. Urinary retention 
4. Increased respirations

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

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? 
1. Headache 
2. Hypotension 
3. Flank pain and hematuria 
4. Complaints of low pelvic pain

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

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

A home care nurse is making home visits to an older client with urinary incontinence who is very concerned about the incontinent episodes. The nurse explores the client's home situation to determine environmental barriers to normal voiding. The nurse identifies which assessment findings as a factor that may be contributing to the client's problem? 
1. Presence of hand railings in the bathroom 
2. Having one bathroom on each floor of the home 
3. Night light present in the hall between the bedroom and bathroom 
4. Bathroom located on the second floor, bedroom on the first floor

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

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? 
1. Salt intake 
2. Water intake 
3. Activity level 
4. Use of diuretics

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? 
1. Blood clots 
2. Ureteral edema 
3. Chemical sediment 
4. 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? 
1. There is a strong likelihood that the client will need dialysis within 5 to 10 years. 
2. There is absolutely no chance of needing dialysis because of the nature of the surgery. 
3. One kidney is adequate to meet the needs of the body so long as it has normal function. 
4. Dialysis could become likely, but it depends on how well the client complies with fluid restriction after surgery.

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? 
1. This will reduce the time needed for surgery by at least half because it provides hemostasis. 
2. This will cause the tumor to become tougher and easier to resect in surgery with the scalpel. 
3. This will prevent the risk of pulmonary embolism by occluding the renal artery and its branches. 
4. This will decrease the size of the tumor because its blood supply will be removed after placement of an absorbable gelatin sponge.

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

The nurse is urging a client to cough and deep breathe after nephrectomy. The client tells the nurse, "That's easy for you to say! You don't have to do this." The nurse interprets that the client's statement is most likely to be a result of which factor? 
1. A stress response to the ordeal of surgery 
2. A latent fear of needing dialysis if the surgery is unsuccessful 
3. Pain that is intensified because of the location of the incision near the diaphragm 
4. Effects of circulating metabolites that have not been excreted by the remaining kidney

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

The nurse is administering care to a client immediately after nephrectomy and renal transplantation. The nurse administers intravenous fluids as prescribed, knowing that the hourly rate is usually calculated on the basis of which guideline? 
1. A strict hourly rate of 100 mL 
2. A strict hourly rate of 150 mL 
3. One half of the previous hour's urine output 
4. The number of milliliters in the previous hour's urine output

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

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

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

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? 
1. All clients undergo bowel preparation with major surgery. 
2. This will decrease the chance of postoperative paralytic ileus. 
3. A portion of the bowel will be used to create the conduit for urinary diversion. 
4. This will reduce the chance that the surgeon will nick the bowel during surgery.

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

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. 
1. Sitz bath 
2. Antibiotics 
3. Scrotal elevation 
4. Use of a heating pad 
5. Bed rest with bathroom privileges

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

A client who is performing peritoneal dialysis at home calls the clinic and reports that the outflow from the dialysis catheter seems to be decreasing in amount. The clinic nurse should ask which question first? 
1. "Have you had any diarrhea?" 
2. "Have you been constipated recently?" 
3. "Have you had any abdominal discomfort?" 
4. "Have you had an increased amount of flatulence?"

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? 
1. Pale pink 
2. Dark pink 
3. Bright red 
4. Red with clots

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

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

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

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? 
1. 5 to 6 kg 
2. 2 to 4 kg 
3. 1 to 1.5 kg 
4. 0.5 to 1.0 kg

A client undergoing hemodialysis begins to experience muscle cramping. What corrective action should the hemodialysis nurse caring for the client take? 
1. Administer hypotonic saline. 
2. Increase the ultrafiltration rate. 
3. Decrease the ultrafiltration rate. 
4. Administer magnesium sulfate.

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? 
1. Ureteral stent 
2. Suprapubic tube 
3. Nephrostomy tube 
4. Jackson Pratt drain

The nurse is preparing to care for a client after a renal scan. Which intervention should the nurse include in the postprocedure plan of care? 
1. Limit contact with the client to 20 minutes per hour. 
2. Place the client on radiation precautions for 18 hours. 
3. Save all urine in a radiation-safe container for 18 hours. 
4. No special precautions are necessary except the wearing of gloves by persons who may have contact with the client's urine.

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? 
1. Increase intake of dairy products. 
2. Avoid citrus fruits and citrus juices. 
3. Avoid green, leafy vegetables such as spinach. 
4. Increase intake of meat, fish, plums, and cranberries.

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

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? 
1. Increase the amount of protein in the diet. 
2. Increase the amount of potassium in the daily diet. 
3. Maintain a diet high in calories with frequent snacks. 
4. Encourage the client to eat a large breakfast and smaller meals later in the day.

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? 
1. Infection 
2. An intact catheter 
3. Bowel perforation 
4. Bladder perforation

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

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

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

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. 
1. Monitor daily weight. 
2. Maintain sodium restrictions. 
3. Maintain a diet low in protein. 
4. Monitor intake and output (I&O). 
5. Maintain bed rest when edema is severe.

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? 
1. Decreased serum lipids 
2. Signs of fluid volume deficit 
3. Decreased protein in the urine 
4. 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. 
1. Proteinuria 
2. Hematuria 
3. Positive ketones 
4. A low specific gravity 
5. A dark and smoky appearance of the urine

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

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? 
1. The procedure will take about 4 hours. 
2. Intravenous fluids may be started on the day of the procedure. 
3. Preprocedure sedatives are never administered with general anesthesia. 
4. A full liquid breakfast only may be allowed on the day of 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. 
1. Increased serum creatinine level 
2. A low and fixed specific gravity 
3. Increased blood urea nitrogen (BUN) level 
4. Urine osmolarity of approximately 300 mOsm/L 
5. A urine output of 600 to 800 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? 
1. "The increase in urine output indicates the return of some renal function." 
2. "The diuretic phase develops about 14 days after the initial insult and lasts about 10 days." 
3. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." 
4. "The blood urea nitrogen (BUN) and creatinine levels will continue to rise during the first few days of diuresis."

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? 
1. Serotonin 
2. Dopamine 
3. Epinephrine 
4. Norepinephrine

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? 
1. Spinach salad, milk, and a banana 
2. Chicken, potatoes, and cranberries 
3. Peanut butter sandwich, milk, and prunes 
4. Linguini with shrimp, tossed salad, and a plum

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

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? 
1. The kidneys get fatigued from having to filter too much fluid. 
2. The kidneys can react adversely to moderate doses of furosemide (Lasix). 
3. The kidneys will shut down easily if serum levels of digoxin (Lanoxin) are high. 
4. The kidneys generally require and receive about 20% to 25% of the resting cardiac output.

When reading the product literature for a medication, the nurse notes that the medication is nephrotoxic. The nurse plans care, knowing that this medication could cause damage to which structure of the kidney? 
1. Pelvis 
2. Calyx 
3. Nephron 
4. Renal artery

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? 
1. 100 to 300 mL/min 
2. 500 to 1000 mL/min 
3. 1200 to 1500 mL/min 
4. 2000 to 2500 mL/min

A client has been diagnosed with a bladder infection. The nurse plans care, knowing that the client will be at increased risk for extension of the infection to the kidneys if there is improper function of which area of the urinary system? 
1. Urethra 
2. Nephron 
3. Glomerulus 
4. Ureterovesical junction

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

A nurse is monitoring the urine output of a client whose Foley catheter has drained less than 30 mL in an hour. The nurse plans care, knowing that the client's low serum protein level could alter glomerular filtration because of which type of pulling pressure that plasma proteins exert? 
1. Oncotic pressure 
2. Osmotic pressure 
3. Filtration pressure 
4. Hydrostatic pressure

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? 
1. Physiological stress 
2. Release of norepinephrine 
3. Release of low levels of dopamine 
4. Sympathetic nervous system stimulation

A nurse is caring for an older client. When evaluating the client's renal function, the nurse recalls that which change takes place as part of the normal aging process? 
1. Tubular reabsorption increases 
2. Urine-concentrating ability increases 
3. Medications are metabolized in larger amounts 
4. The glomerular filtration rate (GFR) diminishes

A nurse has administered a dose of furosemide (Lasix) to a client with diminished urine output. The nurse expects the urine output to increase once the medication has had time to exert an effect on which part of the nephron? 
1. Distal tubule 
2. Loop of Henle 
3. Collecting duct 
4. Proximal tubule

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

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? 
1. Fats 
2. Vitamins 
3. Potassium 
4. Carbohydrates

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

A client tells the nurse about a pattern of a strong urge to void, followed by incontinence before the client can get to the bathroom. The nurse determines the client is most likely experiencing symptoms of which disorder? 
1. Urge incontinence 
2. Total incontinence 
3. Stress incontinence 
4. Reflex incontinence

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

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

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

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

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? 
1. Urinalysis, hematocrit, hemoglobin 
2. Culture and sensitivity testing, serum sodium
3. Urine specific gravity, intravenous pyelogram 
4. Fasting blood glucose, serum potassium, serum calcium

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

A client experiencing end-stage kidney disease has an arteriovenous (AV) fistula placed surgically for hemodialysis. Which action is most appropriate for the nurse to document in the plan for care of the AV fistula? 
1. Palpate the bruit of the AV fistula weekly to assess for thrombosis. 
2. Do not carry heavy objects that would compress the AV fistula and cause thrombosis. 
3. Use the AV fistula site for blood draws to prevent increased pain of multiple blood draws. 
4. Take the blood pressure readings in the extremity with the AV fistula to get a more accurate reading.

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

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

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

A nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse should determine that the client understands the information if the client states to record which parameters daily? 
1. Pulse and respiratory rate 
2. Amount of activity and sleep 
3. Intake and output and weight 
4. Blood urea nitrogen and creatinine levels

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? 
1. Genetic counseling 
2. Sodium restriction 
3. Increased water intake 
4. Antihypertensive medications

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

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

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

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

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

A client with chlamydial infection has received instructions on self-care and prevention of further infection. The nurse determines that the client needs further teaching if the client states that he or she will take which action? 
1. Use latex condoms to prevent disease transmission. 
2. Return to the clinic as requested for follow-up culture in 1 week. 
3. Reduce the chance of reinfection by limiting the number of sexual partners. 
4. Take an antibiotic so as to prophylactically prevent symptoms of Chlamydia.

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? 
1. Decreases the risk of peritonitis 
2. Prevents disequilibrium syndrome 
3. Increases osmotic pressure to produce ultrafiltration 
4. Prevents excess glucose from being removed from the client

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

A client with prostatitis following kidney infection has received instructions on management of the condition at home and prevention of recurrence. The nurse determines that the client understands the instructions if the client verbalizes that they will take which action? 
1. Stop antibiotic therapy when pain subsides. 
2. Exercise as much as possible to stimulate circulation. 
3. Use warm tub baths and analgesics to increase comfort. 
4. Keep fluid intake to a minimum to decrease the need to void.

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

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

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? 
1. Burning on urination 
2. A temperature of 100.6° F 
3. New-onset shortness of breath 
4. A blood pressure of 105/68 mm Hg

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? 
1. The client reports bright red urine. 
2. The client reports pink-tinged urine. 
3. The client reports having urinary frequency. 
4. The client complains of burning when urinating.

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

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

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? 
1. Bradycardia 
2. Hypertension 
3. Decreased cardiac output 
4. Decreased central venous pressure

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

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? 
1. "I will reduce the sodium in my diet, and I can use salt substitutes to spice my food." 
2. "The amount of fluid I can have every day depends on the amount of urine I put out." 
3. "I will weigh myself on my bathroom scale every morning right after I have urinated." 
4. "I should report a gain in weight, trouble with my breathing, or increased leg swelling."

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

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