Urinary System Disorders

1. Which of the following symptoms do you expect to see in a patient

diagnosed with acute pyelonephritis?

1. Jaundice and flank pain

2. Costovertebral angle tenderness and chills
3. Burning sensation on urination
4. Polyuria and nocturia

2. You have a patient that might have a urinary tract infection (UTI).
Which statement by the patient suggests that a UTI is likely?

1. I pee a lot.
2. It burns when I pee.
3. I go hours without the urge to pee.
4. My pee smells sweet.

3. Which instructions do you include in the teaching care plan for a

patient with cystitis receiving phenazopyridine (Pyridium).

1. If the urine turns orange-red, call the doctor.

2. Take phenazopyridine just before urination to relieve pain.
3. Once painful urination is relieved, discontinue prescribed antibiotics.
4. After painful urination is relieved, stop taking phenazopyridine.

4. Which patient is at greatest risk for developing a urinary tract

infection (UTI)?

1. A 35 y.o. woman with a fractured wrist

2. A 20 y.o. woman with asthma
3. A 50 y.o. postmenopausal woman
4. A 28 y.o. with angina
5. You have a patient that is receiving peritoneal dialysis. What should
you do when you notice the return fluid is slowly draining?

1. Check for kinks in the outflow tubing.

2. Raise the drainage bag above the level of the abdomen.
3. Place the patient in a reverse Trendelenburg position.
4. Ask the patient to cough.

6. What is the appropriate infusion time for the dialysate in your 38 y.o.
patient with chronic renal failure?

1. 15 minutes
2. 30 minutes
3. 1 hour
4. 2 to 3 hours

7. A 30 y.o. female patient is undergoing hemodialysis with an internal

arteriovenous fistula in place. What do you do to prevent complications
associated with this device?

1. Insert I.V. lines above the fistula.

2. Avoid taking blood pressures in the arm with the fistula.
3. Palpate pulses above the fistula.
4. Report a bruit or thrill over the fistula to the doctor.

8. Your patient becomes restless and tells you she has a headache and
feels nauseous during hemodialysis. Which complication do you
suspect?

1. Infection
2. Disequilibrium syndrome
3. Air embolus
4. Acute hemolysis
9. Your patient is complaining of muscle cramps while undergoing
hemodialysis. Which intervention is effective in relieving muscle
cramps?

1. Increase the rate of dialysis

2. Infuse normal saline solution
3. Administer a 5% dextrose solution
4. Encourage active ROM exercises

10. Your patient with chronic renal failure reports pruritus. Which
instruction should you include in this patients teaching plan?

1. Rub the skin vigorously with a towel

2. Take frequent baths
3. Apply alcohol-based emollients to the skin
4. Keep fingernails short and clean

11. Which intervention do you plan to include with a patient who has
renal calculi?

1. Maintain bed rest

2. Increase dietary purines
3. Restrict fluids
4. Strain all urine

12. An 18 y.o. student is admitted with dark urine, fever, and

flank pain and is diagnosed with acute glomerulonephritis. Which would
most likely be in this students health history?

1. Renal calculi
2. Renal trauma
3. Recent sore throat
4. Family history of acute glomerulonephritis
13. Which drug is indicated for pain related to acute renal calculi?

1. Narcotic analgesics
2. Nonsteroidal anti-inflammatory drugs (NSAIDS)
3. Muscle relaxants
4. Salicylates

14. Which of the following causes the majority of UTIs in hospitalized

patients?

1. Lack of fluid intake

2. Inadequate perineal care
3. Invasive procedures
4. Immunosuppression

15. Clinical manifestations of acute glomerulonephritis include which of

the following?

1. Chills and flank pain

2. Oliguria and generalized edema
3. Hematuria and proteinuria
4. Dysuria and hypotension

16. You expect a patient in the oliguric phase of renal failure to have a
24 hour urine output less than:

1. 200ml
2. 400ml
3. 800ml
4. 1000ml

17. The most common early sign of kidney disease is:

1. Sodium retention
2. Elevated BUN level
3. Development of metabolic acidosis
4. Inability to dilute or concentrate urine

18. A patient is experiencing which type of incontinence if she

experiences leaking urine when she coughs, sneezes, or lifts heavy
objects?

1. Overflow
2. Reflex
3. Stress
4. Urge

19. Immediately post-op after a prostatectomy, which complications

requires priority assessment of your patient?

1. Pneumonia
2. Hemorrhage
3. Urine retention
4. Deep vein thrombosis

20. The most indicative test for prostate cancer is:

1. A thorough digital rectal examination

2. Magnetic resonance imaging (MRI)
3. Excretory urography
4. Prostate-specific antigen

21. A 22 y.o. patient with diabetic nephropathy says, I have two

kidneys and Im still young. If I stick to my insulin schedule, I dont
have to worry about kidney damage, right? Which of the following
statements is the best response?
1. You have little to worry about as long as your kidneys keep making urine.
2. You should talk to your doctor because statistics show that youre being
unrealistic.
3. You would be correct if your diabetes could be managed with insulin.
4. Even with insulin, kidney damage is still a concern.

22. A patient diagnosed with sepsis from a UTI is being discharged.

What do you plan to include in her discharge teaching?

1. Take cool baths

2. Avoid tampon use
3. Avoid sexual activity
4. Drink 8 to 10 eight-oz glasses of water daily

23. Youre planning your medication teaching for your patient with a
UTI prescribed phenazopyridine (Pyridium). What do you include?

1. Your urine might turn bright orange.

2. You need to take this antibiotic for 7 days.
3. Take this drug between meals and at bedtime.
4. Dont take this drug if youre allergic to penicillin.

24. Which finding leads you to suspect acute glomerulonephritis in your

32 y.o. patient?

1. Dysuria, frequency, and urgency

2. Back pain, nausea, and vomiting
3. Hypertension, oliguria, and fatigue
4. Fever, chills, and right upper quadrant pain radiating to the back

25. What is the priority nursing diagnosis with your patient diagnosed
with end-stage renal disease?
1. Activity intolerance
2. Fluid volume excess
3. Knowledge deficit
4. Pain

26. A patient with ESRD has an arteriovenous fistula in the left arm for
hemodialysis. Which intervention do you include in his plan of care?

1. Apply pressure to the needle site upon discontinuing hemodialysis

2. Keep the head of the bed elevated 45 degrees
3. Place the left arm on an arm board for at least 30 minutes
4. Keep the left arm dry

27. Your 60 y.o. patient with pyelonephritis and possible septicemia has
had five UTIs over the past two years. She is fatigued from lack of
sleep, has lost weight, and urinates frequently even in the night. Her
labs show: sodium, 154 mEq/L; osmolarity 340 mOsm/L; glucose, 127
mg/dl; and potassium, 3.9 mEq/L. Which nursing diagnosis is priority?

1. Fluid volume deficit related to osmotic diuresis induced by hyponatremia

2. Fluid volume deficit related to inability to conserve water
3. Altered nutrition: Less than body requirements related to hypermetabolic
state
4. Altered nutrition: Less than body requirements related to catabolic effects of
insulin deficiency

28. Which sign indicated the second phase of acute renal failure?

1. Daily doubling of urine output (4 to 5 L/day)

2. Urine output less than 400 ml/day
3. Urine output less than 100 ml/day
4. Stabilization of renal function
29. Your patient had surgery to form an arteriovenous fistula for
hemodialysis. Which information is important for providing care for the
patient?

1. The patient shouldnt feel pain during initiation of dialysis

2. The patient feels best immediately after the dialysis treatment
3. Using a stethoscope for auscultating the fistula is contraindicated
4. Taking a blood pressure reading on the affected arm can cause clotting of the
fistula

30. A patient with diabetes mellitus and renal failure begins

hemodialysis. Which diet is best on days between dialysis treatments?

1. Low-protein diet with unlimited amounts of water

2. Low-protein diet with a prescribed amount of water
3. No protein in the diet and use of a salt substitute
4. No restrictions

31. After the first hemodialysis treatment, your patient develops a

headache, hypertension, restlessness, mental confusion, nausea, and
vomiting. Which condition is indicated?

1. Disequilibrium syndrome
2. Respiratory distress
3. Hypervolemia
4. Peritonitis

32. Which action is most important during bladder training in a patient

with a neurogenic bladder?

1. Encourage the use of an indwelling urinary catheter

2. Set up specific times to empty the bladder
3. Encourage Kegel exercises
4. Force fluids

33. A patient with diabetes has had many renal calculi over the past 20
years and now has chronic renal failure. Which substance must be
reduced in this patients diet?

1. Carbohydrates
2. Fats
3. Protein
4. Vitamin C

34. What is the best way to check for patency of the arteriovenous
fistula for hemodialysis?

1. Pinch the fistula and note the speed of filling on release

2. Use a needle and syringe to aspirate blood from the fistula
3. Check for capillary refill of the nail beds on that extremity
4. Palpate the fistula throughout its length to assess for a thrill

35. You have a paraplegic patient with renal calculi. Which factor
contributes to the development of calculi?

1. Increased calcium loss from the bones

2. Decreased kidney function
3. Decreased calcium intake
4. High fluid intake

36. What is the most important nursing diagnosis for a patient in end-
stage renal disease?

1. Risk for injury

2. Fluid volume excess
3. Altered nutrition: less than body requirements
4. Activity intolerance

37. Frequent PVCs are noted on the cardiac monitor of a patient

with end-stage renal disease. The priority intervention is:

1. Call the doctor immediately

2. Give the patient IV lidocaine (Xylocaine)
3. Prepare to defibrillate the patient
4. Check the patients latest potassium level

38. A patient who received a kidney transplant returns for a follow-up

visit to the outpatient clinic and reports a lump in her breast.
Transplant recipients are:

1. At increased risk for cancer due to immunosuppression caused by

cyclosporine (Neoral)
2. Consumed with fear after the life-threatening experience of having a
transplant
3. At increased risk for tumors because of the kidney transplant
4. At decreased risk for cancer, so the lump is most likely benign

39. Youre developing a care plan with the nursing diagnosis risk for
infection for your patient that received a kidney transplant. A goal for
this patient is to:

1. Remain afebrile and have negative cultures

2. Resume normal fluid intake within 2 to 3 days
3. Resume the patients normal job within 2 to 3 weeks
4. Try to discontinue cyclosporine (Neoral) as quickly as possible

40. You suspect kidney transplant rejection when the patient shows
which symptoms?
1. Pain in the incision, general malaise, and hypotension
2. Pain in the incision, general malaise, and depression
3. Fever, weight gain, and diminished urine output
4. Diminished urine output and hypotension

41. Your patient returns from the operating room after abdominal aortic
aneurysm repair. Which symptom is a sign of acute renal failure?

1. Anuria
2. Diarrhea
3. Oliguria
4. Vomiting

42. Which cause of hypertension is the most common in acute renal

failure?

1. Pulmonary edema
2. Hypervolemia
3. Hypovolemia
4. Anemia

43. A patient returns from surgery with an indwelling urinary catheter

in place and empty. Six hours later, the volume is 120ml. The drainage
system has no obstructions. Which intervention has priority?

1. Give a 500 ml bolus of isotonic saline

2. Evaluate the patients circulation and vital signs
3. Flush the urinary catheter with sterile water or saline
4. Place the patient in the shock position, and notify the surgeon

44. Youre preparing for urinary catheterization of a trauma patient and

you observe bleeding at the urethral meatus. Which action has priority?
1. Irrigate and clean the meatus before catheterization
2. Check the discharge for occult blood before catheterization
3. Heavily lubricate the catheter before insertion
4. Delay catheterization and notify the doctor

45. What change indicates recovery in a patient with nephritic

syndrome?

1. Disappearance of protein from the urine

2. Decrease in blood pressure to normal
3. Increase in serum lipid levels
4. Gain in body weight

46. Which statement correctly distinguishes renal failure from prerenal

failure?

1. With prerenal failure, vasoactive substances such as dopamine (Intropin)

increase blood pressure
2. With prerenal failure, there is less response to
such diuretics as furosemide (Lasix)
3. With prerenal failure, an IV isotonic saline infusion increases urine output
4. With prerenal failure, hemodialysis reduces the BUN level

47. Which criterion is required before a patient can be considered for

continuous peritoneal dialysis?

1. The patient must be hemodynamically stable

2. The vascular access must have healed
3. The patient must be in a home setting
4. Hemodialysis must have failed

48. Polystyrene sulfonate (Kayexalate) is used in renal failure to:

1. Correct acidosis
2. Reduce serum phosphate levels
3. Exchange potassium for sodium
4. Prevent constipation from sorbitol use

49. Your patient has complaints of severe right-sided flank pain,

nausea, vomiting and restlessness. He appears slightly pale and is
diaphoretic. Vital signs are BP 140/90 mmHg, Pulse 118 beats/min.,
respirations 33 breaths/minute, and temperature, 98.0F. Which
subjective data supports a diagnosis of renal calculi?

1. Pain radiating to the right upper quadrant

2. History of mild flu symptoms last week
3. Dark-colored coffee-ground emesis
4. Dark, scanty urine output

50. Immunosuppression following Kidney transplantation is continued:

1. For life
2. 24 hours after transplantation
3. A week after transplantation
4. Until the kidney is not anymore rejected

Answers and Rationale

1. Answer: 2. Costovertebral angle tenderness and chills

Costovertebral angle tenderness, flank pain, and chills are symptoms of acute
pyelonephritis.

Option A: Jaundice indicates gallbladder or liver obstruction.

 Option C: A burning sensation on urination is a sign of lower urinary
tract infection.

2. Answer: 2. It burns when I pee.

A common symptom of a UTI is dysuria. A patient with a UTI often reports

frequent voiding of small amounts and the urgency to void.

Option D: Urine that smells sweet is often associated with diabetic

ketoacidosis.

3. Answer: 4. After painful urination is relieved, stop taking

phenazopyridine.

Pyridium is taken to relieve dysuria because is provides an analgesic and

anesthetic effect on the urinary tract mucosa. The patient can stop taking it
after the dysuria is relieved.

Option A: The urine may temporarily turn red or orange due to the dye
in the drug.

Option B: The drug isnt taken before voiding, and is usually taken 3
times a day for 2 days.

4. Answer: 3. A 50 y.o. postmenopausal woman

Women are more prone to UTIs after menopause due to

reduced estrogen levels. Reduced estrogen levels lead to reduced levels of
vaginal Lactobacilli bacteria, which protect against infection.

Options B, C, and D: Angina, asthma and fractures dont increase the risk of
UTI.

5. Answer: 1. Check for kinks in the outflow tubing.

Tubing problems are a common cause of outflow difficulties, check the tubing
for kinks and ensure that all clamps are open. Other measures include having
the patient change positions (moving side to side or sitting up), applying gentle
pressure over the abdomen, or having a bowel movement.

6. Answer: 1. 15 minutes

Dialysate should be infused quickly. The dialysate should be infused over 15

minutes or less when performing peritoneal dialysis. The fluid exchange takes
place over a period ranging from 30 minutes to several hours.

7. Answer: 2. Avoid taking blood pressures in the arm with the fistula.

Dont take blood pressure readings in the arm with the fistula because the
compression could damage the fistula.

Option A: IV lines shouldnt be inserted in the arm used for

hemodialysis.

Option C: Palpate pulses below the fistula.

Option D: Lack of bruit or thrill should be reported to the doctor.

8. Answer: 2. Disequilibrium syndrome

Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and

other solutes from the blood. This can lead to cerebral edema and increased
intracranial pressure (ICP). Signs and symptoms include headache, nausea,
restlessness, vomiting, confusion, twitching, and seizures.

9. Answer: 2. Infuse normal saline solution

Treatment includes administering normal saline or hypertonic normal saline

solution because muscle cramps can occur when the sodium and water are
removed to quickly during dialysis. Reducing the rate of dialysis, not increasing
it, may alleviate muscle cramps.

10. Answer: 4. Keep fingernails short and clean

Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to

excoriation and breaks in the skin that increase the patients risk of infection.
Keeping fingernails short and clean helps reduce the risk of infection.

11. Answer: 4. Strain all urine

All urine should be strained through gauze or a urine strainer to catch stones
that are passed. The stones are then analyzed for composition.

Option A: Ambulation may help the movement of the stone down the
urinary tract.

Option C: Encourage fluid to help flush the stones out.

12. Answer: 3. Recent sore throat

The most common form of acute glomerulonephritis is caused by group A beta-

hemolytic streptococcal infection elsewhere in the body.

13. Answer: 1. Narcotic analgesics

Narcotic analgesics are usually needed to relieve the severe pain of renal calculi.

Options B and D: NSAIDS and salicylates are used for their anti-
inflammatory and antipyretic properties and to treat less severe pain.

Option C: Muscle relaxants are typically used to treat skeletal muscle

spasms.
14. Answer: 3. Invasive procedures

Invasive procedures such as catheterization can introduce bacteria into the

urinary tract. A lack of fluid intake could cause concentration of urine, but
wouldnt necessarily cause infection.

15. Answer: 3. Hematuria and proteinuria

Hematuria and proteinuria indicate acute glomerulonephritis. These finding

result from increased permeability of the glomerular membrane due to the
antigen-antibody reaction. Generalized edema is seen most often in nephrosis.

16. Answer: 2. 400ml

Oliguria is defined as urine output of less than 400ml/24hours.

17. Answer: 2. Elevated BUN level

Increased BUN is usually an early indicator of decreased renal function.

18. Answer: 3. Stress

Stress incontinence is an involuntary loss of a small amount of urine due to

sudden increased intra-abdominal pressure, such as with coughing or sneezing.

19. Answer: 2. Hemorrhage

Hemorrhage is a potential complication.

Option A: Pneumonia may occur if the patient doesnt cough and deep
breathe.
 Option C: Urine retention isnt a problem soon after surgery because a
catheter is in place.

Option D: Thrombosis may occur later if the patient doesnt ambulate.

20. Answer: 4. Prostate-specific antigen

An elevated prostate-specific antigen level indicates prostate cancer, but it can

be falsely elevated if done after the prostate gland is manipulated.

Option A: A digital rectal examination should be done as part of the

yearly screening, and then the antigen test is done if the digital exam
suggests cancer.

Option B: MRI is used in staging the cancer.

21. Answer: 4. Even with insulin, kidney damage is still a concern.

Kidney damage is still a concern. Microvascular changes occur in both of the

patients kidneys as a complication of the diabetes. Diabetic nephropathy is the
leading cause of end-stage renal disease. The kidneys continue to produce urine
until the end stage. Nephropathy occurs even with insulin management.

22. Answer: 4. Drink 8 to 10 eight-oz glasses of water daily

Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps
flush the bacteria from the bladder. The patient should be instructed to void
after sexual activity.

23. Answer: 1. Your urine might turn bright orange.

The drug turns the urine orange. It may be prescribed for longer than 7 days
and is usually ordered three times a day after meals. Phenazopyridine is an azo
(nitrogenous) analgesic; not an antibiotic.
24. Answer: 3. Hypertension, oliguria, and fatigue

Mild to moderate HTN may result from sodium or water retention and
inappropriate renin release from the kidneys. Oliguria and fatigue also may be
seen. Other signs are proteinuria and azotemia.

25. Answer: 2. Fluid volume excess

Fluid volume excess because the kidneys arent removing fluid and wastes. The
other diagnoses may apply, but they dont take priority.

26. Answer: 1. Apply pressure to the needle site upon discontinuing

hemodialysis

Apply pressure when discontinuing hemodialysis and after removing the

venipuncture needle until all the bleeding has stopped. Bleeding may continue
for 10 minutes in some patients.

27. Answer: 2. Fluid volume deficit related to inability to conserve

water

28. Answer: 1. Daily doubling of urine output (4 to 5 L/day)

Daily doubling of the urine output indicates that the nephrons are healing. This
means the patient is passing into the second phase (dieresis) of acute renal
failure.

29. Answer: 4. Taking a blood pressure reading on the affected arm can
cause clotting of the fistula

Pressure on the fistula or the extremity can decrease blood flow and precipitate
clotting, so avoid taking blood pressure on the affected arm.
30. Answer: 2. Low-protein diet with a prescribed amount of water

The patient should follow a low-protein diet with a prescribed amount of water.
The patient requires some protein to meet metabolic needs.

Option C: Salt substitutes shouldnt be used without a doctors order

because it may contain potassium, which could make the patient
hyperkalemic.

Option D: Fluid and protein restrictions are needed.

31. Answer: 1. Disequilibrium syndrome

Disequilibrium occurs when excess solutes are cleared from the blood more
rapidly than they can diffuse from the bodys cells into the vascular system.

32. Answer: 2. Set up specific times to empty the bladder

Instruct the patient with neurogenic bladder to write down his voiding pattern
and empty the bladder at the same times each day.

33. Answer: 3. Protein

Because of damage to the nephrons, the kidney cant excrete all the metabolic
wastes of protein, so this patients protein intake must be restricted.

Options A, B, and D: A higher intake of carbs, fats, and vitamin

supplements is needed to ensure the growth and maintenance of the
patients tissues.

34. Answer: 4. Palpate the fistula throughout its length to assess for a
thrill
The vibration or thrill felt during palpation ensures that the fistula has the
desired turbulent blood flow. Pinching the fistula could cause damage.
Aspirating blood is a needless invasive procedure.

35. Answer: 1. Increased calcium loss from the bones

Bones lose calcium when a patient can no longer bear weight. The calcium lost
from bones form calculi, a concentration of mineral salts also known as a stone,
in the renal system.

36. Answer: 2. Fluid volume excess

Kidneys are unable to rid the body of excess fluids which results in fluid volume
excess during ESRD.

37. Answer: 4. Check the patients latest potassium level

The patient with ESRD may develop arrhythmias caused by hypokalemia.

Option A: Call the doctor after checking the patients potassium values.

Option B: Lidocaine may be ordered if the PVCs are frequent and the
patient is symptomatic.

38. Answer: 1. At increased risk for cancer due to immunosuppression

caused by cyclosporine (Neoral)

Cyclosporine suppresses the immune response to prevent rejection of the

transplanted kidney. The use of cyclosporine places the patient at risk for
tumors.

39. Answer: 1. Remain afebrile and have negative cultures

The immunosuppressive activity of cyclosporine places the patient at risk for
infection, and steroids can mask the signs of infection. The patient may not be
able to resume normal fluid intake or return to work for an extended period of
time and the patient may need cyclosporine therapy for life.

40. Answer: 3. Fever, weight gain, and diminished urine output

Symptoms of rejection include fever, rapid weight gain, hypertension, pain over
the graft site, peripheral edema, and diminished urine output.

41. Answer: 3. Oliguria

Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal
failure. Anuria is uncommon except in obstructive renal disorders.

42. Answer: 2. Hypervolemia

Acute renal failure causes hypervolemia as a result of overexpansion

of extracellular fluid and plasma volume with the hypersecretion of renin.
Therefore, hypervolemia causes hypertension.

43. Answer: 2. Evaluate the patients circulation and vital signs

A total UO of 120ml is too low. Assess the patients circulation and

hemodynamic stability for signs of hypovolemia. A fluid bolus may be required,
but only after further nursing assessment and a doctors order.

44. Answer: 4. Delay catheterization and notify the doctor

Bleeding at the urethral meatus is evidence that the urethra is injured. Because
catheterization can cause further harm, consult with the doctor.

45. Answer: 1. Disappearance of protein from the urine

With nephrotic syndrome, the glomerular basement membrane of the kidney
becomes more porous, leading to loss of protein in the urine. As the patient
recovers, less protein is found in the urine.

46. Answer: 3. With prerenal failure, an IV isotonic saline infusion

increases urine output

Prerenal failure is caused by such conditions as hypovolemia that impairs kidney

perfusion; giving isotonic fluids improves urine output. Vasoactive substances
can increase blood pressure in both conditions.

47. Answer: 1. The patient must be hemodynamically stable

Hemodynamic stability must be established before continuous peritoneal dialysis

can be started.

48. Answer: 3. Exchange potassium for sodium

In renal failure, patients become hyperkalemic because they cant excrete

potassium in the urine. Polystyrene sulfonate acts to excrete potassium by
pulling potassium into the bowels and exchanging it for sodium.

49. Answer: 4. Dark, scanty urine output

Patients with renal calculi commonly have blood in the urine caused by the
stones passage through the urinary tract. The urine appears dark, tests positive
for blood, and is typically scant.

50. Answer: 1. For life.

1. A client is complaining of severe flank and abdominal pain. A flat

plate of the abdomen shows urolithiasis. Which of the following
interventions is important?
1. Strain all urine
2. Limit fluid intake
3. Enforce strict bed rest
4. Encourage a high calcium diet

2. A client is receiving a radiation implant for the treatment of

bladder cancer. Which of the following interventions is appropriate?

1. Flush all urine down the toilet

2. Restrict the clients fluid intake
3. Place the client in a semi-private room
4. Monitor the client for signs and symptoms of cystitis

3. A client has just received a renal transplant and has started

cyclosporine therapy to prevent graft rejection. Which of the following
conditions is a major complication of this drug therapy?

1. Depression
2. Hemorrhage
3. Infection
4. Peptic ulcer disease

4. A client received a kidney transplant 2 months ago. Hes admitted to

the hospital with the diagnosis of acute rejection. Which of the
following assessment findings would be expected?

1. Hypotension
2. Normal body temperature
3. Decreased WBC count
4. Elevated BUN and creatinine levels

5. The client is to undergo kidney transplantation with a living donor.

Which of the following preoperative assessments is important?
1. Urine output
2. Signs of graft rejection
3. Signs and symptoms of rejection
4. Clients support system and understanding of lifestyle changes.

6. A client had a transurethral prostatectomy for benign prostatic

hypertrophy. Hes currently being treated with a continuous bladder
irrigation and is complaining of an increase in severity of bladder
spasms. Which of the interventions should be done first?

1. Administer an oral analgesic

2. Stop the irrigation and call the physician
3. Administer a belladonna and opium suppository as ordered by the physician.
4. Check for the presence of clots, and make sure the catheter is draining
properly.

7. A client is admitted with a diagnosis of hydronephrosis secondary to

calculi. The calculi have been removed and post obstructive diuresis is
occurring. Which of the following interventions should be done?

1. Take vital signs every 8 hours

2. Weigh the client every other day
3. Assess for urine output every shift
4. Monitor the clients electrolyte levels.

8. A client has passed a renal calculus. The nurse sends the specimen to
the laboratory so it can be analyzed for which of the following factors?

1. Antibodies
2. Type of infection
3. Composition of calculus
4. Size and number of calculi
9. Which of the following symptoms indicate acute rejection of a
transplanted kidney?

1. Edema, Nausea
2. Fever, Anorexia
3. Weight gain, pain at graft site
4. Increased WBC count, pain with voiding

10. Adverse reactions of prednisone therapy include which of the

following conditions?

1. Acne and bleeding gums

2. Sodium retention and constipation
3. Mood swings and increased temperature
4. Increased blood glucose levels and decreased wound healing.

11. The nurse suspects that a client with polyuria is experiencing water
diuresis. Which laboratory value suggests water diuresis?

1. High urine specific gravity

2. High urine osmolarity
3. Normal to low urine specific gravity
4. Elevated urine pH

12. A client is diagnosed with prostate cancer. Which test is used to

monitor progression of this disease?

1. Serum creatinine
2. Complete blood cell count (CBC)
3. Prostate-specific antigen (PSA)
4. Serum potassium
13. A 27-year old client, who became paraplegic after a swimming
accident, is experiencing autonomic dysreflexia. Which condition is the
most common cause of autonomic dysreflexia?

1. Upper respiratory infection

2. Incontinence
3. Bladder distention
4. Diarrhea

14. When providing discharge teaching for a client with uric acid calculi,
the nurse should an instruction to avoid which type of diet?

1. Low-calcium
2. Low-oxalate
3. High-oxalate
4. High-purine

15. The client with urolithiasis has a history of chronic urinary tract
infections. The nurse concludes that this client most likely has which of
the following types of urinary stones?

1. Calcium oxalate
2. Uric acid
3. Struvite
4. Cystine

16. The nurse is receiving in transfer from the postanesthesia care unit
a client who has had a percutaneous ultrasonic lithotripsy for
calculuses in the renal pelvis. The nurse anticipates that the clients
care will involve monitoring which of the following?

1. Suprapubic tube
2. Urethral stent
3. Nephrostomy tube
4. Jackson-Pratt drain

17. The client is admitted to the ER following a MVA. The client was
wearing a lap seat belt when the accident occurred. The client has
hematuria and lower abdominal pain. To determine further whether
the pain is due to bladder trauma, the nurse asks the client if the pain is
referred to which of the following areas?

1. Shoulder
2. Umbilicus
3. Costovertebral angle
4. Hip

18. The client complains of fever, perineal pain, and urinary urgency,
frequency, and dysuria. To assess whether the clients problem is
related to bacterial prostatitis, the nurse would look at the results of
the prostate examination, which should reveal that the prostate gland
is:

1. Tender, indurated, and warm to the touch

2. Soft and swollen
3. Tender and edematous with ecchymosis
4. Reddened, swollen, and boggy.

19. The nurse is taking the history of a client who has had benign
prostatic hyperplasia in the past. To determine whether the client
currently is experiencing difficulty, the nurse asks the client about the
presence of which of the following early symptoms?

1. Urge incontinence
2. Nocturia
3. Decreased force in the stream of urine
4. Urinary retention

20. The client who has a cold is seen in the emergency room with
inability to void. Because the client has a history of BPH, the nurse
determines that the client should be questioned about the use of which
of the following medications?

1. Diuretics
2. Antibiotics
3. Antitussives
4. Decongestants

21. The nurse is preparing to care for the client following a renal scan.
Which of the following would the nurse include in the plan of care?

1. Place the client on radiation precautions for 18 hours

2. Save all urine in a radiation safe container for 18 hours
3. Limit contact with the client to 20 minutes per hour.
4. No special precautions except to wear gloves if in contact with the clients
urine.

22. The client passes a urinary stone, and lab analysis of the stone
indicates that it is composed of calcium oxalate. Based on this analysis,
which of the following would the nurse specifically include in the
dietary instructions?

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

2. Avoid citrus fruits and citrus juices
3. Avoid green, leafy vegetables such as spinach.
4. Increase intake of dairy products.
23. The client returns to the nursing unit following a pyelolithotomy for
removal of a kidney stone. A Penrose drain is in place. Which of the
following would the nurse include in the clients postoperative care?

1. Sterile irrigation of the Penrose drain

2. Frequent dressing changes around the Penrose drain
3. Weighing the dressings
4. Maintaining the clients position on the affected side

24. The nurse is caring for a client following a kidney transplant. The
client develops oliguria. Which of the following would the nurse
anticipate to be prescribed as the treatment of oliguria?

1. Encourage fluid intake

2. Administration of diuretics
3. Irrigation of Foley catheter
4. Restricting fluids

25. A week after kidney transplantation the client develops a

temperature of 101, the blood pressure is elevated, and the kidney is
tender. The X-ray results the transplanted kidney is enlarged. Based on
these assessment findings, the nurse would suspect which of the
following?

1. Acute rejection
2. Chronic rejection
3. Kidney infection
4. Kidney obstruction

26. The client with BPH undergoes a transurethral resection of the

prostate. Postoperatively, the client is receiving continuous bladder
irrigations. The nurse assesses the client for signs of transurethral
resection syndrome. Which of the following assessment data would
indicate the onset of this syndrome?

1. Bradycardia and confusion

2. Tachycardia and diarrhea
3. Decreased urinary output and bladder spasms
4. Increased urinary output and anemia

27. The client is admitted to the hospital with BPH, and a transurethral
resection of the prostate is performed. Four hours after surgery the
nurse takes the clients VS and empties the urinary drainage bag. Which
of the following assessment findings would indicate the need to notify
the physician?

1. Red bloody urine

2. Urinary output of 200 ml greater than intake
3. Blood pressure of 100/50 and pulse 130.
4. Pain related to bladder spasms.

28. Which of the following symptoms is the most common clinical

finding associated with bladder cancer?

1. Suprapubic pain
2. Dysuria
3. Painless hematuria
4. Urinary retention

29. A client who has been diagnosed with bladder cancer is scheduled
for an ileal conduit. Preoperatively, the nurse reinforces the clients
understanding of the surgical procedure by explaining that an ileal
conduit:
1. Is a temporary procedure that can be reversed later.
2. Diverts urine into the sigmoid colon, where it is expelled through the rectum.
3. Conveys urine from the ureters to a stoma opening in the abdomen.
4. Creates an opening in the bladder that allows urine to drain into an external
pouch.

30. After surgery for an ileal conduit, the nurse should closely evaluate
the client for the occurrence of which of the following complications
related to pelvic surgery?

1. Peritonitis
2. Thrombophlebitis
3. Ascites
4. Inguinal hernia

31. The nurse is assessing the urine of a client who has had an ileal
conduit and notes that the urine is yellow with a moderate amount of
mucus. Based on the assessment data, which of the following nursing
interventions would be most appropriate at this time?

1. Change the appliance bag

2. Notify the physician
3. Obtain a urine specimen for culture
4. Encourage a high fluid intake

32. When teaching the client to care for an ileal conduit, the nurse
instructs the client to empty the appliance frequently, primarily to
prevent which of the following problems?

1. Rupture of the ileal conduit

2. Interruption of urine production
3. Development of odor
4. Separation of the appliance from the skin
33. The client with an ileal conduit will be using a reusable appliance at
home. The nurse should teach the client to clean the appliance routinely
with what product?

1. Baking soda
2. Soap
3. Hydrogen peroxide
4. Alcohol

34. The nurse is evaluating the discharge teaching for a client who has
an ileal conduit. Which of the following statements indicates that the
client has correctly understood the teaching? Select all that apply.

1. If I limit my fluid intake I will not have to empty my ostomy pouch as often.
2. I can place an aspirin tablet in my pouch to decrease odor.
3. I can usually keep my ostomy pouch on for 3 to 7 days before changing it.
4. I must use a skin barrier to protect my skin from urine.
5. I should empty my ostomy pouch of urine when it is full.

35. A female client with a urinary diversion tells the nurse, This
urinary pouch is embarrassing. Everyone will know that Im not normal.
I dont see how I can go out in public anymore. The most appropriate
nursing diagnosis for this patient is:

1. Anxiety related to the presence of urinary diversion.

2. Deficient Knowledge about how to care for the urinary diversion.
3. Low Self-Esteem related to feelings of worthlessness
4. Disturbed Body Image related to creation of a urinary diversion.

36. The nurse teaches the client with a urinary diversion to attach the
appliance to a standard urine collection bag at night. The most
important reason for doing this is to prevent:
1. Urine reflux into the stoma
2. Appliance separation
3. Urine leakage
4. The need to restrict fluids

37. The nurse teaches the client with an ileal conduit measures to
prevent a UTI. Which of the following measures would be most
effective?

1. Avoid people with respiratory tract infections

2. Maintain a daily fluid intake of 2,000 to 3,000 ml
3. Use sterile technique to change the appliance
4. Irrigate the stoma daily.

38. A client who has been diagnosed with calculi reports that the pain is
intermittent and less colicky. Which of the following nursing actions is
most important at this time?

1. Report hematuria to the physician

2. Strain the urine carefully
3. Administer meperidine (Demerol) every 3 hours
4. Apply warm compresses to the flank area

39. A client has a ureteral catheter in place after renal surgery. A

priority nursing action for care of the ureteral catheter would be to:

1. Irrigate the catheter with 30 ml of normal saline every 8 hours

2. Ensure that the catheter is draining freely
3. Clamp the catheter every 2 hours for 30 minutes.
4. Ensure that the catheter drains at least 30 ml an hour
40. Which of the following interventions would be most appropriate for
preventing the development of a paralytic ileus in a client who has
undergone renal surgery?

1. Encourage the client to ambulate every 2 to 4 hours

2. Offer 3 to 4 ounces of a carbonated beverage periodically.
3. Encourage use of a stool softener
4. Continue intravenous fluid therapy

41. The nurse is conducting a postoperative assessment of a client on

the first day after renal surgery. Which of the following findings would
be most important for the nurse to report to the physician?

1. Temperature, 99.8
2. Urine output, 20 ml/hour
3. Absence of bowel sounds
4. A 22 inch area of serous sanguineous drainage on the flank dressing.

42. Because a clients renal stone was found to be composed to uric

acid, a low-purine, alkaline ash diet was ordered. Incorporation of
which of the following food items into the home diet would indicate that
the client understands the necessary diet modifications?

1. Milk, apples, tomatoes, and corn

2. Eggs, spinach, dried peas, and gravy.
3. Salmon, chicken, caviar, and asparagus
4. Grapes, corn, cereals, and liver.

43. Allopurinol (Zyloprim), 200 mg/day, is prescribed for the client with
renal calculi to take home. The nurse should teach the client about
which of the following side effects of this medication?
1. Retinopathy
2. Maculopapular rash
3. Nasal congestion
4. Dizziness

44. The client has a clinic appointment scheduled 10 days after

discharge. Which laboratory finding at that time would indicate that
allopurinol (Zyloprim) has had a therapeutic effect?

1. Decreased urinary alkaline phosphatase level

2. Increased urinary calcium excretion
3. Increased serum calcium level
4. Decreased serum uric acid level

45. When developing a plan of care for the client with stress
incontinence, the nurse should take into consideration that stress
incontinence is best defined as the involuntary loss of urine associated
with:

1. A strong urge to urinate

2. Overdistention of the bladder
3. Activities that increase abdominal pressure
4. Obstruction of the urethra

46. Which of the following assessment data would most likely be

related to a clients current complaint of stress incontinence?

1. The clients intake of 2 to 3 L of fluid per day.

2. The clients history of three full-term pregnancies
3. The clients age of 45 years
4. The clients history of competitive swimming
47. The nurse is developing a teaching plan for a client with stress
incontinence. Which of the following instructions should be included?

1. Avoid activities that are stressful and upsetting

2. Avoid caffeine and alcohol
3. Do not wear a girdle
4. Limit physical exertion

48. A client has urge incontinence. Which of the following signs and
symptoms would the nurse expect to find in this client?

1. Inability to empty the bladder

2. Loss of urine when coughing
3. Involuntary urination with minimal warning
4. Frequent dribbling of urine

49. A 72-year old male client is brought to the emergency room by his
son. The client is extremely uncomfortable and has been unable to void
for the past 12 hours. He has known for some time that he has an
enlarged prostate but has wanted to avoid surgery. The best method for
the nurse to use when assessing for bladder distention in a male client
is to check for:

1. A rounded swelling above the pubis.

2. Dullness in the lower left quadrant
3. Rebound tenderness below the symphysis
4. Urine discharge from the urethral meatus

50. During a clients urinary bladder catheterization, the bladder is

emptied gradually. The best rationale for the nurses action is that
completely emptying an overdistended bladder at one time tends to
cause:
1. Renal failure
2. Abdominal cramping
3. Possible shock
4. Atrophy of bladder musculature

51. The primary reason for taping an indwelling catheter laterally to the
thigh of a male client is to:

1. Eliminate pressure at the penoscrotal angle

2. Prevent the catheter from kinking in the urethra
3. Prevent accidental catheter removal
4. Allow the client to turn without kinking the catheter

52. The primary function of the prostate gland is:

1. To store underdeveloped sperm before ejaculation

2. To regulate the acidity and alkalinity of the environment for proper sperm
development.
3. To produce a secretion that aids in the nourishment and passage of sperm
4. To secrete a hormone that stimulates the production and maturation of
sperm

53. The nurse is reviewing a medication history of a client with BPH.

Which medication should be recognized as likely to aggravate BPH?

1. Metformin (Glucophage)
2. Buspirone (BuSpar)
3. Inhaled ipratropium (Atrovent)
4. Ophthalmic timolol (Timoptic)

54. A client is scheduled to undergo a transurethral resection of the

prostate gland (TURP). The procedure is to be done under spinal
anesthesia. Postoperatively, the nurse should be particularly alert for
early signs of:

1. Convulsions
2. Cardiac arrest
3. Renal shutdown
4. Respiratory paralysis

55. A client with BPH is being treated with terazosin (Hytrin) 2 mg at

bedtime. The nurse should monitor the clients:

1. Urinary nitrites
2. White blood cell count
3. Blood pressure
4. Pulse

56. A client underwent a TURP, and a large three-way catheter was

inserted into the bladder with continuous bladder irrigation. In which of
the following circumstances would the nurse increase the flow rate of
the continuous bladder irrigation?

1. When the drainage is continuous but slow

2. When the drainage appears cloudy and dark yellow
3. When the drainage becomes bright red
4. When there is no drainage of urine and irrigating solution

57. A priority nursing diagnosis for the client who is being discharged t
home 3 days after a TURP would be:

1. Deficient fluid volume

2. Imbalanced Nutrition: Less than Body Requirements
3. Impaired Tissue Integrity
4. Ineffective Airway Clearance
58. If a clients prostate enlargement is caused by a malignancy, which
of the following blood examinations should the nurse anticipate to
assess whether metastasis has occurred?

1. Serum creatinine level

2. Serum acid phosphatase level
3. Total nonprotein nitrogen level
4. Endogenous creatinine clearance time

59. Steroids, if used following kidney transplantation would cause

which of the following side effects?

1. Alopecia
2. Increase Cholesterol Level
3. Orthostatic Hypotension
4. Increase Blood Glucose Level

60. Mr. Roberto was readmitted to the hospital with acute graft
rejection. Which of the following assessment finding would be
expected?

1. Hypotension
2. Normal Body Temperature
3. Decreased WBC
4. Elevated BUN and Creatinine

Answers and Rationale

1. Answer: 1. Strain all urine

Urine should be strained for calculi and sent to the lab for analysis.
 Option B: Fluid intake of three (3) to four (4) L is encouraged to flush
the urinary tract and prevent further calculi formation.

Option C: Ambulation is encouraged to help pass the calculi through

gravity.

Option D: A low-calcium diet is recommended to help prevent the

formation of calcium calculi.

2. Answer: 4. Monitor the client for signs and symptoms of cystitis

Cystitis is the most common adverse reaction of clients undergoing radiation

therapy; symptoms include dysuria, frequency, urgency, and nocturia. Clients
with radiation implants require a private room. Urine of clients with radiation
implants for bladder cancer should be sent to the radioisotopes lab for
monitoring. It is recommended that fluid intake be increased.

3. Answer: 3. Infection

Infection is the major complication to watch for in clients on cyclosporine

therapy because its an immunosuppressive drug.

Option A: Depression may occur posttransplantation but not because of

cyclosporine.

Option B: Hemorrhage is a complication associated with anticoagulant

therapy.

Option D: Peptic ulcer disease is a complication of steroid therapy.

4. Answer: 4. Elevated BUN and creatinine levels

In a client with acute renal graft rejection, evidence of deteriorating renal

function is expected.
 Option A: The client would most likely have acute hypertension.

Options B and C: The nurse would see elevated WBC counts

and fever because the body is recognizing the graft as foreign and is
attempting to fight it.

5. Answer: 4. Clients support system and understanding of lifestyle

changes.

The client undergoing a renal transplantation will need vigilant follow-up care
and must adhere to the medical regimen. The client is most likely anuric or
oliguric preoperatively but postoperatively will require close monitoring of urine
output to make sure the transplanted kidney is functioning optimally. While the
client will always need to be monitored for signs and symptoms of infection, its
most important post-op will require close monitoring of urine output to make
sure the transplanted kidney is functioning optimally. While the client will always
need to be monitored for signs and symptoms of infection, its most important
postoperatively due to the immunosuppressant therapy. Rejection can occur
postoperatively.

6. Answer: 4. Check for the presence of clots, and make sure the
catheter is draining properly.

Blood clots and blocked outflow if the urine can increase spasms.

Option A: Oral analgesics should be given if the spasms are unrelieved

by the belladonna and opium suppository.

Option B: The irrigation shouldnt be stopped as long as the catheter is

draining because clots will form.

Option C: A belladonna and opium suppository should be given to

relieve spasms but only after assessment of the drainage.
7. Answer: 4. Monitor the clients electrolyte levels.

Postobstructive diuresis seen in hydronephrosis can cause electrolyte

imbalances; lab values must be checked so electrolytes can be replaced as
needed.

Option A: VS should initially be taken every 30 minutes for the first 4

hours and then every 2 hours.

Option B: The clients weight should be taken daily to assess fluid

status more closely.

Option C: Urine output needs to be assessed hourly.

8. Answer: 3. Composition of calculus

The calculus should be analyzed for the composition to determine appropriate

interventions such as dietary restrictions.

Options A and D: The size and number of calculi arent relevant, and
they dont contain antibodies.

Option B: Calculi dont result in infections.

9. Answer: 3. Weight gain, pain at graft site

Pain at the graft site and weight gain indicates the transplanted kidney isnt
functioning and possibly is being rejected. Transplant clients usually have
edema, anorexia, fever, and nausea before transplantation, so those symptoms
may not indicate rejection.

10. Answer: 4. Increased blood glucose levels and decreased wound

healing.
Steroid use tends to increase blood glucose levels, particularly in clients
with diabetes and borderline diabetes. Steroids also contribute to poor wound
healing and may cause acne, mood swings, and sodium and water retention.
Steroids dont affect thermoregulation, bleeding tendencies, or constipation.

Options A, B, and C: Steroids dont affect

thermoregulation, bleeding tendencies, or constipation.

11. Answer: 3. Normal to low urine specific gravity

Water diuresis causes low urine specific gravity, low urine osmolarity, and a
normal to elevated serum sodium level.

Option A: High specific gravity

indicates dehydration. Hypernatremia signals acidosis and shock.

Option D: Elevated urine pH can result from potassium deficiency, a

high-protein diet, or uncontrolled diabetes.

12. Answer: 3. Prostate-specific antigen (PSA)

The PSA test is used to monitor prostate cancer progression; higher PSA levels
indicate a greater tumor burden.

Option A: Serum creatinine levels may suggest blockage from an

enlarged prostate.

Option B: CBC is used to diagnose anemia and polycythemia.

Option D: Serum potassium levels

identify hypokalemia and hyperkalemia.

13. Answer: 3. Bladder distention

Autonomic dysreflexia is a potentially life-threatening complication of spinal
cord injury, occurring from obstruction of the urinary system or bowel.

Option A: An URI could obstruct the respiratory system, but not the
urinary or bowel system.

Options B and D: Incontinence and diarrhea dont result in obstruction

of the urinary system or bowel, respectively.

14. Answer: 4. High-purine

To control uric acid calculi, the client should follow a low-purine diet, which
excludes high-purine foods such as organ meats.

Option A: A low-calcium diet decreases the risk for oxalate renal

calculi.

Options B and C: Oxalate is an essential amino acid and must be

included in the diet. A low-oxalate diet is used to control calcium or
oxalate calculi.

15. Answer: 3. Struvite

Struvite stones commonly are referred to as infection stones because they form
in urine that is alkaline and rich in ammonia, such as with a urinary tract
infection.

Option A: Calcium oxalate stones result from increased calcium intake

or conditions that raise serum calcium concentrations.

Option B: Uric acid stones occur in clients with gout.

 Option D: Cystine stones are rare and occur in clients with a genetic
defect that results in decreased renal absorption of the amino acid
cystine.

16. Answer: 3. Nephrostomy tube

A nephrostomy tube is put in place after a percutaneous ultrasonic lithotripsy to

treat calculuses in the renal pelvis. The client may also 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.

17. Answer: 1. Shoulder

Bladder trauma or injury is characterized by lower abdominal pain that may

radiate to one of the shoulders. Bladder injury pain does not radiate to the
umbilicus, CV angle, or hip.

Options B, C, and D: Bladder injury pain do not radiate to the

umbilicus, CV angle, or hip.

18. Answer: 1. Tender, indurated, and warm to the touch

The client with prostatitis has a prostate gland that is swollen and tender, but
that is also warm to the touch, firm, and indurated. Systemic symptoms
include fever with chills, perineal and low back pain, and signs of urinary tract
infection (which often accompany the disorder).

19. Answer: 3. Decreased force in the stream of urine

Decreased force in the stream of urine is an early sign of BPH. The stream later
becomes weak and dribbling. The client then may develop hematuria,
frequency, urgency, urge incontinence, and nocturia. If untreated, complete
obstruction and urinary retention can occur.

20. Answer: 4. Decongestants

In the client with BPH, episodes of urinary retention can be triggered by certain
medications, such as decongestants, anticholinergics, and antidepressants. The
client should be questioned about the use of these medications if the client has
urinary retention. Retention can also be precipitated by other factors, such as
alcoholic beverages, infection, bedrest, and becoming chilled.

21. Answer: 4. No special precautions except to wear gloves if in

contact with the clients urine.

No specific precautions are necessary following a renal scan. Urination into a

commode is acceptable without risk from the small amount of radioactive
material to be excreted. The nurse wears gloves to maintain body secretion
precautions.

22. Answer: 3. 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.

23. Answer: 2. Frequent dressing changes around the Penrose drain

Frequent dressing changes around the Penrose drain is required to protect the
skin against breakdown from urinary drainage. If urinary drainage is excessive,
an ostomy pouch may be placed over the drain to protect the skin.

Option A: A Penrose drain is not irrigated.

 Option C: Weighing the dressings is not necessary.

Option D: Placing the client on the affected side will prevent a free flow
of urine through the drain.

24. Answer: 2. Administration of diuretics

To increase urinary output, diuretics and osmotic agents are considered. The
client should be monitored closely because fluid overload can cause
hypertension, congestive heart failure, and pulmonary edema.

Options A and D: Fluid intake would not be encouraged or restricted.

Option C: Irrigation of the Foley catheter will not assist in alleviating

this oliguria.

25. Answer: 1. Acute rejection

Acute rejection most often occurs in the first two (2) weeks after transplant.
Clinical manifestations include fever, malaise, elevated WBC count, acute
hypertension, graft tenderness, and manifestations of deteriorating renal
function.

Option B: Chronic rejection occurs gradually during a period of months

to years.

Options C and D: Although kidney infection or obstruction can occur,

the symptoms presented in the question do not relate specifically to
these disorders.

26. Answer: 1. 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.

27. Answer: 3. Blood pressure of 100/50 and pulse 130.

A rapid pulse with a low blood pressure is a potential sign of excessive blood
loss. The physician should be notified.

Option A: Frank bleeding (arterial or venous) may occur during the first
few days after surgery.

Option B: Some hematuria is usual for several days after surgery. A

urinary output of 200 ml of greater than intake is adequate.

Options D: Bladder spasms are expected to occur after surgery.

28. Answer: 3. Painless hematuria

Painless hematuria is the most common clinical finding in bladder cancer. Other
symptoms include frequency, dysuria, and urgency, but these are not as
common as the hematuria.

Options A and D: Suprapubic pain and urinary retention do not occur

in bladder cancer.

29. Answer: 3. Conveys urine from the ureters to a stoma opening in

the abdomen.

An ileal conduit is a permanent urinary diversion in which a portion of the ileum

is surgically resected and one end of the segment is closed. The ureters are
surgically attached to this segment of the ileum, and the open end of the ileum
is brought to the skin surface on the abdomen to form the stoma. The client
must wear a pouch to collect the urine that continually flows through the
conduit. The bladder is removed during the surgical procedure and the ileal
conduit is not reversible.

Option B: Diversion of the urine to the sigmoid colon is called a ureter

ileosigmoidostomy.

Option D: An opening in the bladder that allows urine to drain

externally is called a cystostomy.

30. Answer: 2. Thrombophlebitis

After pelvic surgery, there is an increased chance of thrombophlebitis owing to

the pelvic manipulation that can interfere with circulation and promote venous
stasis.

Option A: Peritonitis is a potential complication of any abdominal

surgery, not just pelvic surgery.

Option C: Ascites is most frequently an indication of liver disease.

Option D: Inguinal hernia may be caused by an increase in abdominal

pressure or a congenital weakness of the abdominal wall; a ventral
hernia occurs at the site of a previous abdominal surgery.

31. Answer: 4. Encourage a high fluid intake

Mucus is secreted by the intestinal segment used to create the conduit and is a
normal occurrence. The client should be encouraged to maintain a large fluid
intake to help flush the mucus out of the conduit.

Option A: Because mucus in the urine is expected, it is not necessary

to change the appliance bag or notify the physician.
 Option C: The mucus is not an indication of an infection, so a urine
culture is not necessary.

32. Answer: 4. Separation of the appliance from the skin

If the appliance becomes too full, it is likely to pull away from the skin
completely or to leak urine onto the skin. A full appliance will not rupture the
ileal conduit or interrupt urine production. Odor formation has numerous
causes.

33. Answer: 2. Soap

A reusable appliance should be routinely cleaned with soap and water.

34. Answers: 3, 4. I can usually keep my ostomy pouch on for 3 to 7

days before changing it. and I must use a skin barrier to protect my
skin from urine.

The client with an ileal conduit must learn self-care activities related to the care
of the stoma and ostomy appliances. The client should be taught to increase
fluid intake to about 3,000 ml per day and should not limit intake. The ostomy
appliance should be changed approximately every 3 to 7 days and whenever a
leak develops. A skin barrier is essential to protecting the skin from the
irritation of the urine.

Option A: Adequate fluid intake helps to flush mucus from the ileal
conduit.

Option B: An aspirin should not be used as a method of odor control

because it can be an irritant to the stoma and lead to ulceration.

Option E: The ostomy pouch should be emptied when it is one-third to

one-half full to prevent the weight from pulling the appliance away
from the skin.
35. Answer: 4. Disturbed Body Image related to the creation of a
urinary diversion.

It is normal for clients to express fears and concerns about the body changes
associated with a urinary diversion. Allowing the client time to verbalize
concerns in a supportive environment and suggest that she discuss these
concerns with people who have successfully adjusted to ostomy surgery can
help her begin coping with these changes in a positive manner.

Options A and C: Although the client may be anxious about this

situation and self-esteem may be diminished, the underlying problem
is a disturbance in body image.

Option B: There are no data to support a diagnosis of Deficient

Knowledge.

36. Answer: 1. Urine reflux into the stoma

The most important reason for attaching the appliance to a standard urine
collection bag at night is to prevent reflux into the stoma and ureters, which can
result in infection.

Options B and C: Use of a standard collection bag also keeps the

appliance from separating from the skin and helps prevent urine
leakage from an overly full bag, but the primary purpose is to prevent
reflux of urine.

Option D: A client with a urinary diversion should drink 2000-3000 ml

of fluid each day; it would be inappropriate to suggest decreasing fluid
intake.

37. Answer: 2. Maintain a daily fluid intake of 2,000 to 3,000 ml

Maintaining a fluid intake of 2,000 to 3,000 ml/day is likely to be effective in
preventing UTI. A high fluid intake results in high urine output, which prevents
urinary stasis and bacterial growth.

Option A: Avoiding people with respiratory tract infections will not

prevent urinary tract infections.

Option C: Clean, not sterile, technique is used to change the appliance.

Option D: An ileal conduit stoma is not irrigated.

38. Answer: 2. Strain the urine carefully

Intermittent pain that is less colicky indicates that the calculi may be moving
along the urinary tract. Fluids should be encouraged to promote movement, and
the urine should be strained to detect the passage of the stone.

Option A: Hematuria is to be expected from the irritation of the stone.

Option C: Analgesics should be administered when the client needs

them, not routinely.

Option D: Moist heat to the flank area is helpful when renal colic
occurs, but it is less necessary as pain is lessened.

39. Answer: 2. Ensure that the catheter is draining freely

The ureteral catheter should drain freely without bleeding at the site.

Option A: The catheter is rarely irrigated, and any irrigation would be

done by the physician.

Option C: The catheter is never clamped.

 Option D: The clients total urine output (ureteral catheter plus voiding
or Foley catheter output) should be 30 ml/hour.

40. Answer: 1. Encourage the client to ambulate every two (2) to four
(4) hours

Ambulation stimulates peristalsis. A client with paralytic ileus is kept NPO until
peristalsis returns.

Option C: A stool softener will not stimulate peristalsis.

Option D: Intravenous fluid infusion is a routine postoperative order

that does not have any effect on preventing paralytic ileus.

41. Answer: 2. Urine output, 20 ml/hour

The decrease in urinary output may indicate inadequate renal perfusion and
should be reported immediately. Urine output of 30 ml/hour or greater is
considered acceptable.

Option A: A slight elevation in temperature is expected after surgery.

Option C: Peristalsis returns gradually, usually the second or third day

after surgery. Bowel sounds will be absent until then.

Option D: A small amount of serous sanguineous drainage is to be

expected.

42. Answer: 1. Milk, apples, tomatoes, and corn

Because a high-purine diet contributes to the formation of uric acid, a low-

purine diet is advocated. An alkaline ash diet is also advocated because uric acid
crystals are more likely to develop in acid urine. Foods that may be eaten as
desired in a low-purine diet include milk, all fruits, tomatoes, cereals, and corn.
Food allowed on an alkaline ash diet include milk, fruits (except cranberries,
plums, and prunes), and vegetables (especially legumes and green vegetables).
Gravy, chicken, and liver are high in purine.

43. Answer: 2. Maculopapular rash

Allopurinol is used to treat renal calculi composed of uric acid. Side effects of
allopurinol include drowsiness, maculopapular rash, anemia, abdominal pain,
nausea, vomiting, and bone marrow depression. Clients should be instructed to
report skin rashes and any unusual bleeding or bruising.

Options A, C, and D: Retinopathy, nasal congestion, and dizziness are

not side effects of allopurinol.

44. Answer: 4. Decreased serum uric acid level

By inhibiting uric acid synthesis, allopurinol decreases its excretion. The drugs
effectiveness is assessed by evaluating for a decreased serum uric acid
concentration.

Options A, B, and C: Allopurinol does not alter the level of alkaline

phosphatase, not does it affect urinary calcium excretion or the serum
calcium level.

45. Answer: 3. Activities that increase abdominal pressure

Stress incontinence is the involuntary loss of urine during such activities as

coughing, sneezing, laughing, or physical exertion. These activities increase
abdominal and detrusor pressure.

Option A: A strong urge to urinate is associated with urge incontinence.

Option B: Overdistention of the bladder can lead to overflow

incontinence.
 Option D: Obstruction of the urethra can lead to urinary retention.

46. Answer: 2. The clients history of three full-term pregnancies

The history of three pregnancies is most likely the cause of the clients current
episodes of stress incontinence. The clients fluid intake, age, or history of
swimming would not create an increase in intra-abdominal pressure.

47. Answer: 2. Avoid caffeine and alcohol

Clients with stress incontinence are encouraged to avoid substances such as

caffeine and alcohol which are bladder irritants.

Option A: Emotional stressors do not cause stress incontinence. It is

caused most commonly be relaxed pelvic musculature.

Option C: Wearing Girdles is not contraindicated.

Option D: Although clients may be inclined to limit physical exertion to

avoid incontinence episodes; they should be encouraged to seek
treatment instead of limiting their activities.

48. Answer: 3. Involuntary urination with minimal warning

A characteristic of urge incontinence is involuntary urination with little or no

warning. Option A: The inability to empty the bladder is urinary retention.
Option B: Loss of urine when coughing occurs with stress incontinence. Option
D: Frequent dribbling of urine is common in male clients after some types of
prostate surgery or may occur in women after the development of

Option A: The inability to empty the bladder is urinary retention.

Option B: Loss of urine when coughing occurs with stress incontinence.

 Option D: Frequent dribbling of urine is common in male clients after
some types of prostate surgery or may occur in women after the
development of a vesicovaginal or ureterovaginal fistula.

49. Answer: 1. A rounded swelling above the pubis.

The best way to assess for a distended bladder in either a male or female client
is to check for a rounded swelling above the pubis. The swelling represents the
distended bladder rising above the pubis into the abdominal cavity.

Option B: Dullness does not indicate a distended bladder.

Option C: The client might experience tenderness or pressure above

the symphysis.

Option D: No urine discharge is expected; the urine flow is blocked by

the enlarged prostate.

50. Answer: 3. Possible shock

Rapid emptying of an overdistended bladder may cause hypotension and shock

due to the sudden change of pressure within the abdominal viscera. Previously,
removing no more than 1,000 ml at one time was the standard of practice, but
this is no longer thought to be necessary as long as the overdistended bladder
is emptied slowly.

51. Answer: 1. Eliminate pressure at the penoscrotal angle

The primary reason for taping an indwelling catheter to a male client soothe
penis is held in a lateral position to prevent pressure at the penoscrotal angle.
Prolonged pressure at the penoscrotal angle can cause a ureterocutaneous
fistula.
52. Answer: 3. To produce a secretion that aids in the nourishment and
passage of sperm

The prostate gland is located below the bladder and surrounds the urethra. It
serves one primary purpose: to produce a secretion that aids in the
nourishment and passage of sperm.

53. Answer: 3. Inhaled ipratropium (Atrovent)

Atrovent is a bronchodilator, and its anticholinergic effects can aggravate

urinary retention.

Options A and B: Glucophage and BuSpar do not affect the urinary

system.

Option D: Timolol does not have a systemic effect.

54. Answer: 4. Respiratory paralysis

If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal
anesthesia is used, the client is likely to develop respiratory paralysis. Artificial
ventilation is required until the effects of the anesthesia subside.

Options A, B, and C: Convulsions, cardiac arrest, and renal shutdown

are not likely results of spinal anesthesia.

55. Answer: 3. Blood pressure

Terazosin (Hytrin) is an antihypertensive drug that is also used in the treatment

of BPH. Blood pressure must be monitored to ensure that the client does not
develop hypotension, syncope, or postural hypotension. The client should be
instructed to change positions slowly.
 Options A, B, and D: Urinary nitrites, white blood cell count, and pulse
rate are not affected by terazosin.

56. Answer: 3. When the drainage becomes bright red

The decision made by the surgeon to insert a catheter after a TURP or

prostatectomy depends on the amount of bleeding that is expected after the
procedure. During continuous bladder irrigation after a TURP or prostatectomy,
the rate at which the solution enters the bladder should be increased when the
drainage becomes brighter red. The color indicates the presence of blood.
Increasing the flow of irrigating solution helps flush the catheter well so clots do
not plug it.

Option B: There would be no reason to increase the flow rate when the
return is continuous or when the return appears cloudy and dark
yellow.

Option D: Increasing the flow would be contraindicated when there is

no return of urine and irrigating solution.

57. Answer: 1. Deficient fluid volume

Deficient Fluid Volume is a priority diagnosis because the client needs to drink a
large amount of fluid to keep the urine clear. The urine should be almost without
color. About two (2) weeks after a TURP, when desiccated tissue is sloughed out,
a secondary hemorrhage could occur. The client should be instructed to call the
surgeon or go to the ED if at any time the urine turns bright red.

Option B: The client is not specifically at risk for nutritional problems

after a TURP. The client is not specifically at risk for nutritional
problems after a TURP.

Option C: The client is not specifically at risk for impaired tissue

integrity because there is no external incision.
 Option D: The client is not specifically at risk for airway problems
because the procedure is done after spinal anesthesia.

58. Answer: 2. Serum acid phosphatase level

The most specific examination to determine whether a malignancy extends

outside of the prostatic capsule is a study of the serum acid phosphatase level.
The level increases when a malignancy has metastasized. The prostate-specific
antigen (PSA) determination and a digital rectal examination are done when
screening for prostate cancer. Serum creatinine level, total nonprotein nitrogen
level, and endogenous creatinine clearance time give information about kidney
function, not

Options A, C, and D: Serum creatinine level, total nonprotein nitrogen level, and
endogenous creatinine clearance time give information about kidney function,
not prostate malignancy.

59. Answer: 4. Increased Blood Glucose Level.

60. Answer: 4. Elevated BUN and Creatinine.

1. Dialysis allows for the exchange of particles across a semipermeable

membrane by which of the following actions?

1. Osmosis and diffusion

2. Passage of fluid toward a solution with a lower solute concentration
3. Allowing the passage of blood cells and protein molecules through it.
4. Passage of solute particles toward a solution with a higher concentration.

2. A client is diagnosed with chronic renal failure and told she must
start hemodialysis. Client teaching would include which of the following
instructions?
1. Follow a high potassium diet
2. Strictly follow the hemodialysis schedule
3. There will be a few changes in your lifestyle.
4. Use alcohol on the skin and clean it due to integumentary changes.

3. A client is undergoing peritoneal dialysis. The dialysate dwell time is

completed, and the dwell clamp is opened to allow the dialysate to
drain. The nurse notes that the drainage has stopped and only 500 ml
has drained; the amount the dialysate instilled was 1,500 ml. Which of
the following interventions would be done first?

1. Change the clients position.

2. Call the physician.
3. Check the catheter for kinks or obstruction.
4. Clamp the catheter and instill more dialysate at the next exchange time.

4. A client receiving hemodialysis treatment arrives at the hospital with

a blood pressure of 200/100, a heart rate of 110, and a respiratory rate
of 36. Oxygen saturation on room air is 89%. He complains of shortness
of breath, and +2 pedal edema is noted. His last hemodialysis
treatment was yesterday. Which of the following interventions should
be done first?

1. Administer oxygen
2. Elevate the foot of the bed
3. Restrict the clients fluids
4. Prepare the client for hemodialysis.

5. A client has a history of chronic renal failure and received

hemodialysis treatments three times per week through an
arteriovenous (AV) fistula in the left arm. Which of the following
interventions is included in this clients plan of care?
1. Keep the AV fistula site dry.
2. Keep the AV fistula wrapped in gauze.
3. Take the blood pressure in the left arm
4. Assess the AV fistula for a bruit and thrill

6. Which of the following factors causes the nausea associated with

renal failure?

1. Oliguria
2. Gastric ulcers
3. Electrolyte imbalances
4. Accumulation of waste products

7. Which of the following clients is at greatest risk for developing acute

renal failure?

1. A dialysis client who gets influenza

2. A teenager who has an appendectomy
3. A pregnant woman who has a fractured femur
4. A client with diabetes who has a heart catheterization

8. In a client in renal failure, which assessment finding may

indicate hypocalcemia?

1. Headache
2. Serum calcium level of 5 mEq/L
3. Increased blood coagulation
4. Diarrhea

9. A nurse is assessing the patency of an arteriovenous fistula in the

left arm of a client who is receiving hemodialysis for the treatment
of chronic renal failure. Which finding indicates that the fistula is
patent?
1. Absence of bruit on auscultation of the fistula.
2. Palpation of a thrill over the fistula
3. Presence of a radial pulse in the left wrist
4. Capillary refill time less than 3 seconds in the nail beds of the fingers on the
left hand.

10. The client with chronic renal failure is at risk of developing

dementia related to excessive absorption of aluminum. The nurse
teaches that this is the reason that the client is being prescribed which
of the following phosphate binding agents?

1. Alu-cap (aluminum hydroxide)

2. Tums (calcium carbonate)
3. Amphojel (aluminum hydroxide)
4. Basaljel (aluminum hydroxide)

11. The client newly diagnosed with chronic renal failure recently has
begun hemodialysis. Knowing that the client is at risk for disequilibrium
syndrome, the nurse assesses the client during dialysis for:

1. Hypertension, tachycardia, and fever

2. Hypotension, bradycardia, and hypothermia
3. restlessness, irritability, and generalized weakness
4. Headache, deteriorating level of consciousness, and twitching.

12. A client with chronic renal failure has completed a hemodialysis

treatment. The nurse would use which of the following standard
indicators to evaluate the clients status after dialysis?

1. Potassium level and weight

2. BUN and creatinine levels
3. VS and BUN
4. VS and weight.
13. The hemodialysis client with a left arm fistula is at risk for steal
syndrome. The nurse assesses this client for which of the following
clinical manifestations?

1. Warmth, redness, and pain in the left hand.

2. Pallor, diminished pulse, and pain in the left hand.
3. Edema and reddish discoloration of the left arm
4. Aching pain, pallor, and edema in the left arm.

14. A client is admitted to the hospital and has a diagnosis of early

stage chronic renal failure. Which of the following would the nurse
expect to note on assessment of the client?

1. Polyuria
2. Polydipsia
3. Oliguria
4. Anuria

15. The client with chronic renal failure returns to the nursing unit
following a hemodialysis treatment. On assessment the nurse notes
that the clients temperature is 100.2. Which of the following is the
most appropriate nursing action?

1. Encourage fluids
2. Notify the physician
3. Monitor the site of the shunt for infection
4. Continue to monitor vital signs

16. The nurse is performing an assessment on a client who has

returned from the dialysis unit following hemodialysis. The client is
complaining of a headache and nausea and is extremely restless. Which
of the following is the most appropriate nursing action?
1. Notify the physician
2. Monitor the client
3. Elevate the head of the bed
4. Medicate the client for nausea

17. The nurse is assisting a client on a low-potassium diet to select food

items from the menu. Which of the following food items, if selected by
the client, would indicate an understanding of this dietary restriction?

1. Cantaloupe
2. Spinach
3. Lima beans
4. Strawberries

18. The nurse is reviewing a 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
bases the response knowing that the glucose:

1. Prevents excess glucose from being removed from the client.

2. Decreases risk of peritonitis.
3. Prevents disequilibrium syndrome
4. Increased osmotic pressure to produce ultrafiltration.

19. The nurse is preparing to care for a client receiving peritoneal

dialysis. Which of the following would be included in the nursing plan of
care to prevent the major complication associated with peritoneal
dialysis?

1. Monitor the clients level of consciousness

2. Maintain strict aseptic technique
3. Add heparin to the dialysate solution
4. Change the catheter site dressing daily
20. A client newly diagnosed with renal failure is receiving peritoneal
dialysis. During the infusion of the dialysate the client complains of
abdominal pain. Which action by the nurse is most appropriate?

1. Slow the infusion

2. Decrease the amount to be infused
3. Explain that the pain will subside after the first few exchanges
4. Stop the dialysis

21. The nurse is instructing a client with diabetes mellitus about

peritoneal dialysis. The nurse tells the client that it is important to
maintain the dwell time for the dialysis at the prescribed time because
of the risk of:

1. Infection
2. Hyperglycemia
3. Fluid overload
4. Disequilibrium syndrome

22. The client with acute renal failure has a serum potassium level of
5.8 mEq/L. The nurse would plan which of the following as a priority
action?

1. Allow an extra 500 ml of fluid intake to dilute the electrolyte concentration.

2. Encourage increased vegetables in the diet
3. Place the client on a cardiac monitor
4. Check the sodium level

23. The client with chronic renal failure who is scheduled for
hemodialysis this morning is due to receive a daily dose of enalapril
(Vasotec). The nurse should plan to administer this medication:
1. Just before dialysis
2. During dialysis
3. On return from dialysis
4. The day after dialysis

24. The client with chronic renal failure has an indwelling catheter for
peritoneal dialysis in the abdomen. The client spills water on the
catheter dressing while bathing. The nurse should immediately:

1. Reinforce the dressing

2. Change the dressing
3. Flush the peritoneal dialysis catheter
4. Scrub the catheter with povidone-iodine

25. The client being hemodialyzed suddenly becomes short of breath

and complains of chest pain. The client is tachycardic, pale, and
anxious. The nurse suspects air embolism. The nurse should:

1. Continue the dialysis at a slower rate after checking the lines for air
2. Discontinue dialysis and notify the physician
3. Monitor vital signs every 15 minutes for the next hour
4. Bolus the client with 500 ml of normal saline to break up the air embolism.

26. The nurse has completed client teaching with the hemodialysis
client about self-monitoring between hemodialysis treatments. The
nurse determines that the client best understands the information
given if the client states to record the daily:

1. Pulse and respiratory rate

2. Intake, output, and weight
3. BUN and creatinine levels
4. Activity log
27. The client with an arteriovenous shunt in place for hemodialysis is
at risk for bleeding. The nurse would do which of the following as a
priority action to prevent this complication from occurring?

1. Check the results of the PT time as they are ordered.

2. Observe the site once per shift
3. Check the shunt for the presence of a bruit and thrill
4. Ensure that small clamps are attached to the AV shunt dressing.

28. The nurse is monitoring a client receiving peritoneal dialysis and

nurse notes that a clients outflow is less than the inflow. Select actions
that the nurse should take.

1. Place the client in good body alignment

2. Check the level of the drainage bag
3. Contact the physician
4. Check the peritoneal dialysis system for kinks
5. Reposition the client to his or her side.

29. The nurse assesses the client who has chronic renal failure and
notes the following: crackles in the lung bases, elevated blood
pressure, and weight gain of 2 pounds in one day. Based on these data,
which of the following nursing diagnoses is appropriate?

1. Excess fluid volume related to the kidneys inability to maintain fluid balance.
2. Increased cardiac output related to fluid overload.
3. Ineffective tissue perfusion related to interrupted arterial blood flow.
4. Ineffective Therapeutic Regimen Management related to lack of knowledge
about therapy.

30. The nurse is caring for a hospitalized client who has chronic renal
failure. Which of the following nursing diagnoses are most appropriate
for this client? Select all that apply.
1. Excess Fluid Volume
2. Imbalanced Nutrition; Less than Body Requirements
3. Activity Intolerance
4. Impaired Gas Exchange
5. Pain.

31. What is the primary disadvantage of using peritoneal dialysis for

long-term management of chronic renal failure?

1. The danger of hemorrhage is high.

2. It cannot correct severe imbalances.
3. It is a time consuming method of treatment.
4. The risk of contracting hepatitis is high.

32. The dialysis solution is warmed before use in peritoneal dialysis

primarily to:

1. Encourage the removal of serum urea.

2. Force potassium back into the cells.
3. Add extra warmth into the body.
4. Promote abdominal muscle relaxation.

33. During the clients dialysis, the nurse observes that the solution
draining from the abdomen is consistently blood tinged. The client has
a permanent peritoneal catheter in place. Which interpretation of this
observation would be correct?

1. Bleeding is expected with a permanent peritoneal catheter

2. Bleeding indicates abdominal blood vessel damage
3. Bleeding can indicate kidney damage.
4. Bleeding is caused by too-rapid infusion of the dialysate.
34. Which of the following nursing interventions should be included in
the clients care plan during dialysis therapy?

1. Limit the clients visitors

2. Monitor the clients blood pressure
3. Pad the side rails of the bed
4. Keep the client NPO.

35. Aluminum hydroxide gel (Amphojel) is prescribed for the client with
chronic renal failure to take at home. What is the purpose of giving this
drug to a client with chronic renal failure?

1. To relieve the pain of gastric hyperacidity

2. To prevent Curlings stress ulcers
3. To bind phosphorus in the intestine
4. To reverse metabolic acidosis.

36. The nurse teaches the client with chronic renal failure when to take
the aluminum hydroxide gel. Which of the following statements would
indicate that the client understands the teaching?

1. Ill take it every four (4) hours around the clock.

2. Ill take it between meals and at bedtime.
3. Ill take it when I have a sour stomach.
4. Ill take it with meals and bedtime snacks.

37. The client with chronic renal failure tells the nurse he takes
magnesium hydroxide (milk of magnesia) at home for constipation. The
nurse suggests that the client switch to psyllium hydrophilic mucilloid
(Metamucil) because:

1. MOM can cause magnesium toxicity

2. MOM is too harsh on the bowel
3. Metamucil is more palatable
4. MOM is high in sodium

38. In planning teaching strategies for the client with chronic renal
failure, the nurse must keep in mind the neurologic impact of uremia.
Which teaching strategy would be most appropriate?

1. Providing all needed teaching in one extended session.

2. Validating frequently the clients understanding of the material.
3. Conducting a one-on-one session with the client.
4. Using videotapes to reinforce the material as needed.

39. The nurse helps the client with chronic renal failure develop a home
diet plan with the goal of helping the client maintain adequate
nutritional intake. Which of the following diets would be most
appropriate for a client with chronic renal failure?

1. High carbohydrate, high protein

2. High calcium, high potassium, high protein
3. Low protein, low sodium, low potassium
4. Low protein, high potassium

40. A client with chronic renal failure has asked to be evaluated for a
home continuous ambulatory peritoneal dialysis (CAPD) program. The
nurse should explain that the major advantage of this approach is that
it:

1. Is relatively low in cost

2. Allows the client to be more independent
3. Is faster and more efficient than standard peritoneal dialysis
4. Has fewer potential complications than standard peritoneal dialysis
41. The client asks whether her diet would change on CAPD. Which of
the following would be the nurses best response?

1. Diet restrictions are more rigid with CAPD because standard peritoneal
dialysis is a more effective technique.
2. Diet restrictions are the same for both CAPD and standard peritoneal
dialysis.
3. Diet restrictions with CAPD are fewer than with standard peritoneal dialysis
because dialysis is constant.
4. Diet restrictions with CAPD are fewer than with standard peritoneal dialysis
because CAPD works more quickly.

42. Which of the following is the most significant sign of

peritoneal infection?

1. Cloudy dialysate fluid

2. Swelling in the legs
3. Poor drainage of the dialysate fluid
4. Redness at the catheter insertion site

43. The main indicator of the need for hemodialysis is:

1. Ascites
2. Acidosis
3. Hypertension
4. Hyperkalemia

44. To gain access to the vein and artery, an AV shunt was used for Mr.
Roberto. The most serious problem with regards to the AV shunt is:

1. Septicemia
2. Clot formation
3. Exsanguination
4. Vessel sclerosis

45. When caring for Mr. Robertos AV shunt on his right arm, you
should:

1. Cover the entire cannula with an elastic bandage

2. Notify the physician if a bruit and thrill are present
3. User surgical aseptic technique when giving shunt care
4. Take the blood pressure on the right arm instead

Answers and Rationale

1. Answer: 1. Osmosis and diffusion

Osmosis allows for the removal of fluid from the blood by allowing it to pass
through the semipermeable membrane to an area of high concentrate
(dialysate), and diffusion allows for passage of particles (electrolytes, urea, and
creatinine) from an area of higher concentration to an area of lower
concentration.

Option B: Fluid passes to an area with a higher solute concentration.

Option C: The pores of a semipermeable membrane are small, thus

preventing the flow of blood cells and protein molecules through it.

2. Answer: 2. Strictly follow the hemodialysis schedule

To prevent life-threatening complications, the client must follow the dialysis

schedule.

Option A: The client should follow a low-potassium diet because

potassium levels increase in chronic renal failure.
 Option C: The client should know hemodialysis is time-consuming and
will definitely cause a change in current lifestyle.

Option D: Alcohol would further dry the clients skin more than it
already is.

3. Answer: 3. Check the catheter for kinks or obstruction.

The first intervention should be to check for kinks and obstructions because that
could be preventing drainage. After checking for kinks, have the client change
position to promote drainage. Dont give the next scheduled exchange until the
dialysate is drained because abdominal distention will occur, unless the output is
within parameters set by the physician. If unable to get more output despite
checking for kinks and changing the clients position, the nurse should then call
the physician to determine the proper intervention.

4. Answer: 1. Administer oxygen

Airway and oxygenation are always the first priority. Because the client is
complaining of shortness of breath and his oxygen saturation is only 89%, the
nurse needs to try to increase his levels by administering oxygen.

Option B: The foot of the bed may be elevated to reduce edema, but
this isnt the priority.

Options C and D: The client is in pulmonary edema from fluid overload

and will need to be dialyzed and have his fluids restricted, but the first
interventions should be aimed at the immediate treatment of hypoxia.

5. Answer: 4. Assess the AV fistula for a bruit and thrill

Assessment of the AV fistula for bruit and thrill is important because, if not
present, it indicates a non-functioning fistula.
 Option A: When not being dialyzed, the AV fistula site may get wet.

Option B: Immediately after a dialysis treatment, the access site is

covered with adhesive bandages.

Option C: No blood pressures or venipunctures should be taken in the

arm with the AV fistula.

6. Answer: 4. Accumulation of waste products

Although clients with renal failure can develop stress ulcers, the nausea is
usually related to the poisons of metabolic wastes that accumulate when the
kidneys are unable to eliminate them.

Options A and C: The client has electrolyte imbalances and oliguria, but
these dont directly cause nausea.

7. Answer: 4. A client with diabetes who has a heart catheterization

Clients with diabetes are prone to renal insufficiency and renal failure. The
contrast used for heart catheterization must be eliminated by the kidneys,
which further stresses them and may produce acute renal failure. A dialysis
client already has end-stage renal disease and wouldnt develop acute renal
failure.

Options B and C: A teenager who has an appendectomy and a

pregnant woman with a fractured femur isnt at increased risk for renal
failure.

8. Answer: 4. Diarrhea

In renal failure, calcium absorption from the intestine declines, leading to

increased smooth muscle contractions, causing diarrhea.
 Option A: CNS changes in renal failure rarely include headache.

Option B: A serum calcium level of 5 mEq/L indicates hypercalcemia.

Option C: As renal failure progresses, bleeding tendencies increase.

9. Answer: 2. Palpation of a thrill over the fistula

The nurse assesses the patency of the fistula by palpating for the presence of a
thrill or auscultating for a bruit.

Option A: The presence of a thrill and bruit indicate patency of the

fistula.

Options C and D: Although the presence of a radial pulse in the left

wrist and capillary refill time less than 3 seconds in the nail beds of the
fingers on the left hand are normal findings; they do not assess fistula
patency.

10. Answer: 2. Tums (calcium carbonate)

Phosphate binding agents that contain aluminum include Alu-caps, Basaljel, and
Amphojel. These products are made from aluminum hydroxide. Tums are made
from calcium carbonate and also bind phosphorus. Tums are prescribed to avoid
the occurrence of dementia related to high intake of aluminum. Phosphate
binding agents are needed by the client in renal failure because the kidneys
cannot eliminate phosphorus.

11. Answer: 4. Headache, deteriorating level of consciousness and

twitching.

Disequilibrium syndrome is characterized by headache, mental confusion,

decreasing level of consciousness, nausea, and 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
brain swelling 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.

12. Answer: 4. VS and weight.

Following dialysis, the clients vital signs are monitored to determine whether
the client is remaining hemodynamically stable. Weight is measured and
compared with the clients predialysis weight to determine the effectiveness of
fluid extraction.

Options A, B, and C: Laboratory studies are done as per protocol but

are not necessarily done after the hemodialysis treatment has ended.

13. Answer: 2. Pallor, diminished pulse, and pain in the left hand.

Steal syndrome results from vascular insufficiency after the creation of a fistula.
The client exhibits pallor and a diminished pulse distal to the fistula. The client
also complains of pain distal to the fistula, which is due to tissue ischemia.

Option A: Warmth, redness, and pain more likely would characterize a

problem with infection.

14. Answer: 1. Polyuria

Polyuria occurs early in chronic renal failure and if untreated can cause
severe dehydration. Polyuria progresses to anuria, and the client loses all
normal functions of the kidney.
 Options B, C, and D: Oliguria and anuria are not early signs, and
polydipsia is unrelated to chronic renal failure.

15. Answer: 4. Continue to monitor vital signs

The client may have an elevated temperature following dialysis because the
dialysis machine warms the blood slightly. If the temperature is elevated
excessively and remains elevated, sepsis would be suspected, and a blood
sample would be obtained as prescribed for culture and sensitivity purposes.

16. Answer: 1. Notify the physician

Disequilibrium syndrome may be due to the rapid decrease in BUN levels during
dialysis. These changes can cause cerebral edema that leads to increased
intracranial pressure. The client is exhibiting early signs of disequilibrium
syndrome and appropriate treatments with anticonvulsant medications and
barbiturates may be necessary to prevent a life-threatening situation. The
physician must be notified.

17. Answer: 3. Lima beans

Lima beans (1/3 c) averages three (3) mEq per serving.

Option A: Cantaloupe (1/4 small)

Option B: Spinach (1/2 cooked)

Option D: Strawberries (1 cups) are high potassium foods and

average 7 mEq per serving.

18. Answer: 4. Increases osmotic pressure to produce ultrafiltration.

Increasing the glucose concentration makes the solution increasingly more

hypertonic. The more hypertonic the solution, the greater the osmotic pressure
for ultrafiltration and thus the greater amount of fluid removed from the client
during an exchange.

19. Answer: 2. Maintain strict aseptic technique

The major complication of peritoneal dialysis is peritonitis. Strict aseptic

technique is required in caring for the client receiving this treatment. Although
option D may assist in preventing infection, this option relates to an external
site.

20. Answer: 3. Explain that the pain will subside after the first few
exchanges

Pain during the inflow of dialysate is common during the first few exchanges
because of peritoneal irritation; however, the pain usually disappears after 1 to
2 weeks of treatment. The infusion amount should not be decreased, and the
infusion should not be slowed or stopped.

21. Answer: 2. Hyperglycemia

An extended dwell time increases the risk of hyperglycemia in the client

with diabetes mellitus as a result of absorption of glucose from the dialysate
and electrolyte changes. Diabetic clients may require extra insulin when
receiving peritoneal dialysis.

22. Answer: 3. Place the client on a cardiac monitor

The client with hyperkalemia is at risk for developing cardiac dysrhythmias and
cardiac arrest. Because of this, the client should be placed on a cardiac monitor.

Option A: Fluid intake is not increased because it contributes to fluid

overload and would not affect the serum potassium level significantly.
 Option B: Vegetables are a natural source of potassium in the diet, and
their use would not be increased.

Option D: The nurse may also assess the sodium level because sodium
is another electrolyte commonly measured with the potassium level.
However, this is not a priority action at this time.

23. Answer: 3. On return from dialysis

Antihypertensive medications such as enalapril are given to the client following

hemodialysis. This prevents the client from becoming hypotensive during
dialysis and also from having the medication removed from the bloodstream by
dialysis. No rationale exists for waiting a full day to resume the medication. This
would lead to ineffective control of the blood pressure.

24. Answer: 2. Change the dressing

Clients with peritoneal dialysis catheters are at high risk for infection. A dressing
that is wet is a conduit for bacteria for bacteria to reach the catheter insertion
site. The nurse assures that the dressing is kept dry at all times.

Option A: Reinforcing the dressing is not a safe practice to prevent

infection in this circumstance.

Option C: Flushing the catheter is not indicated.

Option D: Scrubbing the catheter with povidone-iodine is done at the

time of connection or disconnecting of peritoneal dialysis.

25. Answer: 2. Discontinue dialysis and notify the physician

If the client experiences air embolus during hemodialysis, the nurse should
terminate dialysis immediately, notify the physician, and administer oxygen as
needed.
26. Answer: 2. Intake, output, and weight

The client on hemodialysis should monitor fluid status between hemodialysis

treatments by recording intake and output and measuring weight daily. Ideally,
the hemodialysis client should not gain more than 0.5 kg of weight per day.

27. Answer: 4. Ensure that small clamps are attached to the AV shunt
dressing.

An AV shunt is a less common form of access site but carries a risk

of 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 connection occurs, the client could lose blood rapidly.
For this reason, small clamps are attached to the dressing that covers the
insertion site to use if needed.

Option B: The shunt site should be assessed at least every four hours.

28. Answer: 1, 2, 4, 5.

If outflow drainage is inadequate, the nurse attempts to stimulate outflow by

changing the clients position. Turning the client to the other side or making
sure that the client is in good body alignment may assist with outflow drainage.
The drainage bag needs to be lower than the clients abdomen to enhance
gravity drainage. The connecting tubing and the peritoneal dialysis system is
also checked for kinks or twisting and the clamps on the system are checked to
ensure that they are open. There is no reason to contact the physician.

29. Answer: 1. Excess fluid volume related to the kidneys inability to

maintain fluid balance.

Crackles in the lungs, weight gain, and elevated blood pressure are indicators
of excess fluid volume, a common complication in chronic renal failure. The
clients fluid status should be monitored carefully for imbalances on an ongoing
basis.

30. Answer: 1, 2, 3.

Appropriate nursing diagnoses for clients with chronic renal failure

include excess fluid volume related to fluid and sodium retention; imbalanced
nutrition, less than body requirements related to anorexia, nausea, and
vomiting; and activity intolerance related to fatigue.

Options D and E: The nursing diagnoses of impaired gas exchange and

pain are not commonly related to the chronic renal failure.

31. Answer: 3. It is a time-consuming method of treatment.

The disadvantages of peritoneal dialysis in the long-term management of

chronic renal failure is that requires large blocks of time.

Options A and D: The risk of hemorrhage or hepatitis is not high with

PD.

Option B: PD is effective in maintaining a clients fluid and electrolyte

balance.

32. Answer: 1. Encourage the removal of serum urea.

The main reason for warming the peritoneal dialysis solution is that the warm
solution helps dilate peritoneal vessels, which increases urea clearance.

Options B and D: The warmed solution does not force potassium into
the cells or promote abdominal muscle relaxation.
 Option C: Warmed dialyzing solution also contributes to client comfort
by preventing chilly sensations, but this is a secondary reason for
warming the solution.

33. Answer: 2. Bleeding indicates abdominal blood vessel damage

Because the client has a permanent catheter in place, blood tinged drainage
should not occur. Persistent blood tinged drainage could indicate damage to the
abdominal vessels, and the physician should be notified.

Option C: The bleeding is originating in the peritoneal cavity, not the

kidneys.

Option D: Too rapid infusion of the dialysate can cause pain.

34. Answer: 2. Monitor the clients blood pressure

Because hypotension is a complication of peritoneal dialysis, the nurse records

intake, and output, monitors VS, and observes the clients behavior.

Option A: The nurse also encourages visiting and other diversional

activities.

Options C and D: A client on PD does not need to be placed in bed with

padded side rails or kept NPO.

35. Answer: 3. To bind phosphorus in the intestine

A client in renal failure develops hyperphosphatemia that causes a

corresponding excretion of the bodys calcium stores, leading to renal
osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to
bind phosphates in the intestine and facilitate their excretion.
 Option A: Gastric hyperacidity is not necessarily a problem associated
with chronic renal failure.

Options B and D: Antacids will not prevent Curlings stress ulcers and
do not affect metabolic acidosis.

36. Answer: 4. Ill take it with meals and bedtime snacks.

Aluminum hydroxide gel is administered to bind the phosphates in ingested

foods and must be given with or immediately after meals and snacks.

Option A: There is no need for the client to take it on a 24-hour

schedule.

Options B and C: It is not administered to treat hyperacidity in clients

with CRF and therefore is not prescribed between meals.

37. Answer: 1. MOM can cause magnesium toxicity

Magnesium is normally excreted by the kidneys. When the kidneys fail,

magnesium can accumulate and cause severe neurologic problems.

Option B: MOM is harsher than Metamucil, but magnesium toxicity is a

more serious problem.

Option C: A client may find both MOM and Metamucil unpalatable.

Option D: MOM is not high in sodium.

38. Answer: 2. Validating frequently the clients understanding of the

material.

Uremia can cause decreased alertness, so the nurse needs to validate the
clients comprehension frequently.
 Option A: Because the clients ability to concentrate is limited, short
lesions are most effective.

Option C: If family members are present at the sessions, they can

reinforce the material.

Option D: Written materials that the client can review are superior to
videotapes, because the clients may not be able to maintain alertness
during the viewing of the videotape.

39. Answer: 3. Low protein, low sodium, low potassium

Dietary management for clients with chronic renal failure is usually designed to
restrict protein, sodium, and potassium intake. Protein intake is reduced
because the kidney can no longer excrete the byproducts of protein metabolism.
Reducing sodium in the diet helps to control high blood pressure. It also keeps
one from being thirsty and prevents the body from holding onto extra fluid. Too
much potassium can build up when the kidneys no longer function well. It can
cause an irregular heartbeat or a heart attack.

40. Answer: 2. Allows the client to be more independent

The major benefit of CAPD is that it frees the client from daily dependence on
dialysis centers, home health care personnel, and machines for life-sustaining
treatment. The independence is a valuable outcome for some people.

Option A: CAPD is costly and must be done daily.

Option D: Side effects and complications are similar to those of

standard peritoneal dialysis.

41. Answer: 3. Diet restrictions with CAPD are fewer than with
standard peritoneal dialysis because dialysis is constant.
Dietary restrictions with CAPD are fewer than those with standard peritoneal
dialysis because dialysis is constant, not intermittent. The constant slow
diffusion of CAPD helps prevent accumulation of toxins and allows for a more
liberal diet. CAPD does not work more quickly, but more consistently. Both types
of peritoneal dialysis are effective.

42. Answer: 1. Cloudy dialysate fluid

Cloudy drainage indicates bacterial activity in the peritoneum. Other signs and
symptoms of infection are fever, hyperactive bowel sounds, and abdominal
pain.

Option B: Swollen legs may be indicative of congestive heart failure.

Option C: Poor drainage of dialysate fluid is probably the result of a

kinked catheter.

Option D: Redness at the insertion site indicates local infection,

not peritonitis. However, a local infection that is left untreated can
progress to the peritoneum.

43. Answer: 4. Hyperkalemia

44. Answer: 3. Exsanguination

45. Answer: 3. User surgical aseptic technique when giving shunt care

1. The nurse is aware that the following findings would be further

evidence of a urethral injury in a male client during rectal examination?

A. A low-riding prostate
B. The presence of a boggy mass
C. Absent sphincter tone
D. A positive Hemoccult
2. When a female client with an indwelling urinary (Foley) catheter
insists on walking to the hospital lobby to visit with family members,
nurse Rose teaches how to do this without compromising the catheter.
Which client action indicates an accurate understanding of this
information?

A. The client sets the drainage bag on the floor while sitting down.
B. The client keeps the drainage bag below the bladder at all times.
C. The client clamps the catheter drainage tubing while visiting with the family.
D. The client loops the drainage tubing below its point of entry into the drainage
bag.

3. A female client has just been diagnosed with condylomata acuminata

(genital warts). What information is appropriate to tell this client?

A. This condition puts her at a higher risk for cervical cancer; therefore, she
should have a Papanicolaou (Pap) smear annually.
B. The most common treatment is metronidazole (Flagyl), which should
eradicate the problem within 7 to 10 days.
C. The potential for transmission to her sexual partner will be eliminated if
condoms are used every time they have sexual intercourse.
D. The human papillomavirus (HPV), which causes condylomata acuminata,
cant be transmitted during oral sex.

4. A male client with bladder cancer has had the bladder removed and
an ileal conduit created for urine diversion. While changing this clients
pouch, the nurse observes that the area around the stoma is red,
weeping, and painful. What should Nurse Kaye conclude?

A. The skin wasnt lubricated before the pouch was applied.

B. The pouch faceplate doesnt fit the stoma.
C. A skin barrier was applied properly.
D. Stoma dilation wasnt performed.
5. The nurse is aware that the following laboratory values supports a
diagnosis of pyelonephritis?

A. Myoglobinuria
B. Ketonuria
C. Pyuria
D. Low white blood cell (WBC) count

6. A female client with chronic renal failure (CRF) is receiving a

hemodialysis treatment. After hemodialysis, nurse Sarah knows that
the client is most likely to experience:

A. Hematuria.
B. Weight loss.
C. Increased urine output.
D. Increased blood pressure.

7. Nurse Lily is assessing a male client diagnosed with gonorrhea.

Which symptom most likely prompted the client to seek medical
attention?

A. Rashes on the palms of the hands and soles of the feet

B. Cauliflower-like warts on the penis
C. Painful red papules on the shaft of the penis
D. Foul-smelling discharge from the penis

8. Nurse Pete is reviewing the report of a clients routine urinalysis.

Which value should the nurse consider abnormal?

A. Specific gravity of 1.03

B. Urine pH of 3.0
C. Absence of protein
D. Absence of glucose
9. A male client is scheduled for a renal clearance test. Nurse Sheldon
should explain that this test is done to assess the kidneys ability to
remove a substance from the plasma in:

A. 1 minute.
B. 30 minutes.
C. 1 hour.
D. 24 hours.

10. A male 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:

A. Keep the clients knee on the affected side bent for 6 hours.
B. Apply pressure to the puncture site for 30 minutes.
C. Check the clients pedal pulses frequently.
D. Remove the dressing on the puncture site after vital signs stabilize.

11. A female client is admitted for treatment of chronic renal

failure (CRF). Nurse Julian knows that this disorder increases the
clients risk of:

A. Water and sodium retention secondary to a severe decrease in the

glomerular filtration rate.
B. A decreased serum phosphate level secondary to kidney failure.
C. An increased serum calcium level secondary to kidney failure.
D. Metabolic alkalosis secondary to retention of hydrogen ions.

12. Because of difficulties with hemodialysis, peritoneal dialysis is

initiated to treat a female clients uremia. Which finding signals a
significant problem during this procedure?
A. Potassium level of 3.5 mEq/L
B. Hematocrit (HCT) of 35%
C. Blood glucose level of 200 mg/dl
D. White blood cell (WBC) count of 20,000/mm3

13. For a male client in the oliguric phase of acute renal failure (ARF),
which nursing intervention is most important?

A. Encouraging coughing and deep breathing

B. Promoting carbohydrate intake
C. Limiting fluid intake
D. Providing pain-relief measures

14. A female client requires hemodialysis. Which of the following drugs

should be withheld before this procedure?

A. Phosphate binders
B. Insulin
C. Antibiotics
D. Cardiac glycosides

15. A client comes to the outpatient department complaining of vaginal

discharge, dysuria, and genital irritation. Suspecting a sexually
transmitted disease (STD), Dr. Smith orders diagnostic tests of the
vaginal discharge. Which STD must be reported to the public health
department?

A. Chlamydia
B. Gonorrhea
C. Genital herpes
D. Human papillomavirus infection
16. A male client with acute pyelonephritis receives a prescription for
co-trimoxazole (Septra) P.O. twice daily for 10 days. Which finding best
demonstrates that the client has followed the prescribed regimen?

A. Urine output increases to 2,000 ml/day.

B. Flank and abdominal discomfort decrease.
C. Bacteria are absent on urine culture.
D. The red blood cell (RBC) count is normal.

17. A 26-year-old female client seeks care for a possible infection. Her
symptoms include burning on urination and frequent, urgent voiding of
small amounts of urine. Shes placed on trimethoprim-sulfamethoxazole
(Bactrim) to treat possible infection. Another medication is prescribed
to decrease the pain and frequency. Which of the following is the most
likely medication prescribed?

A. Nitrofurantoin (Macrodantin)
B. Ibuprofen (Motrin)
C. Acetaminophen with codeine
D. Phenazopyridine (Pyridium)

18. A triple-lumen indwelling urinary catheter is inserted for continuous

bladder irrigation following a transurethral resection of the prostate. In
addition to balloon inflation, the nurse is aware that the functions of
the three lumens include:

A. Continuous inflow and outflow of irrigation solution.

B. Intermittent inflow and continuous outflow of irrigation solution.
C. Continuous inflow and intermittent outflow of irrigation solution.
D. Intermittent flow of irrigation solution and prevention of hemorrhage.

19. Nurse Pippy is reviewing a clients fluid intake and output record.
Fluid intake and urine output should relate in which way?
A. Fluid intake should be double the urine output.
B. Fluid intake should be approximately equal to the urine output.
C. Fluid intake should be half the urine output.
D. Fluid intake should be inversely proportional to the urine output.

20. After trying to conceive for a year, a couple consults

an infertility specialist. When obtaining a history from the husband,
Nurse Jessica inquires about childhood infectious diseases. Which
childhood infectious disease most significantly affects male fertility?

A. Chickenpox
B. Measles
C. Mumps
D. Scarlet fever

21. A male 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 diagnosed 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?

A. Kidney
B. Ureter
C. Bladder
D. Urethra

22. A female client with acute renal failure is undergoing dialysis for
the first time. The nurse in charge monitors the client closely for
dialysis equilibrium syndrome, a complication that is most common
during the first few dialysis sessions. Typically, dialysis equilibrium
syndrome causes:
A. Confusion, headache, and seizures.
B. Acute bone pain and confusion.
C. Weakness, tingling, and cardiac arrhythmias.
D. Hypotension, tachycardia, and tachypnea.

23. Dr. Grey prescribes norfloxacin (Noroxin), 400 mg P.O. 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:

A. 3 to 5 days.
B. 7 to 10 days.
C. 12 to 14 days.
D. 10 to 21 days.

24. Nurse Harry 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 ultrahigh-frequency sound waves to shatter renal calculi.
The nurse should instruct the client to:

A. limit oral fluid intake for 1 to 2 weeks.

B. report the presence of fine, sand-like particles through the nephrostomy
tube.
C. notify the physician about cloudy or foul-smelling urine.
D. report bright pink urine within 24 hours after the procedure.

25. A client is frustrated and embarrassed by urinary incontinence.

Which of the following measures should Nurse Ginny include in a
bladder retraining program?

A. Establishing a predetermined fluid intake pattern for the client

B. Encouraging the client to increase the time between voidings
C. Restricting fluid intake to reduce the need to void
D. Assessing present elimination patterns

26. After having transurethral resection of the prostate (TURP), a Mr.

Lim returns to the unit with a three-way indwelling urinary catheter
and continuous closed bladder irrigation. Which finding suggests that
the clients catheter is occluded?

A. The urine in the drainage bag appears red to pink.

B. The client reports bladder spasms and the urge to void.
C. The normal saline irrigant is infusing at a rate of 50 drops/minute.
D. About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have
been returned.

27. Nurse Mary 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:

A. Initiate a stream of urine.

B. Breathe deeply.
C. Turn to the side.
D. Hold the labia or shaft of penis.

28. A female adult client admitted with a gunshot wound to the

abdomen is transferred to the intensive care unit after an exploratory
laparotomy. Which assessment finding suggests that the client is
experiencing acute renal failure (ARF)?

A. Blood urea nitrogen (BUN) level of 22 mg/dl

B. Serum creatinine level of 1.2 mg/dl
C. Temperature of 100.2 F (37.8 C)
D. Urine output of 400 ml/24 hours
29. A 55-year old client with benign prostatic hyperplasia doesnt
respond to medical treatment and is admitted to the facility for prostate
gland removal. Before providing preoperative and postoperative
instructions to the client, Nurse Gerry asks the surgeon which
prostatectomy procedure will be done. What is the most widely used
procedure for prostate gland removal?

A. Transurethral resection of the prostate (TURP)

B. Suprapubic prostatectomy
C. Retropubic prostatectomy
D. Transurethral laser incision of the prostate

30. A female client with suspected renal dysfunction is scheduled for

excretory urography. Nurse January reviews the history for conditions
that may warrant changes in client preparation. Normally, a client
should be mildly hypovolemic (fluid depleted) before excretory
urography. Which history finding would call for the client to be well
hydrated instead?

A. Cystic fibrosis
B. Multiple myeloma
C. Gout
D. Myasthenia gravis

31. Nurse Karen is caring for a client who had a cerebrovascular

accident (CVA). Which nursing intervention promotes urinary
continence?

A. Encouraging intake of at least 2 L of fluid daily

B. Giving the client a glass of soda before bedtime
C. Taking the client to the bathroom twice per day
D. Consulting with a dietitian
32. When examining a female clients genitourinary system, Nurse
Sandy assesses for tenderness at the costovertebral angle by placing
the left hand over this area and striking it with the right fist. Normally,
this percussion technique produces which sound?

A. A flat sound
B. A dull sound
C. Hyperresonance
D. Tympany

33. A male client with chronic renal failure has a serum potassium level
of 6.8 mEq/L. What should nurse Olivia assess first?

A. Blood pressure
B. Respirations
C. Temperature
D. Pulse

34. Nurse Harry is aware that the following is an appropriate nursing

diagnosis for a client with renal calculi?

A. Ineffective tissue perfusion

B. Functional urinary incontinence
C. Risk for infection
D. Decreased cardiac output

35. A male client develops acute renal failure (ARF) after receiving I.V.
therapy with a nephrotoxic antibiotic. Because the clients 24-hour
urine output totals 240 ml, Nurse Billy suspects that the client is at risk
for:

A. Cardiac arrhythmia.
B. Paresthesia.
C. Dehydration.
D. Pruritus.

36. After undergoing transurethral resection of the prostate to

treat benign prostatic hyperplasia, a male client returns to the room
with continuous bladder irrigation. On the first day after surgery, the
client reports bladder pain. What should Nurse Anthony do first?

A. Increase the I.V. flow rate.

B. Notify the physician immediately.
C. Assess the irrigation catheter for patency and drainage.
D. Administer meperidine (Demerol), 50 mg I.M., as prescribed.

37. When performing a scrotal examination, Nurse Payne finds a

nodule. What should the nurse do next?

A. Notify the physician.

B. Change the clients position and repeat the examination.
C. Perform a rectal examination.
D. Transilluminate the scrotum.

38. A male client who has been treated for chronic renal failure (CRF) is
ready for discharge. Nurse Billy should reinforce which dietary
instruction?

A. Be sure to eat meat at every meal.

B. Monitor your fruit intake, and eat plenty of bananas.
C. Increase your carbohydrate intake.
D. Drink plenty of fluids, and use a salt substitute.

39. Nurse Gil is aware that the following statements describing urinary
incontinence in the elderly is true?
A. Urinary incontinence is a normal part of aging.
B. Urinary incontinence isnt a disease.
C. Urinary incontinence in the elderly cant be treated.
D. Urinary Incontinence is a disease.

40. The client underwent a transurethral resection of the prostate gland

24 hours ago and is on continuous bladder irrigation. Nurse Yonny is
aware that the following nursing interventions is appropriate?

A. Tell the client to try to urinate around the catheter to remove blood clots.
B. Restrict fluids to prevent the clients bladder from becoming distended.
C. Prepare to remove the catheter.
D. Use aseptic technique when irrigating the catheter.

41. A female client with a urinary tract infection is prescribed co-

trimoxazole (trimethoprim-sulfamethoxazole). Nurse Dolly should
provide which medication instruction?

A. Take the medication with food.

B. Drink at least eight 8-oz glasses of fluid daily.
C. Avoid taking antacids during co-trimoxazole therapy.
D. Dont be afraid to go out in the sun.

42. A male client is admitted for treatment of glomerulonephritis. On

initial assessment, Nurse Miley detects one of the classic signs of acute
glomerulonephritis of sudden onset. Such signs include:

A. Generalized edema, especially of the face and periorbital area.

B. Green-tinged urine.
C. Moderate to severe hypotension.
D. Polyuria.
43. A client reports experiencing vulvar pruritus. Which assessment
factor may indicate that the client has an infection caused by Candida
albicans?

A. Cottage cheeselike discharge

B. Yellow-green discharge
C. Gray-white discharge
D. Discharge with a fishy odor

44. A 24-year old female client has just been diagnosed with
condylomata acuminata (genital warts). What information is
appropriate to tell this client?

A. This condition puts her at a higher risk for cervical cancer; therefore, she
should have a Papanicolaou (Pap) smear annually.
B. The most common treatment is metronidazole (Flagyl), which should
eradicate the problem within 7 to 10 days.
C. The potential for transmission to her sexual partner will be eliminated if
condoms are used every time they have sexual intercourse.
D. The human papillomavirus (HPV), which causes condylomata acuminata,
cant be transmitted during oral sex.

45. Nurse Vic 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)?

A. Maintaining a closed indwelling urinary catheter system and securing the

catheter to the leg
B. Limiting fluid intake to 1 L/day
C. Encouraging the client to use a feminine deodorant after bathing
D. Encouraging the client to douche once a day after removal of the indwelling
urinary catheter
46. Nurse Eve is caring for a client who had a cerebrovascular
accident (CVA). Which nursing intervention promotes urinary
continence?

A. Encouraging intake of at least 2 L of fluid daily

B. Giving the client a glass of soda before bedtime
C. Taking the client to the bathroom twice per day
D. Consulting with a dietitian

47. A female client with an indwelling urinary catheter is suspected of

having a urinary tract infection. Nurse Angel should collect a urine
specimen for culture and sensitivity by:

A. Disconnecting the tubing from the urinary catheter and letting the urine flow
into a sterile container.
B. Wiping the self-sealing aspiration port with antiseptic solution and aspirating
urine with a sterile needle.
C. Draining urine from the drainage bag into a sterile container.
D. Clamping the tubing for 60 minutes and inserting a sterile needle into the
tubing above the clamp to aspirate urine.

48. Nurse Grace is assessing a male client diagnosed with gonorrheA.

Which symptom most likely prompted the client to seek medical
attention?

A. Rashes on the palms of the hands and soles of the feet

B. Cauliflower-like warts on the penis
C. Painful red papules on the shaft of the penis
D. Foul-smelling discharge from the penis

49. Nurse Erica 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:

A. Retain the enema for 30 minutes to allow for sodium exchange; afterward,
the client should have diarrhea.
B. Retain the enema for 30 minutes to allow for glucose exchange; afterward,
the client should have diarrhea.
C. Retain the enema for 60 minutes to allow for sodium exchange; diarrhea isnt
necessary to reduce the potassium level.
D. Retain the enema for 60 minutes to allow for glucose exchange; diarrhea
isnt necessary to reduce the potassium level.

50. When caring for a male client with acute renal failure (ARF), Nurse
Fatrishia expects to adjust the dosage or dosing schedule of certain
drugs. Which of the following drugs would not require such
adjustment?

A. Acetaminophen (Tylenol)
B. Gentamicin sulfate (Garamycin)
C. Cyclosporine (Sandimmune)
D. Ticarcillin disodium (Ticar)

Answers and Rationale

1. Answer: B. The presence of a boggy mass

When the urethra is ruptured, a hematoma or collection of blood separates the

two sections of the urethra. This may feel like a boggy mass on rectal
examination.
 Option A: Because of the rupture and hematoma, the prostate
becomes high riding. A palpable prostate gland usually indicates a non-
urethral injury.

Option C: Absent sphincter tone would refer to a spinal cord injury.

Option D: The presence of blood would probably correlate with

GI bleeding or a colon injury.

2. Answer: B. 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; this allows the urine to flow by gravity from the bladder to the
drainage bag. Option A: The client shouldnt lay the drainage bag on the floor
because it could become grossly contaminated. Option C: The client shouldnt
clamp the catheter drainage tubing because this impedes the flow of urine.
Option D: To promote drainage, the client may loop the drainage tubing above
not below its point of entry into the drainage bag.

Option A: The client shouldnt lay the drainage bag on the floor
because it could become grossly contaminated.

Option C: The client shouldnt clamp the catheter drainage tubing

because this impedes the flow of urine

. Option D: To promote drainage, the client may loop the drainage

tubing above not below its point of entry into the drainage bag.

3. Answer: A. This condition puts her at a higher risk for cervical

cancer; therefore, she should have a Papanicolaou (Pap) smear
annually.
Women with condylomata acuminata are at risk for cancer of the cervix and
vulva. Yearly Pap smears are very important for early detection.

Option B: Because condylomata acuminata is a virus, there is no

permanent cure. Option C: Because condylomata acuminata can occur
on the vulva, a condom wont protect sexual partners. Option D: HPV
can be transmitted to other parts of the body, such as the mouth,
oropharynx, and larynx.

Option C: Because condylomata acuminata can occur on the vulva, a

condom wont protect sexual partners.

Option D: HPV can be transmitted to other parts of the body, such as

the mouth, oropharynx, and larynx.

4. Answer: B. The pouch faceplate doesnt fit the stoma.

If the pouch faceplate doesnt fit the stoma properly, the skin around the stoma
will be exposed to continuous urine flow from the stoma, causing excoriation
and red, weeping, and painful skin.

Option A: A lubricant shouldnt be used because it would prevent the

pouch from adhering to the skin.

Option C: When properly applied, a skin barrier prevents skin

excoriation.

Option D: Stoma dilation isnt performed with an ileal conduit, although

it may be done with a colostomy if ordered.

5. Answer: C. Pyuria

Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria,

and bacteriuria.
 Option B: Ketonuria indicates a diabetic state.

Option D: The client exhibits fever, chills, and flank pain. Because
there is often a septic picture, the WBC count is more likely to be high
rather than low.

6. Answer: B. Weight loss.

Because CRF causes loss of renal function, the client with this disorder retains
fluid. Hemodialysis removes this fluid, causing weight loss.

Option A: Hematuria is unlikely to follow hemodialysis because the

client with CRF usually forms little or no urine.

Option C: Hemodialysis doesnt increase urine output because it

doesnt correct the loss of kidney function, which severely decreases
urine production in this disorder.

Option D: By removing fluids, hemodialysis decreases rather than

increases the blood pressure.

7. Answer: D. Foul-smelling discharge from the penis

Symptoms of gonorrhea in men include purulent, foul-smelling drainage from

the penis and painful urination.

Option A: Rashes on the palms of the hands and soles of the feet are
symptoms of the secondary stage of syphilis.

Option B: Cauliflower-like warts on the penis are a sign of human

papillomavirus.

Option C: Painful red papules on the shaft of the penis may be a sign of
the first stage of genital herpes.
8. Answer: B. Urine pH of 3.0

Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal. Urine

specific gravity normally ranges from 1.002 to 1.035, making this clients value
normal. Normally, urine contains no protein, glucose, ketones, bilirubin,
bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-
power field; white blood cells, 0 to 4 per high-power field. Urine should be clear,
its color ranging from pale yellow to deep amber.

9. Answer: A. 1 minute.

The renal clearance test determines the kidneys ability to remove a substance
from the plasma in 1 minute. It doesnt measure the kidneys ability to remove
a substance over a longer period.

10. Answer: C. Check the clients pedal pulses frequently.

After renal angiography involving a femoral puncture site, the nurse should
check the clients 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.

Option A: The client should be kept on bed rest for several hours so the
puncture site can seal completely. Keeping the clients knee bent is
unnecessary.

Option B: 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.

Option D: The nurse shouldnt remove this dressing for several hours
and only if instructed to do so.
11. Answer: A. Water and sodium retention secondary to a severe
decrease in the glomerular filtration rate.

A client with CRF is at risk for fluid imbalance dehydration if the kidneys fail
to concentrate urine, or fluid retention if the kidneys fail to produce urine.
Electrolyte imbalances associated with this disorder result from the kidneys
inability to excrete phosphorus; such imbalances may lead to
hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic
acidosis, not metabolic alkalosis, secondary to the inability of the kidneys to
excrete hydrogen ions.

Options B and C: Electrolyte imbalances associated with this disorder

result from the kidneys inability to excrete phosphorus; such
imbalances may lead to hyperphosphatemia with
reciprocal hypocalcemia.

Option D: CRF may cause metabolic acidosis, not metabolic alkalosis,

secondary to the inability of the kidneys to excrete hydrogen ions.

12. Answer: D. White blood cell (WBC) count of 20,000/mm3

An increased WBC count indicates infection, probably resulting from peritonitis,

which may have been caused by insertion of the peritoneal catheter into the
peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its
ability to filter solutes; therefore, peritoneal dialysis would no longer be a
treatment option for this client.

Option A: A potassium level of 3.5 mEq/L can be treated by adding

potassium to the dialysate solution.

Option B: An HCT of 35% is lower than normal. However, in this client,

the value isnt abnormally low because of the daily blood samplings. A
lower HCT is common in clients with chronic renal failure because of
the lack of erythropoietin.
 Option D: Hyperglycemia occurs during peritoneal dialysis because of
the high glucose content of the dialysate; its readily treatable with
sliding-scale insulin.

13. Answer: C. Limiting fluid intake

During the oliguric phase of ARF, urine output decreases markedly, possibly
leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid
overload and its complications, such as heart failure and pulmonary edema.

Option A: Encouraging coughing and deep breathing is important for

clients with various respiratory disorders.

Option B: Promoting carbohydrate intake may be helpful in ARF but

doesnt take precedence over fluid limitation.

Option D: Controlling pain isnt important because ARF rarely causes

pain.

14. Answer: D. Cardiac glycosides

Cardiac glycosides such as digoxin should be withheld before

hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during
dialysis, and a hypokalemic client is at risk for arrhythmias secondary
to digitalis toxicity.

Option A: Phosphate binders and insulin can be administered because

they arent removed from the blood by dialysis.

Option C: Some antibiotics are removed by dialysis and should be

administered after the procedure to ensure their therapeutic effects.
The nurse should check a formulary to determine whether a particular
antibiotic should be administered before or after dialysis.
15. Answer: B. Gonorrhea

Gonorrhea must be reported to the public health department.

Options A, C, and D: Chlamydia, genital herpes, and human

papillomavirus infection arent reportable diseases.

16. Answer: C. Bacteria are absent on urine culture.

Co-trimoxazole is a sulfonamide antibiotic used to treat urinary tract infections.

Therefore, the absence of bacteria on urine culture indicates that the drug has
achieved its desired effect.

Options A and D: Co-trimoxazole doesnt affect urine output or the RBC

count.

Option B: Although flank pain may decrease as the infection resolves,

this isnt a reliable indicator of the drugs effectiveness.

17. Answer: D. Phenazopyridine (Pyridium)

Phenazopyridine may be prescribed in conjunction with an antibiotic for painful

bladder infections to promote comfort. Because of its local anesthetic action on
the urinary mucosa, phenazopyridine specifically relieves bladder pain.

Option A: Nitrofurantoin is a urinary antiseptic with no analgesic

properties.

Options B and C: While ibuprofen and acetaminophen with codeine are

analgesics, they dont exert a direct effect on the urinary mucosa.

18. Answer: A. Continuous inflow and outflow of irrigation solution.

When preparing for continuous bladder irrigation, a triple-lumen indwelling
urinary catheter is inserted. The three lumens provide for balloon inflation and
continuous inflow and outflow of irrigation solution.

19. Answer: B. Fluid intake should be approximately equal to the urine

output.

Normally, fluid intake is approximately equal to the urine output. Any other
relationship signals an abnormality. For example, fluid intake that is double the
urine output indicates fluid retention; fluid intake that is half the urine output
indicates dehydration. Normally, fluid intake isnt inversely proportional to the
urine output.

20. Answer: C. Mumps

Mumps is the most significant childhood infectious disease affecting male

fertility. Chickenpox, measles, and scarlet fever dont affect male fertility.

21. Answer: A. Kidney

The most common site of renal calculi formation is the kidney. Calculi may
travel down the urinary tract with or without causing damage and may lodge
anywhere along the tract or may stay within the kidney.

Options B, C, and D: The ureter, bladder, and urethra are less common
sites of renal calculi formation.

22. Answer: A. Confusion, headache, and seizures.

Dialysis equilibrium syndrome causes confusion, a decreasing level of

consciousness, headache, and seizures. These findings, which may last several
days, probably result from a relative excess of interstitial or intracellular solutes
caused by rapid solute removal from the blood. The resultant organ swelling
interferes with normal physiologic functions. To prevent this syndrome, many
dialysis centers keep first-time sessions short and use a reduced blood flow
rate.

Option B: Acute bone pain and confusion are associated with aluminum
intoxication, another potential complication of dialysis.

Option C: Weakness, tingling, and cardiac arrhythmias

suggest hyperkalemia, which is associated with renal failure.

Option D: Hypotension, tachycardia, and tachypnea signal hemorrhage,

another dialysis complication.

23. Answer: B. 7 to 10 days.

For an uncomplicated UTI, norfloxacin therapy usually lasts 7 to 10 days. Taking

the drug for less than 7 days wouldnt eradicate such an infection. Taking it for
more than 10 days isnt necessary.

Option D: Only a client with a complicated UTI must take norfloxacin

for 10 to 21 days.

24. Answer: C. Notify the physician about cloudy or foul-smelling urine.

The client should report the presence of foul-smelling or cloudy urine.

Option A: Unless contraindicated, the client should be instructed to

drink large quantities of fluid each day to flush the kidneys.

Option B: Sand-like debris is normal due to residual stone products.

Option D: Hematuria is common after lithotripsy.

25. Answer: D. Assessing present elimination patterns

The guidelines for initiating bladder retraining include assessing the clients
intake patterns, voiding patterns, and reasons for each accidental voiding.

Option A: Lowering the clients fluid intake wont reduce or prevent

incontinence.

Option B: A voiding schedule should be established after assessment.

Option C: The client should actually be encouraged to drink 1.5 to 2 L

of water per day.

26. Answer: B. The client reports bladder spasms and the urge to void.

Reports of bladder spasms and the urge to void suggest that a blood clot may
be occluding the catheter.

Option A: After TURP, urine normally appears red to pink.

Option C: The normal saline irrigant usually is infused at a rate of 40 to

60 drops/minute or according to facility protocol.

Option D: The amount of retained fluid (1,200 ml) should correspond

to the amount of instilled fluid, plus the clients urine output (1,000 ml
+ 200 ml), which reflects catheter patency.

27. Answer: B. Breathe deeply.

When inserting a urinary catheter, facilitate insertion by asking the client to

breathe deeply. Doing this will relax the urinary sphincter.

Option A: Initiating a stream of urine isnt recommended during

catheter insertion.

Options C and D: Turning to the side or holding the labia or penis wont
ease insertion, and doing so may contaminate the sterile field.
28. Answer: D. Urine output of 400 ml/24 hours

ARF, characterized by abrupt loss of kidney function, commonly causes oliguria,

which is demonstrated by a urine output of 400 ml/24 hours.

Options A and C: BUN level of 22 mg/dl or a temperature of 100.2 F

(37.8 C) wouldnt result from this disorder.

Option B: A serum creatinine level of 1.2 mg/dl isnt diagnostic of ARF.

29. Answer: A. Transurethral resection of the prostate (TURP)

TURP is the most widely used procedure for prostate gland removal. Because it
requires no incision, TURP is especially suitable for men with relatively minor
prostatic enlargements and for those who are poor surgical risks.

Options B, C, and D: Suprapubic prostatectomy, retropubic

prostatectomy, and transurethral laser incision of the prostate are less
common procedures; they all require an incision.

30. Answer: B. Multiple myeloma

Fluid depletion before excretory urography is contraindicated in clients with

multiple myeloma, severe diabetes mellitus, and uric acid nephropathy
conditions that can seriously compromise renal function in fluid-depleted clients
with reduced renal perfusion. If these clients must undergo excretory
urography, they should be well hydrated before the test.

Options A, C, and D: Cystic fibrosis, gout, and myasthenia gravis dont

necessitate changes in client preparation for excretory urography.

31. Answer: A. Encouraging intake of at least 2 L of fluid daily

By encouraging a daily fluid intake of at least 2 L, the nurse helps fill the clients
bladder, thereby promoting bladder retraining by stimulating the urge to void.

Option B: The nurse shouldnt give the client soda before bedtime;
soda acts as a diuretic and may make the client incontinent.

Option C: The nurse should take the client to the bathroom or offer the
bedpan at least every 2 hours throughout the day; twice per day is
insufficient.

Option D: Consultation with a dietitian wont address the problem of

urinary incontinence.

32. Answer: B. A dull sound

Percussion over the costovertebral angle normally produces a dull, thudding

sound, which is soft to moderately loud with a moderate pitch and duration.
This sound occurs over less dense, mostly fluid-filled matter, such as the
kidneys, liver, and spleen.

Option A: In contrast, a flat sound occurs over highly dense matter

such as muscle.

Option C: Hyperresonance occurs over the air-filled, overinflated lungs

of a client with pulmonary emphysema or the lungs of a child (because
of a thin chest wall).

Option D: Tympany occurs over enclosed structures containing air, such

as the stomach and bowel.

33. Answer: D. Pulse

An elevated serum potassium level may lead to a life-threatening cardiac

arrhythmia, which the nurse can detect immediately by palpating the pulse.
 Option A: The clients blood pressure may change, but only as a result
of the arrhythmia. Therefore, the nurse should assess blood
pressure later.

Options B and C: The nurse also can delay assessing respirations and
temperature because these arent affected by the serum potassium
level.

34. Answer: C. Risk for infection

Infection can occur with renal calculi from urine stasis caused by obstruction.

Options A and D arent appropriate for this diagnosis.

Option B: Retention of urine usually occurs, rather than incontinence.

35. Answer: A. Cardiac arrhythmia.

As urine output decreases, the serum potassium level rises; if it rises

sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia.

Option B: Hyperkalemia doesnt cause paresthesia (sensations of

numbness and tingling).

Option C: Dehydration doesnt occur during this oliguric phase of ARF,

although typically it does arise during the diuretic phase.

Option D: In a client with ARF, pruritus results from increased

phosphates and isnt associated with hyperkalemia.

36. Answer: C. Assess the irrigation catheter for patency and drainage.

Although postoperative pain is expected, the nurse should make sure that other
factors, such as an obstructed irrigation catheter, arent the cause of the pain.
 Option A: Increasing the I.V. flow rate may worsen the pain.

Option B: Notifying the physician isnt necessary unless the pain is

severe or unrelieved by the prescribed medication.

Option D: After assessing catheter patency, the nurse should

administer an analgesic, such as meperidine, as prescribed.

37. Answer: D. Transilluminate the scrotum.

A nurse who discovers a nodule, swelling, or other abnormal finding during a

scrotal examination should transilluminate the scrotum by darkening the room
and shining a flashlight through the scrotum behind the mass. A scrotum filled
with serous fluid transilluminates as a red glow; a more solid lesion, such as a
hematoma or mass, doesnt transilluminate and may appear as a dark shadow.

Option A: Although the nurse should notify the physician of the

abnormal finding, performing transillumination first provides additional
information.

Options B and C: The nurse cant uncover more information about a

scrotal mass by changing the clients position and repeating the
examination or by performing a rectal examination.

38. Answer: C. Increase your carbohydrate intake.

In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid
may lead to a dangerous accumulation of electrolytes and protein metabolic
products, such as amino acids and ammonia. Therefore, the client must limit
intake of sodium; meat, which is high in protein; bananas, which are high in
potassium; and fluid, because the failing kidneys cant secrete adequate urine.
 Option D: Salt substitutes are high in potassium and should be
avoided. Extra carbohydrates are needed to prevent protein
catabolism.

39. Answer: B. Urinary incontinence isnt a disease.

Urinary incontinence isnt a normal part of aging nor is it a disease. It may be

caused by confusion, dehydration, fecal impaction, restricted mobility, or other
causes. Certain medications, including diuretics, hypnotics, sedatives,
anticholinergics, and antihypertensives, may trigger urinary incontinence. Most
clients with urinary incontinence can be treated; some can be cured.

40. Answer: D. Use aseptic technique when irrigating the catheter.

If the catheter is blocked by blood clots, it may be irrigated according to

physicians orders or facility protocol. The nurse should use sterile technique to
reduce the risk of infection.

Option A: Urinating around the catheter can cause painful bladder

spasms.

Option B: Encourage the client to drink fluids to dilute the urine and
maintain urine output.

Option C: The catheter remains in place for 2 to 4 days after surgery

and is only removed with a physicians order.

41. Answer: B. Drink at least eight 8-oz glasses of fluid daily.

When receiving a sulfonamide such as co-trimoxazole, the client should drink at

least eight 8-oz glasses of fluid daily to maintain a urine output of at least 1,500
ml/day. Otherwise, inadequate urine output may lead to crystalluria or tubular
deposits.
 Option A: For maximum absorption, the client should take this drug at
least 1 hour before or 2 hours after meals.

Option C: No evidence indicates that antacids interfere with the effects

of sulfonamides.

Option D: To prevent a photosensitivity reaction, the client should

avoid direct sunlight during co-trimoxazole therapy.

42. Answer: A. Generalized edema, especially of the face and periorbital

area.

Generalized edema, especially of the face and periorbital area, is a classic sign
of acute glomerulonephritis of sudden onset. Other classic signs and symptoms
of this disorder include hematuria (not green-tinged urine), proteinuria, fever,
chills, weakness, pallor, anorexia, nausea, and vomiting. The client also may
have moderate to severe hypertension (not hypotension), oliguria or anuria (not
polyuria), headache, reduced visual acuity, and abdominal or flank pain.

43. Answer: A. Cottage cheeselike discharge

The symptoms of C. albicans include itching and a scant white discharge that
has the consistency of cottage cheese.

Option B: Yellow-green discharge is a sign of Trichomonas vaginalis.

Options C and D: Gray-white discharge and a fishy odor are signs of

Gardnerella vaginalis.

44. Answer: A. This condition puts her at a higher risk for cervical
cancer; therefore, she should have a Papanicolaou (Pap) smear
annually.
Women with condylomata acuminata are at risk for cancer of the cervix and
vulva. Yearly Pap smears are very important for early detection. Option B:
Because condylomata

Option B: Because condylomata acuminata is a virus, there is no

permanent cure.

Option C: Because condylomata acuminata can occur on the vulva, a

condom wont protect sexual partners.

Option D: HPV can be transmitted to other parts of the body, such as

the mouth, oropharynx, and larynx.

45. Answer: A. Maintaining a closed indwelling urinary catheter system

and securing the catheter to the leg

Maintaining a closed indwelling urinary catheter system helps prevent

introduction of bacteria; securing the catheter to the clients leg also decreases
the risk of infection by helping to prevent urethral trauma.

Option B: To flush bacteria from the urinary tract, the nurse should
encourage the client to drink at least 10 glasses of fluid daily, if
possible.

Options C and D: Douching and feminine deodorants may irritate the

urinary tract and should be discouraged.

46. Answer: A. Encouraging intake of at least 2 L of fluid daily

By encouraging a daily fluid intake of at least 2 L, the nurse helps fill the clients
bladder, thereby promoting bladder retraining by stimulating the urge to void.

Option B: The nurse shouldnt give the client soda before bedtime;
soda acts as a diuretic and may make the client incontinent.
 Option C: The nurse should take the client to the bathroom or offer the
bedpan at least every 2 hours throughout the day; twice per day is
insufficient.

Option D: Consultation with a dietitian wont address the problem of

urinary incontinence.

47. Answer: B. wiping the self-sealing aspiration port with antiseptic

solution and aspirating urine with a sterile needle.

Most catheters have a self-sealing port for obtaining a urine specimen.

Antiseptic solution is used to reduce the risk of introducing microorganisms into
the catheter. Option A: Tubing shouldnt be disconnected from the urinary
catheter. Any break in the closed urine drainage system may allow the entry of
microorganisms. Option C: Urine in urine drainage bags may not be fresh and
may contain bacteria, giving false test results. Option D: When there is no urine
in the tubing, the catheter may be clamped for no more than 30 minutes to
allow urine to collect.

48. Answer: D. Foul-smelling discharge from the penis

Symptoms of gonorrhea in men include purulent, foul-smelling drainage from

the penis and painful urination.

Option A: Rashes on the palms of the hands and soles of the feet are
symptoms of the secondary stage of syphilis.

Option B: Cauliflower-like warts on the penis are a sign of human

papillomavirus.

Option C: Painful red papules on the shaft of the penis may be a sign of
the first stage of genital herpes.
49. Answer: A. retain the enema for 30 minutes to allow for sodium
exchange; afterward, the client should have diarrhea.

Kayexalate is a sodium exchange resin. Thus the client will gain sodium as
potassium is lost in the bowel. For the exchange to occur, Kayexalate must be in
contact with the bowel for at least 30 minutes. Sorbitol in the Kayexalate enema
causes diarrhea, which increases potassium loss and decreases the potential for
Kayexalate retention.

50. Answer: A. acetaminophen (Tylenol)

Because acetaminophen is metabolized in the liver, its dosage and dosing

schedule need not be adjusted for a client with ARF.

Options B and D: In contrast, the dosages and schedules for

gentamicin and ticarcillin, which are metabolized and excreted by the
kidney, should be adjusted.

Option C: Because cyclosporine may cause nephrotoxicity, the nurse

must monitor both the dosage and blood drug level in a client receiving
this drug.