NCLEX RN Practice Questions assess not only factual knowledge but also the application of critical thinking skills in clinical scenarios.
NCLEX Renal and Urinary System Questions - NCLEX Questions on Renal and Urinary System
Renal and Urinary System NCLEX Questions Test Strategies
NGN Case Study
Mr. Ranjan is a 58-year-old male who was admitted to the hospital with complaints of weakness, fatigue, and shortness of breath. He has a medical history of hypertension, diabetes mellitus type 2, and hyperlipidemia. He was also previously diagnosed with chronic kidney disease stage 3. Mr. Ranjan has been compliant with his medications, including lisinopril, metformin, and atorvastatin.
Vital Signs: Upon admission, Mr. Ranjan's vital signs were stable, with a blood pressure of 130/80 mrnHg, heart rate of 80 beats per minute, respiratory rate of 18 breaths per minute, and temperature of 98.6°F (37°C).
Lab Values:
- Upon admission, Mr. Ranjan's laboratory values were as follows:
- Blood urea nitrogen (BUN) level: 45 rng/dL (16.2 mmol/L)
- Serum creatinine level: 3.5 mg/dL (309 pmol/L)
- BUN/creatinine ratio: 12.8
- Serum sodium level: 138 mEq/L
- Serum potassium level: 6.2 mEq/L
- Urine specific gravity: 1.010
Physician's Order:
- Mr. Ranjan's physician ordered the following interventions:
- Initiate fluid challenges with IV boluses of 500 to 1000 mL over 1 hour to increase renal blood flow.
- Restrict fluid intake to 400 to 1000 mL plus the measured urinary output if hypertension is present.
- Administer diuretics as prescribed to increase renal blood flow and diuresis of retained fluid and electrolytes.
- Monitor Mr. Ranjan's electrolyte levels closely and administer electrolyte replacements as necessary.
- Perform daily labs to monitor Mr. Ranjan's kidney function and adjust interventions as necessary.
Question 1.
Fill in the blank with the most appropriate option:
Mr. Ranjan's laboratory values indicate that he has been diagnosed with due to prerenal factors such as decreased renal blood flow caused by dehydration or decreased cardiac output.
(a) chronic kidney disease
(b) acute liver injury
(c) acute kidney injury
(d) acute pancreatitis
Answer:
(c) acute kidney injury
Explanation:
Based on Mr. Ranjan's laboratory values, he has been diagnosed with acute kidney injury (AKI) due to prerenal factors such as decreased renal blood flow caused by dehydration or decreased cardiac output. His elevated BUN and serum creatinine levels, decreased glomerular filtration rate (GFR). and hyperkalemia indicate impaired kidney function. Therefore, option (c) is the correct answer.
Option (a) is incorrect because chronic kidney disease is a chronic condition characterized by impaired kidney function over time, whereas AKI is a sudden onset of impaired kidney function. Option (b) is incorrect because Mr. Ranjan's liver function is not mentioned in the case study. Option (d) is incorrect because there is no mention of pancreatitis in the case study.
Question 2.
Select all that applies to the diagnosis and treatment plan of Mr. Ranjan's acute kidney injury:
(a) Mr. Ranjan's laboratory values indicate prerenal AKI.
(b) Mr. Ranjan's chronic kidney disease stage 3 may have contributed to his AKI.
(c) Mr. Ranjan's medication history may have contributed to his AKI.
(d) Mr. Ranjan's vital signs are indicative of a hyperdynamic state.
(e) Mr. Ranjan's physician ordered fluid challenges to increase renal blood flow.
(f) Mr. Ranjan's urine output in the oliguric phase of AKI was less than 500 mL/day.
(g) Mr. Ranjan's electrolyte levels were not monitored closely during his hospital stay.
Answer:
(a) Mr. Ranjan's laboratory values indicate prerenal AKI.
Explanation:
(a) Correct. Mr. Ranjan's laboratory values and medical history suggest prerenal AKI, which is caused by decreased renal blood flow due to dehydration or decreased cardiac output. (b) Correct. Mr. Ranjan's chronic kidney disease may have contributed to his AKI, as patients with pre-existing kidney disease are more susceptible to AKI. (c) Correct. Mr. Ranjan's medication history may have contributed to his AKI, as some medications can cause kidney damage. (d) Incorrect.
Mr. Ranjan's vital signs were stable upon admission and do not suggest a hyperdynamic state. (e) Correct. Mr. Ranjan's physician ordered fluid challenges to increase renal blood flow and promote diuresis. (f) Incorrect. Mr. Ranjan's urine output in the oliguric phase of AKI was less than 400 mL/day, not 500 mL/day. (g) Incorrect. Mr. Ranjan's electrolyte levels were closely monitored, and electrolyte replacements were administered as necessary.
Question 3.
Which of the following lab values is most likely elevated in Mr. Ranjan due to his acute kidney injury?
(a) Serum sodium level: 138 mEq/L
(b) Serum potassium level: 6.2 mEq/L
(c) Blood urea nitrogen (BUN) level: 25 mg/dL (8.9 mmol/L)
(d) Serum creatinine level: 1.0 mg/dL (88.4 pmol/L)
Answer:
(b) Serum potassium level: 6.2 mEq/L
Explanation:
Mr. Ranjan's acute kidney injury (AKI) is marked by the oliguric phase, in which his urine output is less than 400 mL/day, and he exhibits signs of excess fluid volume and uremia. His laboratory values show elevated BUN and serum creatinine levels, decreased glomerular filtration rate (GFR), and hyperkalemia, indicating impaired kidney function.
Elevated serum potassium level is a common finding in AKI and can cause life-threatening dysrhythmias if not corrected. Option (a). serum sodium level, is within the normal range and not affected by AKI. Option (c). BUN level, is elevated in AKI, but the given value (25 mg/dL) is not consistent with Mr. Ranjan’s value (45 mg/dL). Option (d), serum creatinine level, is elevated in AKI, but the given value (1.0 mg/dL) is within the normal range and not consistent with Mr. Ranjan's value (3.5 mg/dL).
Question 4.
Which of the following interventions was NOT ordered by Mr. Ranjan's physician upon admission to the hospital?
(a) Initiate fluid challenges with IV boluses of 500 to 1000 mL over 1 hour to increase renal blood flow.
(b) Administer diuretics as prescribed to increase renal blood flow and diuresis of retained fluid and electrolytes.
(c) Restrict fluid intake to 400 to 1000 mL plus the measured urinary output if hypertension is present.
(d) Increase Mr. Ranjan's sodium intake to correct hyponatremia.
Answer:
(d) Increase Mr. Ranjan's sodium intake to correct hyponatremia.
Explanation:
Mr. Ranjan's physician ordered fluid challenges with IV boluses, diuretics, and fluid restriction to manage his acute kidney injury and its associated symptoms. Close monitoring of his electrolyte levels was also ordered, and electrolyte replacements were to be administered as necessary. However, there is no mention of increasing Mr. Ranjan's sodium intake to correct hyponatremia in the physician's orders or the lab values provided.
Question 5.
What is the most likely cause of Mr. Ranjan's acute kidney injury (AKI)?
(a) Prerenal factors such as decreased renal blood flow due to dehydration or decreased cardiac output.
(b) Intrinsic factors such as direct damage to the kidney, such as from toxins or ischemia.
(c) Postrenal factors such as obstruction of the urinary tract.
(d) Autoimmune disorders such as lupus or vasculitis.
Answer:
(a) Prerenal factors such as decreased renal blood flow due to dehydration or decreased cardiac output.
Explanation:
Based on Mr. Ranjan's laboratory values and medical history, the most likely cause of his AKI is prerenal factors such as decreased renal blood flow due to dehydration or decreased cardiac output. This is because his laboratory values show elevated BUN and serum creatinine levels, indicating impaired kidney function, and he has a history of chronic conditions such as hypertension and diabetes mellitus type 2, which can decrease renal blood flow.
Option (b) is incorrect because Mr. Ranjan's laboratory values do not suggest direct damage to the kidney. Option (c) is unlikely because there is no indication of urinary tract obstruction in Mr. Ranjan's case. Option (d) is also unlikely because there is no indication of autoimmune disorders in Mr. Ranjan's medical history or laboratory values.
Renal and Urinary System NCLEX Practice Questions
Match the following lab values with their normal range:
Question 1.
Blood urea nitrogen (BUN) level B. Serum creatinine level C. Serum sodium level D. Serum potassium level
(a) 136-145 mEq/L
(b) 0.7-1.3 mg/dL (62-115 pmol/L)
(c) 3.5-5.0 mEq/L
(d) 8-25 mg/dL (2.9-9.0 mmol/L)
Answer:
(d) 8-25 mg/dL (2.9-9.0 mmol/L)
(b) 0.7-1.3 mg/dL (62-115 pmol/L)
(a) 136-145 mEq/L
(d) 3.5-5.0 mEq/L
Explanation:
Blood urea nitrogen (BUN) level indicates the amount of nitrogen in the blood that comes from urea, a waste product of protein metabolism. The normal range for BUN is 8-25 mg/dL (2.9¬9.0 mmol/L). Serum creatinine level indicates the amount of creatinine in the blood, which is a waste product produced by muscles. The normal range for serum creatinine level is 0.7-1.3 mg/dL (62-115 pmol/L). Serum sodium level measures the concentration of sodium ions in the blood.
The normal range for serum sodium level is 136-145 mEq/L. Serum potassium level measures the concentration of potassium ions in the blood. The normal range for serum potassium level is 3.5-5.0 mEq/L.
Incorrect matches:
Option (a) The normal range of serum sodium level is 136-145 mEq/L, not for BUN level.
Option (b) The normal range of serum creatinine level is 0.7-1.3 mg/dL (62-115 pmol/L), not for serum potassium level.
Option (d) The normal range of serum potassium level is 3.5-5.0 mEq/L, not for BUN level.
Question 2.
Mr. Alvin, a 65-year-old male with a history of chronic kidney disease and hypertension, presents to the emergency department with complaints of weakness and palpitations. His lab results reveal a serum potassium level of 6.9 niEq/L (normal range is 3.5-5.0 mEq/L) and an electrocardiogram (ECG) shows tall peaked T-waves, prolonged QRS interval, and widened QRS complexes.
Mr. Alvin is diagnosed with hyperkalemia.
What is the appropriate treatment for hyperkalemia in Mr. Alvin?
(a) Administer spironolactone to excrete potassium
(b) Provide a high-potassium diet to replace lost potassium
(c) Administer 50% dextrose and regular insulin IV to shift potassium into the cells
(d) Administer calcium gluconate IV to increase potassium levels
Answer:
(c) Administer 50% dextrose and regular insulin IV to shift potassium into the cells
Explanation:
Hyperkalemia is a medical emergency that requires prompt intervention to prevent life-threatening dysrhythmias. The appropriate treatment for hyperkalemia in Mr. Alvin would be to administer 50% dextrose and regular insulin IV to shift potassium into the cells. Insulin stimulates the uptake of potassium into the cells, while dextrose prevents hypoglycemia from the insulin administration.
Calcium gluconate IV may also be prescribed to reduce myocardial irritability from hyperkalemia. Loop diuretics can also be given to excrete potassium. Spironolactone and triamterene should be avoided, as they are potassium-sparing diuretics that will increase the potassium level. Providing a high-potassium diet is contraindicated in hyperkalemia.
Question 3.
Mr. Ranjan is a 65-year-old man who presents with urinary symptoms such as difficulty starting urination, weak urine stream, urgency, feeling unable to completely empty the bladder, and nocturia. He also experiences occasional constipation. His medical history includes hypertension and high cholesterol. A digital rectal exam reveals an enlarged prostate gland. After a prostate-specific
antigen (PSA) blood test is performed and ruled out prostate cancer, he is diagnosed with BPH.
Which of the following statements regarding benign prostatic hyperplasia (BPH) is/'are correct?
(a) BPH is a condition that only affects young men
(b) Symptoms of BPH include hematuria and polyuria
(c) BPH can lead to serious complications if left untreated
(d) The most commonly prescribed medications for BPH are antibiotics
(e) Lifestyle changes such as reducing caffeine and alcohol intake can help alleviate symptoms of BPH
(f) Surgery is the first line of treatment for BPH
(g) BPH is a life-threatening condition
Answer:
(c) BPH can lead to serious complications if left untreated
(e) Lifestyle changes such as reducing caffeine and alcohol intake can help alleviate symptoms of BPH
Explanation:
(a) Incorrect. BPH is a condition that typically affects older men, not young men.
(b) Incorrect. Hematuria and polyuria are not typical symptoms of BPH.
(c) Correct. If left untreated, BPH can lead to serious complications such as acute urinary retention, urinary tract infections, bladder stones, and kidney damage.
(d) Incorrect. Antibiotics are not typically prescribed for BPH. Alpha-blockers and 5-alpha reductase inhibitors are the most commonly prescribed medications for BPH.
(e) Correct. Lifestyle changes such as reducing caffeine and alcohol intake, maintaining a healthy weight, and practicing pelvic floor exercises may help alleviate symptoms of BPH.
(f) Incorrect. Surgery is not always the first line of treatment for BPH. Depending on the severity of symptoms and the size of the prostate gland, medication or minimally invasive procedures may be recommended first.
(g) Incorrect. While BPH can lead to serious complications if left untreated, it is not typically a life-threatening condition.
Question 4.
A patient who fell from a cliff has been ordered a urinary catheter insertion by the healthcare provider in the emergency department. However, the nurse preparing for the procedure observes blood at the urinary meatus.
Question 4 What should the nurse do next?
(a) Use a small-sized catheter.
(b) Notify the healthcare provider before performing the procedure.
(c) Use parenteral analgesic before the procedure.
(d) Clean the meatus with soap and water before inserting the catheter.
(e) Proceed with the catheterization regardless of the bleeding.
(f) Apply pressure to the meatus to stop the bleeding.
(g) Administer antibiotics to prevent infection.
Answer:
(b) Notify the healthcare provider before performing the procedure.
(d) Clean the meatus with soap and water before inserting the catheter.
Explanation:
Blood at the urinary meatus is a sign of urethral trauma or disruption. It is important for the nurse to notify the healthcare provider before performing the procedure to rule out the cause of bleeding. Diagnostic testing may be required to assess the extent of injury. Cleaning the meatus with soap and water before inserting the catheter helps prevent infection.
Using a smaller sized catheter (Option a) may aggravate the injury and cause more bleeding. Parenteral analgesic (Option c ) may not be necessary if the procedure is delayed. Proceeding with the catheterization regardless of the bleeding (Option e) can cause more damage and increase the risk of infection. Applying pressure to the meatus (Option f) may temporarily stop the bleeding, but it does not address the underlying issue. Administering antibiotics (Option g) is not necessary at this point since there is no confirmed infection.
Question 5.
Nurse Mary is caring for a client with acute renal failure. Client is now undergoing hemodialysis through an arteriovenous (AV) fistula in the right arm. Which of the following actions should the nurse avoid in the care plan for a patient with acute renal failure
undergoing hemodialysis through an arteriovenous (AV) fistula in the right arm?
Select all that apply:
(a) Drawing blood from the access arm
(b) Vigorous exercise of the access arm
(c) Applying a tight tourniquet to the access arm
(d) Assessing the AV fistula for a thrill and bruit
(e) Placing the client in the Trendelenburg position during dialysis
(f) Using scissors to remove tape or dressings from the access site
(g) Administering anticoagulants before or during dialysis
Answer:
(a) Drawing blood from the access arm
(b) Vigorous exercise of the access arm
Explanation:
(a) Drawing blood from the access ami can damage the AV fistula and interfere with hemodialysis. Blood pressure should also not be taken on the access arm.
(b) Vigorous exercise of the access ann can cause trauma to the fistula, leading to clots or infection. However, moderate exercise can be helpful in strengthening the AV fistula.
(c) Applying a tight tourniquet to the access arm can damage the fistula and impede blood flow. A loose tourniquet may be used to help identify the access site for needle insertion.
(d) Assessing the AV fistula for a thrill and bruit is an important nursing intervention to assess patency and detect any complications. The presence of a thrill or bruit indicates adequate blood flow through the fistula.
(e) Placing the client in the Trendelenburg position during dialysis is not recommended as it may increase the risk of complications such as hypotension.
(f) Using scissors to remove tape or dressings from the access site can cause trauma to the fistula and should be avoided. The tape or dressing should be gently removed by hand.
(g) Administering anticoagulants before or during dialysis may be necessary to prevent blood clots, but this is not an action to be avoided. The use of anticoagulants should be based on the patient's individual needs and risk factors.
Question 6.
A nurse is assigned to a patient who is receiving peritoneal dialysis. During the procedure, the nurse observes that the return fluid is slowly draining. To resolve this issue, the nurse should check for and change the of the patient.
(a) Check for fibrin strings and plugs; position
(b) Check for air in the tubing; medication
(c) Check for skin irritation; catheter
(d) Check for blood in the drainage bag; diet
Answer:
(a) Check for fibrin strings and plugs; position
Explanation:
Slowing of flow rate and presence of fibrin suggests partial catheter occlusion requiring further evaluation and intervention. Checking the tubing for kinks and ensuring that all clamps are open can also help resolve the issue. Additionally, changing the position of the patient can facilitate the drainage of the fluid. The other options listed are not relevant to addressing the issue of slow draining during peritoneal dialysis.
Question 7.
The nurse is assessing patients on the medical unit. The nurse identifies which of the following patients at highest risk of developing bacterial cystitis?
(a) 35-year-old female who is nulliparous
(b) 45-year-old male taking cyclophosphamide
(c) 60-year-old female who has declined hormone replacement therapy
(d) 75-year-old male admitted with mild congestive heart failure
Answer:
(c) 60-year-old female who has declined hormone replacement therapy
Explanation:
Bacterial cystitis is inflammation of the bladder as a result of bacterial infection. It most commonly occurs in women and sometimes children. Post-menopausal women who are not taking estrogen replacement are at highest risk for bacterial cystitis due to urethral and vaginal changes of cells.
Recent urinary catheterization is another risk factor for cystitis. Symptoms include burning on urination, cloudy urine, and a strong odor to the urine. Treatment includes antibiotics, urinary tract analgesics (phenazopyridine), and saw palmetto herbal supplement. Cranberry juice or other urine acidifiers may be beneficial as well.
Rationale:
(a) is incorrect because the nulliparous female is not as at risk as the older woman not taking hormones.
(b) is incorrect because men are not susceptible to bacterial cystitis due to the longer urethra. Cyclophosphamide is an alkylating antineoplastic agent used to treat leukemia and multiple myeloma. Adverse effects include bone marrow suppression, ototoxicity, and renal toxicity, but not cystitis.
(d) is incorrect because men are not as susceptible as women due to the longer urethra, and CHF is not a risk factor for cystitis.
Question 8.
The nurse is reviewing lab results of a patient who has a urinary tract infection. The nurse notes a shift to the left in the white blood cell count. Which of the following actions should be taken by the nurse?
(a) Call the lab for differential analysis of white blood cells
(b) Notify the healthcare provider for parenteral antibiotics
(c) Instruct the unlicensed assistive personnel (UAP) to strain the patient’s urine for calculi
(d) Assess for allergic reaction or anaphylactic shock
Answer:
(b) Notify the healthcare provider for parenteral antibiotics
Rationale:
(a) shift to the left in white blood cells indicates an increase in the number of bands and is suggestive of urosepsis. This is not seen in urinary tract infection with no complications. The nurse needs to notify the healthcare provider and prepare for administration of IV antibiotics. (a) is incorrect because a shift to the left is determined by reading the differential analysis of white blood cells. This is a blood test that has already been completed, so it does not need to be repeated.
(c) is incorrect because shift to the left does not indicate kidney stones, so straining the urine for calculi is not necessary. Symptoms of kidney stones include flank pain radiating to the shoulder, diaphoresis, nausea, vomiting, hematuria, and WBCs and bacteria in urine.
(d) is incorrect because shift to left indicates infection, not allergic reaction. Increased eosinophil count would cause the nurse to be concerned about allergy or anaphylaxis. Signs of anaphylaxis include hypotension, dyspnea, decreased oxygenation, and flushing.
Question 9.
A 68-year-old female is in the family clinic after a second episode of bacterial urethritis in six months. When the patient asks the nurse why this is happening now, as she never had urinary tract infections before, what is the best response by the nurse?
(a) “The immune system doesn’t weaken with age, so we will need to look into this further.”
(b) “Decreased estrogen levels increase tissue susceptibility to infection.”
(c) “You must be more diligent about personal hygiene in that area.”
(d) “You may have a sexually transmitted disease that has been left untreated.”
Answer:
(b) “Decreased estrogen levels increase tissue susceptibility to infection.”
Rationale:
Bacterial urethritis is inflammation of the urethra due to bacterial infection. Decreased estrogen levels decrease normal levels of moist secretions in the perineal area. This, along with tissue changes, predispose the area to infections. Postmenopausal women commonly develop urethritis due to these changes.
(a) is incorrect because the immune system does weaken with age. However, the more likely cause for this patient’s infection is decreased estrogen levels.
(c) is incorrect because personal hygiene does not often contribute to bacterial urethritis risk.
(d) is incorrect because sexually transmitted disease may cause urethritis, however due to this patient’s age, the infection is most likely due to decreased estrogen levels.
Question 10.
The nurse in the clinic is caring for a patient who has been experiencing overflow incontinence. In order to assist the patient with elimination, which intervention does the nurse include?
(a) Medial aspect of the thigh is stroked
(b) Intermittent catheterization
(c) Digital anal stimulation
(d) Valsalva maneuver
Answer:
(d) Valsalva maneuver
Explanation:
Overflow incontinence is due to involuntary urine release from the bladder when it is overfull, yet the patient lacks the urge to urinate. This leads to urine leaking during the day and bed-wetting at night. The voiding reflex arc is absent, causing incontinence. Valsalva maneuver, or bearing down, and holding the breath (similar to while defecating), provides mechanical pressure that can assist in initiating voiding of urine.
Rationale:
(a) is incorrect because stroking the thigh will not stimulate urination when the reflex arc is not intact.
(b) is incorrect because intermittent catheterization increases the risk of infection and is only implemented when all other interventions are unsuccessful. The nurse should attempt non- invasive interventions first.
(c) is incorrect because digital anal stimulation will not work to elicit urine output when the reflex arc is not intact.
Question 11.
The nurse on the medical unit is caring for a patient admitted for pneumonia who has an indwelling urinary catheter. The day after admission, the nurse should ask the healthcare provider which of the following questions during interdisciplinary rounds?
(a) “Would you like daily weights?”
(b) “Is the patient able to be discharged home?”
(c) “Can the indwelling urinary catheter be discontinued?”
(d) “Would you like a chest X-ray today?”
Answer:
(c) “Can the indwelling urinary catheter be discontinued?”
Explanation:
Urinary tract infections (UTIs) are the most common type of healthcare-associated infection, and 80% of these are caused by indwelling urinary catheters, which can also lead to urosepsis. These catheters should only be left in as long as medically necessary, yet many catheters are often used or continued without valid medical indication.
The nurse should advocate for the patient by consulting with the healthcare provider daily regarding continuing medical need for catheterization and possible discontinuation of the catheter. After catheter removal, the nurse must assess the patient for voiding every two hours for six to eight hours. If the patient is unable to void after six to eight hours or complains of discomfort or voids more than 250 mL over two to four hours, the nurse should consider assessing bladder volume with bladder ultrasound.
Rationale:
(a) is incorrect because daily weights are appropriate but not priority in this patient and not related to the catheter.
(b) is incorrect because discharge home is appropriate to ask about but not priority in this patient and not related to the catheter.
(d) is incorrect because a chest X-ray is appropriate but not priority in this patient and not related to the catheter.
Question 12.
The nurse is teaching a patient regarding renal calculi. Which patient statement demonstrates correct understanding?
(a) “I need to increase my fluid intake to 2 liters per day.”
(b) “All dairy and calcium sources should be eliminated from my diet.”
(c) “Aspirin and products that contain aspirin can lead to stones.”
(d) “I will notify the healthcare provider for antibiotics when I experience signs of a stone.”
Answer:
(a) “I need to increase my fluid intake to 2 liters per day.”
Explanation:
Renal calculi, or kidney stones, are deposits of minerals that form in the kidneys, usually due to dehydration. Renal calculi lead to obstruction and urinary stasis. The patient needs adequate fluid intake in order to prevent dehydration and likelihood of stone formation. It is important not to over-hydrate (increases pain) or under-hydrate (increases length of time to pass stone). Other causes of renal calculi may include hypercalcemia, immobility, and gout.
Rationale:
(b) is incorrect because although hypercalcemia may cause kidney stones, all calcium does not need to be eliminated from the diet. Adequate calcium is required for skeletal structure support, adequate nerve impulse transmission, muscle contraction, absorption, blood clotting, and enzyme activation. The patient should also be taught about limiting intake of oxalates, which can lead to stone formation (oxalates are found in swiss chard, peanuts, wheat germ, cola, tea, chocolate, and spinach.)
(c) is incorrect because aspirin and products that contain aspirin do not lead to stone formation. Aspirin can increase risk for bleeding and should not be administered to patients younger than age 21. Medications that can lead to stone formation include: topiramate (anticonvulsant), anti-gout medications, and calcium supplements. Hyperparathyroidism also can lead to stones.
(d) is incorrect because antibiotics do not treat or prevent stone formation. Analgesics will be encouraged or provided when a patient is experiencing kidney stones, and antibiotics will only be necessary if the stone leads to signs of infection (fever, foul-smelling urine, pus in urine.)
Question 13.
A patient on the medical-surgical floor has just had extracorporeal shock wave lithotripsy to treat renal calculi. When assessing the patient, the nurse notes ecchymosis to the right side of the lower back. Which of the following actions should be taken by the nurse?
(a) Prepare to administer fresh frozen plasma
(b) Apply ice to the site
(c) Have the patient lie in prone position
(d) Draw labs for serum coagulation levels
Answer:
(b) Apply ice to the site
Explanation:
Extracorporeal shock wave lithotripsy is the use of high energy sound waves through the skin to break down kidney stones into smaller pieces that are able to pass through the ureters to be eliminated through the urethra. The shock waves may cause bleeding in the tissues it passes through, so ecchymosis is a common finding that does not require high level intervention. Applying ice to the site can reduce blood flow to the area, decreasing bruising and discomfort.
Rationale:
(a) is incorrect because fresh frozen plasma (FFP) is not indicated for lithotripsy or bruising. FFP is used for reversal of anticoagulant effects.
(c) is incorrect because prone position will not have an effect on bruising.
(d) is incorrect because serum coagulation tests are not indicated. The patient has not been given any medications that affect coagulation, and lithotripsy does not affect coagulation either. The bruising is an expected finding and should be monitored.
Question 14.
The nurse on the medical unit is caring for four patients. Which patient does the nurse identify as being at greatest risk for bladder cancer?
(a) 27-year-old female who has had venereal diseases
(b) 45-year-old male who has spent 10 years working in a lumber yard
(c) 50-year-old female who has frequent bacterial cystitis
(d) 84-year-old male who has a 40-pack year history of smoking
Answer:
(d) 84-year-old male who has a 40-pack year history of smoking
Explanation:
Bladder cancer is most frequently found in older adults (age over 55), and if found early, treatment is often successful. However, bladder cancer can often recur, so patients must follow up with their health care provider routinely. Modifiable risk factors for bladder cancer include smoking, not drinking enough fluids, and arsenic in drinking water (uncommon in the U.S.).
Non-modifiable risk factors include history of chronic infections of the urinary tract, race (Caucasian people are twice as likely to get bladder cancer than other races), age, and gender (men are more likely to get bladder cancer than women).
Rationale:
(a) is incorrect because venereal diseases do not increase risk of bladder cancer. Patients who have had prior chemotherapy or radiation or who have family members who have had bladder cancer are at greater risk.
(b) is incorrect because working in a lumber yard does not increase risk of bladder cancer. Certain occupations (painters, machinists, printers, hairdressers, and truck drivers) are at higher risk for cancer, due to exposure to toxins.
(c) is incorrect because frequent bacterial cystitis is one risk factor, but patient D has three risk factors (age, gender, smoking).
Question 15.
The nurse in the surgical unit is caring for a patient who had a complete cystectomy and ileal conduit placement. For which of the following assessment findings would the nurse identify as a need to contact the healthcare provider immediately?
(a) Ileostomy drains blood-tinged urine
(b) Presence of sero-sanguineous drainage on surgical dressing, mucous surrounding stoma
(c) Pale and bluish color noted on stoma assessment
(d) Oxygen saturation 93%
Answer:
(c) Pale and bluish color noted on stoma assessment
Explanation:
Complete cystectomy is removal of the bladder. Ileal conduit placement involves removal of a small portion of the small intestine to be used to facilitate drainage of urine from the ureters through a small opening in the abdomen, called a stoma. The stoma empties urine into an external urostomy bag. The stoma should always be soft, moist, and pink-to-red in color.
The stoma should not be painful to touch, as it has no nerve endings. Pale and cyanotic tissue, including an ileostomy stoma, is an indication of impaired circulation. The healthcare provider needs to be notified to intervene and prevent tissue necrosis.
Rationale:
(a) is incorrect because blood-tinged urine is an expected finding after complete cystectomy and ileal conduit placement.
(b) is incorrect because sero-sanguineous drainage and a small amount of mucous are expected findings after complete cystectomy and ileal conduit placement. Bright red drainage would be an indication of hemorrhage, and foul-smelling drainage would be indication of infection; both of these findings would be reason to call the healthcare provider.
(d) is incorrect because the oxygen saturation level is slightly low (normal is 95% or above), but the nurse can encourage coughing and deep breathing and reposition the patient to facilitate better oxygenation before calling the healthcare provider.
Question 16.
A patient with suspected bladder cancer is in the clinic with the nurse. When documenting health history, which of the following questions does the nurse ask to determine risk factors?
(a) “Are you a cigarette smoker?”
(b) “Do you drink alcohol?”
(c) “Do you currently use any recreational drugs?”
(d) “What prescription medications are you taking?”
Answer:
(a) “Are you a cigarette smoker?”
Explanation:
Bladder cancer is most frequently found in adults over the age of 55. Smoking is the single greatest modifiable risk factor for preventing development of bladder cancer.
Rationale:
(b) is incorrect because drinking alcohol does not increase risk of bladder cancer.
(c) is incorrect because the use of recreational drugs is not linked to an increased risk of bladder cancer. However, marijuana use has been found to increase the risk of testicular cancer.
(d) is incorrect because rarely do prescription drugs increase the risk of bladder cancer. The exceptions are medications containing phenacetin (which has been banned in the U.S. since 1983) and long-term use of cyclophosphamide.
Question 17.
The nurse is performing preoperative care for a patient scheduled for surgical ileal conduit creation. When the patient tells the nurse he is anxious about the procedure and wants to know what the drainage tube will be like, what is the best response by the nurse?
(a) “I can notify the healthcare provider for antianxiety medication.”
(b) “Would you like me to call the healthcare provider to talk to you about the procedure again?”
(c) “It would be convenient to not have to look for a bathroom.”
(d) “Would you feel better if you could talk with someone who has undergone the procedure?”
Answer:
(d) “Would you feel better if you could talk with someone who has undergone the procedure?”
Explanation:
A positive self-image is an important goal for a patient who will have an ileal conduit placed. It is important for the nurse to provide information to help relieve the patient’s anxiety. Arranging for a conversation between the patient and someone who has had the same procedure done can help provide information.
Other appropriate nursing interventions include showing the patient a picture of the drainage tube, reading through an informational pamphlet with the patient, and using words to describe the tube and the post-operative goals for the patient regarding urine elimination.
Rationale:
(a) is incorrect because asking for antianxiety medication does not answer the patient’s question and does not promote a positive self-image. The nurse should always attempt to reduce anxiety with non-pharmacologic measures first.
(b) is incorrect because having the healthcare provider explain the procedure again does not promote a positive self-image. The nurse should focus on providing information to the patient and calling the healthcare provider is not needed. The nurse is capable of providing information.
(c) is incorrect because sharing an opinion does not answer the patient’s question; this is a dismissive statement and does not promote a positive self-image. Whenever the patient asks a question, it is important to select the answer that addresses the question.
Question 18.
The nurse is teaching a 19-year-old female about amoxicillin, which has been prescribed for a urinary tract infection. Which of the following statements should be included by the nurse?
(a) “Use two forms of birth control while taking the amoxicillin.”
(b) “Increased menstrual bleeding is common while taking amoxicillin.”
(c) “An irregular heartbeat is common while taking amoxicillin.”
(d) “Watch your urine for blood while taking amoxicillin.”
Answer:
(a) “Use two forms of birth control while taking the amoxicillin.”
Explanation:
Amoxicillin is in the drug class of penicillin medications, which are bactericidal. They are used to treat UTIs by inhibiting cell-wall synthesis in susceptible gram-positive organisms. Penicillin drugs have been known to reduce the effectiveness of contraceptives that contain estrogen, so a second form should be used while taking amoxicillin. Patients should also be taught to take this medication one hour before or two hours after meals, to reduce gastric acid destruction of the medication. It is also important for the nurse to teach the patient to take the full course of the medication, even after symptoms resolve.
Rationale:
(b) is incorrect because amoxicillin does not cause increased menstrual bleeding. Adverse effects of penicillin medications include glossitis, superinfections, diarrhea, and gastritis.
(c) is incorrect because an irregular heartbeat is not expected when taking amoxicillin.
(d) is incorrect because blood in the urine is not an expected finding with amoxicillin. If the patient’s UTI caused blood in the urine, the amoxicillin should help resolve the issue. If the blood in the urine persists, the patient should call the healthcare provider.
Question 19.
A patient experiencing functional urinary incontinence is being taught by the nurse in the clinic. Which of the following statements does the nurse include?
(a) “Clean daily around the catheter with soap and water.”
(b) “Vaginal weights must be washed with 10% bleach solution after use.”
(c) “You can consider operations for bladder repair.”
(d) “Slacks with elastic waistbands are recommended for easy removal.”
Answer:
(d) “Slacks with elastic waistbands are recommended for easy removal.”
Explanation:
Functional urinary incontinence is inability to get to the bathroom for physical or mental reasons that results in leakages of urine, in either small or large volume. Independent management of clothing is a reasonable goal for these patients. The nurse should instruct the patient to select loose-fitting clothing with stretch waist bands rather than buttons or zippers.
Buttons, snaps, and multilayered clothing should be avoided, and substituting Velcro for hooks and zippers can be beneficial. Elastic waistbands provide for easier removal when the patient gets to the bathroom. Functional urinary incontinence can be related to cognitive disorders (delirium, dementias), neuromuscular limitations impairing mobility, impaired vision, weakened pelvic muscles, and environmental barriers.
Rationale:
(a) is incorrect because patients with functional urinary incontinence do not necessarily have a catheter in place.
(b) is incorrect because vaginal weights are not cleaned with bleach. If using vaginal weights to strengthen pelvic floor muscles (which can help with incontinence), soap and warm water should be used before and after each use of the weights.
(c) is incorrect because functional urinary incontinence is not treated with bladder repair surgical procedures.
Question 20.
A patient with urinary incontinence is in the clinic experiencing an extremely dry mouth, acute constipation, and is unable to void. Which of the following questions does the nurse ask the patient first?
(a) “Have you been drinking enough water?”
(b) “What are your current medications?”
(c) “Have you recently used a laxative or enema?”
(d) “Have you experienced this before?”
Answer:
(b) “What are your current medications?”
Explanation:
Urinary incontinence is inability to control the flow of urine and results in small to large leakages of urine. Incontinence can be treated with anticholinergic agents including propantheline, with side effects that can include dry mouth, acute constipation, and retention of urine. The medication list needs to be assessed by the nurse to see if an anticholinergic medication is being taken by the patient.
Rationale:
(a) is incorrect because although the patient’s symptoms are indicative of dehydration, asking about medications is more important to help the nurse identify the cause of these symptoms.
(c) is incorrect because recent use of a laxative or enema would not cause the symptoms listed and is not related to this situation.
(d) is incorrect because asking about previous experiences is not helpful for this situation. Focusing on the patient here-and-now is more important than assessing history.
Question 21.
The nurse in the recovery room is caring for a patient recovering from urologic procedure. Which of the following assessments would alert the nurse to a possible urine flow obstruction?
(a) Severe pain
(b) Slowed urine stream
(c) Hypotension
(d) Blood-tinged urine
Answer:
(b) Slowed urine stream
Explanation:
Urologic procedures sometimes result in urethral stricture, and a common manifestation of this is urine flow obstruction. Slowed urine stream, sometimes described as a “dribble,” is a sign of obstruction. Other manifestations of obstruction include patient complaint that the bladder does not feel empty after voiding, decreased urine output, or distended bladder.
Rationale:
(a) is incorrect because severe pain is not characteristic of urine flow obstruction. Some post¬op pain is expected, and should be treated with analgesics, but severe pain should be investigated by the nurse.
(c) is incorrect because hypotension is concerning and can be indicative of fluid volume depletion or post-op shock but is not characteristic of urine flow obstruction.
(d) is incorrect because blood-tinged urine is common and expected after a urologic surgical procedure and is not characteristic of urine flow obstruction.
Question 22.
A patient tells the nurse they are embarrassed by their urinary incontinence and it feels like they have a child’s bladder. What is the best response by the nurse?
(a) “I understand. I would be embarrassed, too.”
(b) “If you wear incontinence pads, it will minimize public leaks.”
(c) “There are strategies for controlling incontinence you can learn.”
(d) “It happens to more women than you think.”
Answer:
(c) “There are strategies for controlling incontinence you can learn.”
Explanation:
Urinary incontinence is inability to control the flow of urine and results in small to large leakages of urine. This strategy demonstrates the nurse acknowledging the patient’s concerns. The patient can be taught strategies to control the incontinence which would be helpful to the patient.
Rationale:
(a) is incorrect because although it is reflective, this is not the best way to address the patient’s concerns. It’s important to respond in a manner that focuses on the patient, not the nurse. “I” statements are nurse-focused.
(b) is incorrect because it minimizes the patient’s concerns. It would be more helpful to teach the patient strategies for strengthening pelvic floor muscles and planning bathroom trips than to simply wear incontinence pads.
(d) is incorrect because it does not address the patient’s concerns. This statement focuses on others.
Question 23.
A pregnant patient calls the triage nurse and says she has a burning sensation with urination. What is the best response by the nurse?
(a) “This is a sign that labor is starting soon. Get ready to come to the hospital.”
(b) “You could have a urinary tract infection. Drink some cranberry juice.”
(c) “You need to call your healthcare provider to make an appointment to be checked for infection.”
(d) “The pelvic wall is weakening, but pelvic muscle exercises can help.”
Answer:
(c) “You need to call your healthcare provider to make an appointment to be checked for infection.”
Explanation:
A patient who is pregnant and develops a urinary tract infection (UTI) needs quick and aggressive antibiotic treatment to prevent acute pyelonephritis. The nurse needs to encourage the patient to notify her healthcare provider for an appointment to diagnose and treat the infection. To prevent UTI, the female patient should be taught to void before and after intercourse, clean properly after defecation (wipe from front to back), and void every two to three hours to minimize urinary stasis in the bladder.
Rationale:
(a) is incorrect because burning with urination does not indicate that labor is starting soon. Characteristic findings of the onset of labor include lightening, softening of the cervix, expulsion of the mucus plug, and regular and progressive uterine contractions.
(b) is incorrect because the patient needs to see the healthcare provider. Cranberry juice can help to acidify urine which can be beneficial for the patient experiencing a UTI, but proper diagnosis and prescription of antibiotics is more important.
(d) is incorrect because burning with urination does not occur with weakening of pelvic muscles.
Question 24.
A patient with polycystic kidney disease (PKD) is admitted to the medical unit. When assessing the patient, which finding would indicate the nurse needs to notify the healthcare provider immediately?
(a) Flank pain
(b) Periorbital edema
(c) Cloudy, bloody urine
(d) Distended abdomen
Answer:
(b) Periorbital edema
Explanation:
Polycystic kidney disease (PKD) causes cysts to grow within the kidneys and is caused by a gene mutation. Periorbital edema is a symptom of fluid retention and may be linked with hypertension. Hypertension can occur with PKD because the kidneys are not able to effectively diurese fluid, leading to increased circulatory volume. This increases the patient’s risk for further kidney damage and stroke and must be assessed immediately by the healthcare provider.
Rationale:
(a) is incorrect because flank pain is due to enlarged kidneys and displacement of organs due to PKD. This is a common and expected finding and often is the reason the patient comes into the healthcare facility.
(c) is incorrect because cloudy, bloody urine could be due to infection or rupture of a cyst, but the circulatory issue (hypertension) is greater priority.
(d) is incorrect because a distended abdomen is a common finding due to enlarged kidneys and displacement of organs due to PKD.
Question 25.
The nurse has taught a patient with early polycystic kidney disease (PKD) regarding therapy with nutrition. Which patient statement demonstrates correct understanding?
(a) “I should take a laxative nightly at bedtime.”
(b) “I will increase dietary fiber intake and fluid intake.”
(c) “I will use salt only when I cook food myself.”
(d) “Eating white bread will decrease gastrointestinal gas.”
Answer:
(b) “I will increase dietary fiber intake and fluid intake.”
Explanation:
Polycystic kidney disease (PKD) causes cysts to grow within the kidneys and is caused by a gene mutation. PKD often leads to constipation that can be improved with fiber, exercise, and water intake.
Rationale:
(a) is incorrect because patients with PKD should use laxatives cautiously. Constipation is common with kidney disease, but if laxatives are taken regularly, this can lead to electrolyte disturbances, which can worsen kidney disease.
(c) is incorrect because patients with PKD should restrict their salt intake and limit salt use when cooking. Salt substitutes can be a safe way to flavor food without increasing dietary sodium intake.
(d) is incorrect because white bread is low in fiber. Patients with kidney disease should be encouraged to increase intake of whole grain products.
Question 26.
A 55-year-old female patient with a history of diabetes mellitus is in the clinic for the third time this year for acute pyelonephritis. When the patient asks what she can do to prevent the infections, what is the best response by the nurse?
(a) “You can test your urine every day for ketones and proteins.”
(b) “Don’t use sanitary napkins during your period, use tampons instead.”
(c) “Increase your water intake and empty your bladder more often while awake.”
(d) “Improve your blood sugar control to keep your hemoglobin AiC under g%.”
Answer:
(c) “Increase your water intake and empty your bladder more often while awake.”
Explanation:
Pyelonephritis is bacterial infection of the kidney and renal pelvis which causes kidney inflammation and can lead to scarring and failure of the kidneys. Symptoms include fever, malaise, flank pain, urinary frequency, and dysuria (pain or burning with urination). Patients who have diabetes mellitus are at increased risk for pyelonephritis due to elevated blood glucose and pH change of the urine, neuropathy, and decreased bladder tone.
The nurse should suggest increased water intake (up to 3 liters daily) and more frequent voiding to prevent overgrowth of bacteria within the urinary tract. Other predisposing factors for pyelonephritis include UTI, pregnancy, tumor near the kidneys, or urinary obstruction. Antibiotics, antiseptics, IV fluids, and analgesics will be used to treat pyelonephritis.
Rationale:
(a) is incorrect because testing for ketones and proteins will not prevent pyelonephritis. Proteins and ketones are not generally found in the urine, but they are not specifically linked to infection. WBCs and nitrites in the urine are indicative of infection.
(b) is incorrect because using tampons instead of sanitary napkins will not prevent pyelonephritis. (Patients who have experienced toxic shock syndrome should consider using pads instead of tampons.)
(d) is incorrect because 9% is much too high for hemoglobin AiC. Normal glycosylated hemoglobin is under 6%.
Question 27.
A patient with acute glomerulonephritis (GN) is admitted to the medical unit. When the nurse evaluates the patient, which finding would be recognized as positive response to treatment as prescribed?
(a) 7 pound weight loss over 10 days
(b) Specific gravity of urine 1.047
(c) Patient is able to expectorate secretions
(d) Blood pressure 154/86 mmHg
Answer:
(a) 7 pound weight loss over 10 days
Explanation:
Acute glomerulonephritis (GN) is inflammation of the glomeruli, which affects filtration in the kidney. This is often caused by an immunological reaction due to an infection in another part of the body (10 days after a skin or throat infection.) GN is characterized by fever, chills, generalized edema, hypertension, fluid retention, and lung rales. A 7 pound weight loss over 10 days indicates diuresis, meaning the glomeruli are filtrating properly. This is a positive response to prescribed treatment.
Rationale:
(b) is incorrect because specific gravity of urine 1.047 is elevated and is indicative of concentrated urine, which is seen with GN. Positive response to treatment would be a specific gravity that fluctuates within normal limits (1.010-1.030).
(c) is incorrect because GN can cause fluid in the lungs, so if the patient is expectorating secretions, this suggests that fluid is still accumulating within the lungs. Positive response to treatment would be clear lung fields with no secretions present.
(d) is incorrect because blood pressure of 154/86 mmHg is high and could indicate damage to the kidneys or continuing overload of fluid. Antihypertensives are a component of treatment for GN, so a good outcome would be BP within normal limits.
Question 28.
The nurse in the surgical unit is assessing a patient with renal cell carcinoma who underwent radical nephrectomy. Blood pressure has changed from 136/92 to 102/60 mmHg, and urine output for the past hour is 20 mL. Which of the following actions should be taken by the nurse?
(a) Place the patient on the surgical incision
(b) Measure urine specific gravity
(c) Administer IV pain medicine
(d) Assess pulse rate and quality
Answer:
(d) Assess pulse rate and quality
Explanation:
Radical nephrectomy is removal of a kidney due to cancer, persistent infection, or anomalies. This is a “last resort” intervention when other treatments have failed. The nurse needs to assess the patient for volume depletion and shock signs, including pulse rate and quality, and notify the healthcare provider. The surgery is radical and close to the adrenal gland, risking hemorrhage risk as well as adrenal insufficiency.
Rationale:
(a) is incorrect because placing the patient on the surgical incision is inappropriate and will likely cause pain. The patient should be turned regularly, with the HOB elevated to prevent stretching and pressure on the incision.
(b) is incorrect because measuring specific gravity does not provide necessary data related to the drop in blood pressure.
(c) is incorrect because administering pain medication is not related to this situation. The question does not state that the patient is in pain, and when hypotension is present, the nurse should address that circulatory issue ahead of pain treatment. Pain post-nephrectomy is often treated with patient controlled analgesia. However, this can drop BP, so should be used cautiously.
Question 29.
The nurse in the emergency room cares for a patient admitted with a puncture wound with kidney trauma. The nurse notes abdominal tenderness and distention and blood at the urinary meatus. Which of the following orders by the healthcare provider should the nurse question?
(a) 15-minute vital signs
(b) Insertion of a urinary catheter
(c) IV fluids 125 mL/hr
(d) Type and crossmatch
Answer:
(b) Insertion of a urinary catheter
Explanation:
Diagnostic testing should be performed before insertion of a urinary catheter when blood is visualized at the urinary meatus. This could indicate a torn urethra. If a catheter is needed, a suprapubic catheter can be inserted by the healthcare provider.
Rationale:
(a) is incorrect because vital signs should be monitored frequently for a patient with a puncture wound.
(c) is incorrect because IV fluids are appropriate for a patient who has experienced trauma. Fluids are used to restore or maintain fluid volume in a patient who is NPO or who has experienced blood loss.
(d) is incorrect because type and crossmatch is appropriate for a patient who has experienced trauma. This is an appropriate and safe assessment for the nurse to make prior to giving blood replacement products.
Question 30.
A patient is taught about hypertension related to kidney disease by the nurse. Which patient statement demonstrates more teaching is needed?
(a) “If I manage my blood pressure, further kidney damage can be prevented.”
(b) “I should drink less during daytime hours if I have to get up at night to urinate.”
(c) “I will speak with the registered dietitian about limiting protein intake.”
(d) “I will take my antihypertensive medications as ordered by the healthcare provider.”
Answer:
(b) “I should drink less during daytime hours if I have to get up at night to urinate.”
Explanation:
Increased nighttime urination is not an indication to restrict daytime fluid intake. Only when necessary, the healthcare provider will prescribe fluid restriction for the patient with renal disease. Fluid intake later in the day can be decreased in order to decrease nocturnal voiding, but adequate hydration throughout the day is necessary.
Rationale:
(a) is incorrect because blood pressure management will slow progression of renal disease, indicating correct understanding.
(c) is incorrect because the patient prescribed limited protein intake should be referred to the registered dietitian, indicating correct understanding. The purpose of the kidney diet is to keep protein, potassium, and sodium low. Food examples include unsalted vegetables, white rice, and canned fruits. Restricted foods include beans, cereals, and citrus fruits.
(d) is incorrect because blood pressure management will slow progression of renal disease, indicating correct understanding.
Question 31.
A patient who underwent nephrostomy tube placement six hours ago has decreased tube drainage from 50 mL/hr to 15 mL/hr. What action should be taken by the nurse?
(a) Document urine output in the chart
(b) Report the tube is draining as expected in hand-off report
(c) Clamp the tube to prepare for removal
(d) Assess abdomen and vital signs
Answer:
(d) Assess abdomen and vital signs
Explanation:
A nephrostomy tube (catheter) is placed through a flank incision into the pelvis of the kidney to drain urine into a collection bag. The tube should have consistent drainage. If the nurse notes decrease in drainage, obstruction is suspected. The nurse needs to assess the abdomen for distention and vital signs and then notify the healthcare provider.
Rationale:
(a) is incorrect because the decreased urine output warrants further assessment and is a higher priority than documentation.
(b) is incorrect because the tube is not draining as expected. The decrease in output indicates the tube may be obstructed and this is important information to include in the hand-off report.
(c) is incorrect because a nephrostomy tube should never be clamped or irrigated.
Question 32.
A patient is in the clinic for pre-renal acute kidney injury (AKI). When reviewing the patient history, which condition would the nurse consider as a cause for this patient’s AKI?
(a) Pyelonephritis
(b) Myocardial infarction
(c) Bladder cancer
(d) Kidney stones
Answer:
(b) Myocardial infarction
Explanation:
Pre-renal acute kidney injury (AKI) is injury that occurs to the kidneys as a result of decreased blood flow, vascular obstruction, or vascular resistance. The term pre-renal indicates that the cause for the kidney damage occurred in a body system before the kidney is reached. Myocardial infarction decreases blood flow to the kidneys, and therefore, reduces filtration by the kidneys.
Rationale:
(a) is incorrect because pyelonephritis causes chronic kidney disease, not pre-renal AKI.
(c) is incorrect because bladder cancer is post-renal, not pre-renal.
(d) is incorrect because kidney stones are post-renal, not pre-renal.
Question 33.
A patient who is a marathon runner is admitted to the emergency room for tachycardia. Heart rate is 115 bpm and blood pressure 82/56. The patient tells the nurse he hasn’t urinated much for the last few days. Which of the following actions is priority?
(a) Encourage PO fluids immediately
(b) Start peripheral IV of 0.45% NaCl
(c) Instruct the patient drink at least 2 liters of water per day
(d) Perform an EKG
Answer:
(a) Encourage PO fluids immediately
Explanation:
Tachycardia and hypotension indicate dehydration. The patient should be encouraged to drink fluids immediately to replenish depleted circulating fluid volume.
Rationale:
(b) is incorrect because starting an IV is appropriate, but 0.45 sodium chloride is hypotonic and can be detrimental to a patient who is already exhibiting signs of hypotension. This patient does not have any symptoms that necessitate NPO status, so PO fluids should be started first, with isotonic IV fluids started afterward if the symptoms don’t improve.
(c) is incorrect because teaching the patient about daily fluid intake is not priority at this time. The nurse must select the answer that will immediately help the patient right now. Teaching about daily fluid needs can be done after the patient is stabilized or at discharge.
(d) is incorrect because an EKG is not needed at this time.
Question 34.
A patient admitted to the emergency room has a serum creatinine level of 2.4 mg/dL and blood urea nitrogen (BUN) of 26 mL/dL. What is the first question the nurse should ask when documenting patient history?
(a) “Have you taken aspirin, naproxen, or ibuprofen recently?”
(b) “Does anyone in your family have renal failure?”
(c) “Have you been following a low-protein diet?”
(d) “Has anyone in your family had a kidney transplant recently?”
Answer:
(a) “Have you taken aspirin, naproxen, or ibuprofen recently?”
Explanation:
The nonsteroidal anti-inflammatory drugs aspirin, naproxen, and ibuprofen are nephrotoxic and can elevate creatinine and BUN. The nurse should ask the patient about taking these medications recently. Normal adult creatinine is 0.7-1.4 mg/dL and normal BUN is 10-20 mg/dL. Both of these are tested to evaluate kidney function.
Rationale:
(b) is incorrect because family history of renal failure is not priority over current medications which may be causing the abnormal lab values.
(c) is incorrect because a high protein diet can cause elevated BUN.
(d) is incorrect because family history of kidney transplant is not pertinent to the situation.
Question 35.
A patient in the intensive care unit (ICU) has potassium level 6.4 mmol/L, creatinine 2.2 mg/dL, and urine output has been 325 mL/day. Which action by the nurse is priority?
(a) Put the patient on cardiac monitor
(b) Teach the patient about limiting high-potassium foods
(c) Monitor intake and output
(d) Redraw blood specimen for retesting
Answer:
(a) Put the patient on cardiac monitor
Explanation:
Normal potassium is 3.5-5.O mEq/L, so this patient is extremely hyperkalemic. Normal adult creatinine is 0.7-1.4 mg/dL, so this patient has impaired renal function or severe dehydration. The urine output is extremely low (normal UP is 1-1.5 L daily). Monitoring cardiac rhythm, is priority because hyperkalemia can cause EKG changes, dysrhythmias, and cardiac arrest. Potassium-wasting diuretics may be given to increase renal clearance of excess potassium.
Rationale:
(b) is incorrect because teaching about limiting high-potassium foods is not priority until after the patient is stabilized and cardiac function is being properly monitored. Calcium gluconate or sodium bicarbonate should be available at the bedside.
(c) is incorrect because monitoring intake and output is not as important as monitoring cardiac rhythm.
(d) is incorrect because redrawing the blood specimen is not priority.
Question 36.
A patient has just had a hemodialysis catheter placed. Which of the following actions by the nurse is most appropriate?
(a) Use the line for drawing blood
(b) Monitor central venous pressure (CVP) using the line
(c) Use the line for IV medication administration
(d) Place heparin or heparin/saline dwell following hemodialysis
Answer:
(d) Place heparin or heparin/saline dwell following hemodialysis
Explanation:
A hemodialysis catheter is a line placed for blood exchange between the body and the hemodialysis machine when the kidneys fail. Following hemodialysis, the nurse should instill heparin or heparin/saline dwell to keep the line patent. Other important nursing assessments after hemodialysis include monitoring for hemorrhage and disequilibrium syndrome (headache, confusion.) It is also important to avoid using the arm with the hemodyalisis catheter for blood pressure readings.
Rationale:
(a) is incorrect because a hemodialysis catheter should not be used for blood draws.
(b) is incorrect because a hemodialysis catheter cannot be used for CVP measurement. CVP is measured through a central line, such as a triple-lumen catheter. The measurement reflects the pressure in the right atrium of the heart.
(c) is incorrect because a hemodialysis catheter should not be used for IV medication infusion.
Question 37.
A patient in the intensive care unit (ICU) has continuous venovenous hemofiltration (CWH) started for renal failure. Which finding by the nurse warrants immediate intervention?
(a) Blood pressure 84/48 mmHg
(b) Sodium level 136 mEq/L
(c) Potassium level 5.6 mEq/L
(d) Heart rate 94 bpm
Answer:
(a) Blood pressure 84/48 mmHg
Explanation:
Continuous venovenous hemofiltration (CWH) is temporary hemodialysis performed continuously for patients who have low blood pressure or other contraindications for hemodialysis. CWH is a form of continuous renal replacement therapy (CRRT). Replacement fluid is infused along with CWH, and if there is not enough volume, then hypotension can result. The nurse trained to perform CWH monitors for BP and fluid and electrolyte balance while performing the procedure.
Rationale:
(b) is incorrect because normal sodium level is 135-145 mEq/L.
(c) is incorrect because the slightly elevated potassium is expected in the patient experiencing acute kidney injury7. (Normal potassium is 3.5-5.0 mEq/L.)
(d) is incorrect because the heart rate is within normal limits and is not concerning to the nurse.
Question 38.
The nurse on the medical-surgical unit has just received the hand-off report on four patients with chronic kidney disease (CKD). Which patient does the nurse plan on assessing first?
(a) Female patient with blood pressure 156/94 mmHg
(b) Patient exhibiting Kussmaul respirations
(c) Male patient who is experiencing itching head to toe
(d) Patient who has halitosis and stomatitis
Answer:
(b) Patient exhibiting Kussmaul respirations
Explanation:
Chronic kidney disease (CKD) is gradual kidney function loss over an extended period of time. A patient with CKD and Kussmaul respirations is experiencing air hunger and a worsening of the condition and breathing faster and deeper in order to blow off carbon dioxide.
Rationale:
(a) is incorrect because CKD is commonly associated with hypertension.
(c) is incorrect because itching is due to calcium-phosphate imbalance that is common with CKD.
(d) is incorrect because halitosis and stomatitis are due to uremia and ammonia formation that are common with CKD.
Question 39.
A float nurse is working with a patient who has an arteriovenous (AV) fistula in the left arm for hemodialysis. Which of the following actions by the float nurse warrants intervention by the charge nurse?
(a) Palpating access site for bruit or thrill
(b) Using the right arm for blood pressure
(c) Administering IV fluids through AV fistula
(d) Checking pulses distal to AV fistula
Answer:
(c) Administering IV fluids through AV fistula
Explanation:
An arteriovenous (AV) fistula is formed in surgery by joining a vein and artery under the skin with a special tube. Once healed, the AV fistula is accessed for hemodialysis by placing needles in the arterial and venous sides and allowing increased blood flow during dialysis. An AV fistula should never be used for administration of IV fluids or medications, which would require intervention by the charge nurse.
Rationale:
(a) is incorrect because palpating for thrill and auscultating for bruit is appropriate assessment of an AV fistula and should be performed every eight hours.
(b) is incorrect because using the arm without an AV fistula is appropriate for blood pressure measurement.
(d) is incorrect because checking pulses distal to the AV fistula is appropriate.
Question 40.
A patient undergoing peritoneal dialysis is assessed by the nurse. The nurse notes the effluent is opaque. Which of the following actions by the nurse is priority?
(a) Warm dialysate solution in the microwave before using
(b) Sample effluent and send to the lab for evaluation
(c) Flush tubing with normal saline for patency
(d) Check peritoneal catheter for curling or kinking
Answer:
(b) Sample effluent and send to the lab for evaluation
Explanation:
Peritoneal dialysis uses the peritoneum as the filter for waste products and excess fluid from the blood as an alternative to hemodialysis. When effluent is opaque or cloudy, this usually indicates peritonitis, an infection of the peritoneum. The nurse should take a sample of the effluent and send it to the lab for culture and sensitivity for identification of microbes and antibiotic choice by the healthcare provider.
Rationale:
(a) is incorrect because the microwave is never used for medications of any type. The dialysate solution should be warmed to body temperature by a cycler machine or heating pad prior to peritoneal dialysis administration. Temperature of solution is unrelated to peritonitis.
(c) is incorrect because flushing the peritoneal dialysis tubing or catheter is unsafe and is not related to the potential infection.
(d) is incorrect because checking for obstruction is an appropriate routine nursing assessment when caring for a peritoneal dialysis patient but is not related to the indication of peritonitis.
Question 41.
A patient in the intensive care unit (ICU) has received a kidney transplant. Which assessment by the nurse is the most concerning?
(a) Scant urine output
(b) Temperature 99.1°F (37.3°C)
(c) Leukopenia
(d) Heartrate 122 bpm
Answer:
(d) Heartrate 122 bpm
Explanation:
Kidney transplant involves the replacement of a diseased kidney with a healthy kidney from a cadaver, identical twin, or histo-compatible donor. Tachycardia after transplantation is a sign of shock, and the patient’s blood pressure must be assessed immediately. The nurse should be prepared to notify the healthcare provider immediately and push fluids.
Rationale:
(a) is incorrect because urine output is expected to be scant for days to weeks following the transplant. Hemodialysis may be needed until the implanted kidney functions well (two to three weeks after transplant).
(b) is incorrect because a slightly elevated temperature is common the first day post-operatively. The nurse should continue to monitor for signs of post-op infection, including a persistent elevated temperature.
(c) is incorrect because immunosuppressant medications are given to prevent rejection of the new kidney. A common finding is low white blood cells.
Question 42.
The home health nurse is teaching a patient about self-catheterization at home. Which of the following statements should be included by the nurse? (Select all that apply.)
(a) “Before and after self-catheterization, wash your hands well.”
(b) “A large-lumen catheter should be used each time.”
(c) “Lubricate the tip of the catheter before self-catheterization.”
(d) “Self-catheterization should be performed every 12 hours or twice a day.”
(e) “Sterile technique with sterile gloves should be utilized.”
(f) “Keep a schedule for self-catheterization.”
Answer:
(a) “Before and after self-catheterization, wash your hands well.”
(c) “Lubricate the tip of the catheter before self-catheterization.”
(f) “Keep a schedule for self-catheterization.”
Explanation:
The patient learning about self-catheterization should be taught to wash their hands before and after the procedure, use lubrication on the catheter, and keep a schedule to prevent distention of the bladder and urinary retention that contribute to growth of bacteria.
Rationale:
(b) is incorrect because a small-lumen catheter should be used. A larger catheter is only needed if the smaller lumen catheter is unable to properly drain the urine.
(d) is incorrect because self-catheterization should be performed more frequently than twice a day.
(e) is incorrect because self-catheterization is performed utilizing clean technique.
Question 43.
A patient in the clinic has a fungal urinary tract infection (UTI). Which actions should be completed by the nurse? (Select all that apply.)
(a) Initiate antifungal treatment
(b) Assess medical history
(c) Assess for neutropenia
(d) Ask about recent travel to a foreign country
(e) Obtain a list of current medications
Answer:
(b) Assess medical history
(c) Assess for neutropenia
(e) Obtain a list of current medications
Explanation:
Fungal UTIs are more likely to occur in patients who have diabetes mellitus or are severely immunocompromised. The fungal infection usually spreads from the GI tract or from fungus presence on a urinary catheter and can also develop secondary to antibiotic treatment for a bacterial infection.
The nurse should assess medical history and current medications to determine the cause of the fungal infection. Not all fungal UTIs require medical treatment, as they often are asymptomatic and will clear up on their own. However, a neutropenic patient is a candidate for antifungal medication, so assessing for neutropenia is important.
Rationale:
(a) is incorrect because antifungal treatment is not indicated unless the patient is symptomatic, neutropenic, has a renal allograft, or is high-risk.
(d) is incorrect because foreign country7 travel is not related to development of fungal UTI.
Question 44.
A patient who has had calcium phosphate kidney stones is educated by the nurse. Which of the following statements regarding dietary teaching does the nurse include? (Select all that apply.)
(a) “Limit animal protein intake.”
(b) “Reduce sodium intake and read nutrition labels.”
(c) “Avoid black tea, rhubarb, and spinach.”
(d) “Drink beer or white wine rather than red wine.”
(e) “Reduce or avoid dairy products.”
Answer:
(a) “Limit animal protein intake.”
(b) “Reduce sodium intake and read nutrition labels.”
(e) “Reduce or avoid dairy products.”
Explanation:
Patients who experience calcium phosphate kidney stones should be educated about limiting animal protein intake, sodium intake, and calcium. (Sodium increases calcium in the urine.)
Rationale:
(c) is incorrect because black tea, rhubarb, and spinach should be avoided by those with calcium oxalate stones, not calcium phosphate stones.
(d) is incorrect because red wine should be avoided by those with uric acid stones, not calcium phosphate stones.
Question 45.
The patient who had a urinary calculus lithotripsy treatment is educated by the nurse. Which of the following statements does the nurse include in discharge teaching? (Select all that apply.)
(a) “Finish your antibiotics even if you feel better.”
(b) “Drink 2-3 liters of water each day.”
(c) “Bruising on your back could take several weeks to get better.”
(d) “Notify your healthcare provider if you notice any blood in your urine.”
(e) “Pain and difficulty urinating are common.”
Answer:
(a) “Finish your antibiotics even if you feel better.”
(b) “Drink 2-3 liters of water each day.”
(c) “Bruising on your back could take several weeks to get better.”
Explanation:
Extracorporeal shock wave lithotripsy is the use of high energy sound waves through the skin to break down kidney stones into smaller pieces that are able to pass through the ureters and into the bladder to be eliminated with voiding. Prophylactic antibiotics should be taken until the course is completed to prevent a urinary tract infection and urosepsis. The patient should drink at least 2-3 liters of water daily to maintain adequate hydration and prevent the formation of more kidney stones. The bruising that results from lithotripsy takes several weeks to improve.
Rationale:
(d) is incorrect because blood in urine is common after lithotripsy and this is not an indication of a complication.
(e) is incorrect because pain and difficulty urinating may be indications of infection or persistent kidney stones and these findings should be reported to the healthcare provider.
Question 46.
A female patient is learning about stress incontinence and pelvic muscle exercises from the nurse. Which of the following statements should be included by the nurse? (Select all that apply.)
(a) “Pelvic muscles are used when starting and stopping the urine stream.”
(b) “Tighten the pelvic muscles for ten seconds then relax for ten seconds.”
(c) “Perform pelvic muscle exercises when seated upright with feet on the floor.”
(d) “Do these exercises for a couple of days, and your urine control will get better.”
(e) “Your pelvic muscles, like other muscles, strengthen with contraction.”
Answer:
(a) “Pelvic muscles are used when starting and stopping the urine stream.”
(b) “Tighten the pelvic muscles for ten seconds then relax for ten seconds.”
(e) “Your pelvic muscles, like other muscles, strengthen with contraction.”
Rationale:
The nurse should include teaching the patient that the purpose of pelvic floor muscles is for stopping and starting urine stream. Muscles are strengthened with contraction and relaxation for ten seconds each time.
(c) is incorrect because pelvic muscle exercises should be done in multiple positions: lying down, sitting up, and standing, for maximum effect.
(d) is incorrect because it takes several weeks for improvement in urine control to be achieved.
The nurses take utmost care while treating renal failure or renal-related patients by giving sufficient water and liquids that make the urine analysis easy and most of the waste from the cells will purify.
Read More: