210-241 Urinary

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211
NEPHROTIC SYNDROME
TRANSPLANT
GLOMERULONEPHRITIS
DIALYSIS
PYELONEPHRITIS
RENAL FAILURE
URINARY TRACT INFECTIONS
CYSTITIS, URETHRITIS
PROCEDURES
-LITHIASIS
INCONTINENCE
DIAGNOSTICS
KIDNEY
NURSING
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NEPHROTIC SYNDROME
1. Mr. Rivera has symptoms of nephrotic syndrome, as a nurse in the medical ward, you know
that which of the following medications could help control the symptoms of nephrotic syndrome?
a.
b.
c.
d.
Corticosteroids, Prednisone and Aspirin

Aspirin, Lactulose and Antibiotics
Corticosteroids, Prednisone and Diuretics
Corticosteroids, Heparin and Diuretics
2. A child who suffers from nephrotic syndrome will be on a long-term steroid therapy. The
primary nursing goal for this child during the duration of the drug therapy will be?
a.
b.
c.
d.
Prevention
Prevention
Prevention
Prevention
of
of
of
of
hyperglycemia.
additional weight gain.
gastric distress.
infection.
3. Kurapika, a patient with nephrotic syndrome complains of flank pain. Nurse Gon
who is the nurse on duty for the care of Kurapika will anticipate treatment with:
a.
b.
c.
d.
Antihypertensives
Antibiotics
Anticoagulants
Corticosteroids
GLOMERULONEPHRITIS
4. Elena has a diagnosis of glomerulonephritis. Upon assessment, the nurse observes one of the
classic signs of acute glomerulonephritis of rapid onset. An example of a classic sign includes:
a.
b.
c.
d.
Green-tinged urine
Periorbital edema
Polyuria
Moderate to severe hypotension
5. A nurse is caring for the client diagnosed with (AGN). As the nurse on duty, you know that
which of the following treatment regimen would not be included for acute glomerulonephritis?
a.
b.
c.
d.
Antibiotics
Decreased protein in the diet
Increased potassium in the diet
Dialysis
6. Leorio was admitted in the hospital and was diagnosed with acute glomerulonephritis. Nurse
Killua knows that the laboratory findings consistent with acute glomerulonephritis include all of
the following except:
a.
b.
c.
d.
polyuria
proteinuria
hematuria
white cell casts
7. An 87 year old, elderly client is diagnosed with chronic glomerulonephritis and was admitted.
Which laboratory value indicates the condition has gotten worse?
a. The 24-hour creatinine clearances is 100 mL/minute
b. The glomerular filtration rate is 40 mL/minute
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c. The creatinine level is 1.2 mg/dL
d. The BUN is 15 mg/dL
8. Nurse Rukawa is caring for a client with glomerulonephritis. What should the nurse instruct
the client to do to prevent recurrent attacks?
a. Avoid situations that involve physical activity.
b. Continue the same restrictions on fluid intake
c. Seek early treatment for respiratory tract infections.
d. Take showers instead of tub baths
9. The 5 a.m. blood pressure reading was 170/90mmHg. At 9 a.m., the nursing
assistant informs the charge nurse that a female adolescent client with acute
glomerulonephritis has a blood pressure of 200/100. The client reports to the nursing
assistant that she is upset because her boyfriend broke up with her last night. What
action should the charge nurse take first?
a. Administer PRN prescription of nifedipine (Procardia) sublingually.
b. Give the client her 9 a.m. prescription for an oral diuretic early.
c. Attempt to calm the client and retake the blood pressure in thirty minutes.
d. Notify the healthcare provider and inform the nursing supervisor of the client's
condition.
RENAL FAILURE
10. A client who has a chronic renal failure is ordered by the physician to be placed on a low
protein diet. The nurse reinforced to the patient that the diet should be low in protein because:
a.
b.
c.
d.
Protein
Protein
Protein
Protein
decreases serum calcium levels

decreases the amount of serum albumin and promotes edema formation
increases the amount of sodium and potassium to be regulated by the kidneys
breaks down into waste products that increases the workload of the kidneys
11. Mr. Piccolo, a client diagnosed with end-stage renal disease (ESRD) has developed anemia.
Which would the nurse anticipate the health care provider prescribing for this client?
a.
b.
c.
d.
Monitor CBC daily to assess for bleeding.

Give client erythropoietin, a biologic response modifier.
Place the client in reverse isolation.
Discontinue treatments until blood count improves.
12. Recca is observed to have decreased urine output refractory to fluid challenges and is
evaluated for possible renal failure. Which of the following conditions may cause the intrinsic
(intrarenal) form of acute renal failure?
a.
b.
c.
d.
Poor perfusion to the kidneys

Damage to epithelial cells in the adrenal cortex
Obstruction of the urinary collecting system
Nephrotoxic injury secondary to use of contrast media
13. The licensed nurse is explaining chronic renal failure to the students in the dialysis unit. The
nurse also added that low levels of calcium occur in chronic renal failure because of:
a.
b.
c.
d.
Lack of vitamin D normally created by the kidneys

Elevated levels of phosphate
An osmotic diuresis related to sodium loss
A decreased production of erythropoietin
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14. Assessing the laboratory findings of Mrs. Yalung, a client with kidney disease, which of the
following results would the nurse most likely expect to find in a client with chronic renal failure?
a.
b.
c.
d.
BUN 35 to 40 mg/dl, potassium 3.5 mEq/L, pH 7.35, decreased serum calcium

BUN 15 mg/dl, increased serum calcium, creatinine l.0 mg/dl
Decreased serum calcium, blood pH 7.2, potassium 6.5 mEq/L
BUN 10 to 30 mg/dl, potassium 4.0 mEq/L, creatinine 0.5 to 1.5 mg/dl
15. A nurse is caring for a client diagnosed with endstage renal disease (ESRD). The client is 6
feet tall and weighs 180 pounds. The clients total serum protein is 5.8 g/dL. According to the
nurses assessment it reveals that the patient has +2 pitting edema. The nurse determines that
this clients edema is most likely the result of:
a.
b.
c.
d.
Increased capillary hydrostatic pressure.

Decreased plasma oncotic pressure.
Increased capillary permeability.
Decreased serum electrolytes.
16.
An adult with chronic renal failure is encouraged to have peritoneal dialysis.
His acid- base balance and electrolyte levels are now within normal limits. His
hemoglobin is 9.2 and his hematocrit is 30. What is the most likely cause for his
anemia?
a. Eating insufficient protein due to taste changes that occur with dialysis.
b. Hemodilution secondary to fluid retention.
c. Hemolysis of red blood cells as they move past the membrane containing the
dialysis solution.
d. Failure of his kidneys to produce the hormone necessary to stimulate bone
marrow to produce red blood cells.
17.
Client Mang Ashiong has a urine output of 1000 mL/day and a serum
creatinine level of 2 mg/dL. How will the nurse categorize Mang Ashiongs renal
failure?
a.
b.
c.
d.
Non-oliguric
Intrarenal
Postrenal
Prerenal
18. Don Roberts chronic renal failure was caused by a crushing injury to the lower left leg right
after an accident. The acute renal failure progresses to chronic renal failure until now, his case is
considered irreversible. The nurse is correct in determining that the cause of Don Roberts Acute
renal failure before was:
a.
b.
c.
d.
Post renal
Pre renal
Extra renal
Renal
19. The nurse is caring for a client who was diagnosed with acute renal failure. The
nurse wants to identify what type of acute renal failure the patient has. Which
assessment finding does the nurse associate with the clients acute renal failure, if it is
classified post-renal type?
a.
b.
c.
d.
Feeling of urgency
Weight gain
Elevated blood urea nitrogen (BUN)
Elevated creatinine
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20. Mr. Sih, a client suffering from acute renal failure has an unexpected increase in urinary
output to 150ml/hr. The nurse on duty assesses that Mr. Sih has entered the second phase of
acute renal failure. Nursing actions throughout this phase include observation for signs and
symptoms of
a.
b.
c.
d.
Hypovolemia, no fluctuation in serum sodium and potassium levels.

Hypovolemia, wide fluctuations in serum sodium and potassium levels.
Hypervolemia, hyperkalemia, and hypernatremia.
Hypervolemia, hypokalemia, and hypernatremia.
21. A 23-year-old woman is admitted to the medical surgical ward with a diagnosis of acute renal
failure. She is oliguric and has massive proteinuria. She asks the nurse, How long will it be
before I start to make urine again? Which of the following would be the correct response by the
nurse?
a.
b.
c.
d.
This
This
This
This
phase
phase
phase
phase
of
of
of
of
renal
renal
renal
renal
failure
failure
failure
failure
will
will
will
will
last
last
last
last
one to two weeks.

for three to four weeks.
for one to two days.
for three to seven days.
22. A client with acute kidney failure is prescribed by the physician to have a very low-protein
diet. The nurse understands that this diet is based on the principle that:
a. Urea nitrogen cannot be used to synthesize amino acids in the body so the nitrogen for
amino acid synthesis must come from the dietary protein
b. Essential and nonessential amino acids are necessary in the diet to supply materials for
tissue protein synthesis
c. This supplies only essential amino acids and calories, reducing the amount of metabolic
waste products thus decreasing stress on the kidneys
d. A high-protein intake ensures an adequate daily supply of amino acids to compensate for
losses
23. Client Encarnacion seek out for medical attention yesterday and is diagnosed with rule out
Acute Renal Failure. The nurse knows that which condition would predispose the client to
developing pre-renal failure?
a.
b.
c.
d.
Aminoglycosides.
Benign prostatic hypertrophy.
Diabetes mellitus.
Hypotension.
24. The patients serum potassium is elevated in acute renal failure, and the nurse administers
sodium polystyrene sulfonate (Kayexalate). This drug acts to?
a.
b.
c.
d.
release hydrogen ions for sodium loss.

increase potassium excretion from the colon.
exchange sodium for potassium ions in the colon.
increase calcium absorption in the colon.
25. Mr. Yamcha develops acute renal failure (ARF) after receiving an I.V. therapy with a
nephrotoxic antibiotic. The physician ordered a 24-hour urine test for Mr. Yamcha. Because Mr.
Yamchas 24-hour urine output totals 240 ml, nurse Bulma suspects that the client is at risk for:
a.
b.
c.
d.
paresthesia.
cardiac arrhythmia.
pruritus.
dehydration.
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26. Sakura, a female client is admitted for treatment of chronic renal failure (CRF). Nurse Sasuke
knows that this disorder increases the clients risk of:
a.
b.
c.
d.
an increased serum calcium level secondary to kidney failure.

metabolic alkalosis secondary to retention of hydrogen ions.
water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
a decreased serum phosphate level secondary to kidney failure.
27. The nurse is discussing renal failure to the students in the medical surgical ward. The nurse
questions one of the male students, which client is a likely candidate for developing acute renal
failure? The student would be correct if he answered?
a.
b.
c.
d.
Middle age male with elevated temperature and chronic pancreatitis.

Young female with recent ileostomy due to ulcerative colitis.
Child with compound fracture of right femur and massive laceration to left arm.
Teenager in hypovolemic shock following a crushing injury to the chest.
KIDNEY TRANSPLANT
28. Mang Isko has just received a renal transplant and has started cyclosporine therapy to
prevent graft rejection. Which of the following condition is a major complication of this drug
therapy?
a.
b.
c.
d.
Depression
Infection
Hemorrhage
Peptic ulcer disease
29. Argie, a client receiving kidney transplant will receive immunosuppressant therapy. Nurse
Van knows that the agent used to induce immunosuppression immediately following a transplant
is often:
a.
b.
c.
d.
muromonab- CD3
corticosteroids
azathioprine
antithymocyte globulin
30. A patient with kidney transplantation asked the renal nurse, what is the reason why
Azathioprine (Imuran), Prednisone or Cyclosporine (SandImmune) is given in a client that has
undergone Kidney Transplantation? The nurses answer would be?
a.
b.
c.
d.
To
To
To
To
enhance the immune system preventing rejection

protect the newly transplanted kidney from invading pathogens
suppress the immune system preventing rejection
enhance kidney function
31. A client with kidney transplantation asked the nurse about the therapy he is receiving. The
client asked how long he has to undergo the Immunosuppression therapy. The nurse best
response would be?
a.
b.
c.
d.
For life
24 hours after transplantation
A week after transplantation
Until the kidney is not anymore rejected
32. One month after a kidney transplant, Mr. Patrick returns to the hospital and is diagnosed as
having an acute rejection episode. Mr. Patrick says, I was doing so well with my new kidney and
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the thought of having to go back to living on hemodialysis is so disappointing. What is the
nurses best response?
a. You should remember that finding a donor for a new kidney is the easiest transplant option.
Our center is high on the list for obtaining organs for transplant from the national registry.
b. You should keep in mind that one acute rejection episode does not mean that you will lose
the new kidney. Usually, these episodes can be reversed with the right treatment.
c. You should be glad that at least hemodialysis is an option for you. Remember that people
whose liver transplants are rejected have no other options.
d. You should have followed your drug regimen better.
DIALYSIS
33. Mrs. Sanggalang, a female client with acute renal failure is undergoing dialysis for the first
time. The nurse in charge monitors Mrs. Sanggalang closely for dialysis equilibrium syndrome, a
complication that is most common during the first few dialysis sessions. Typically, dialysis
equilibrium syndrome causes:
a.
b.
c.
d.
weakness, tingling, and cardiac arrhythmias.

hypotension, tachycardia, and tachypnea.
confusion, headache, and seizures.
acute bone pain and confusion.
34. Shawn is receiving peritoneal dialysis because of his renal failure. His acid- base balance and
electrolytes are now within normal limits. Which of the following best explains the mechanism of
action of peritoneal dialysis?
a. Hypotonic fluid is instilled into the peritoneal cavity and waste products passively diffuse into
it.
b. Sodium and bicarbonate form the dialysate in the peritoneal cavity are exchanged for excess
potassium and hydrogen ions from the blood.
c. Increased intra- abdominal pressure caused by the dialysate solution in the abdomen creates
a filtration pressure similar to that in the kidney, causing wastes and electrolytes to move out of
the blood.
d. Glucose added to the dialysate solution increases the osmotic pressure of the dialysate,
causing fluid to move from the blood into the dialysate along with wastes and electrolytes.
35. The client who is receiving peritoneal dialysis has an outflow that is less than the inflow for
two consecutive exchanges. Which of the following action should the nurse take first?
a.
b.
c.
d.
Change the clients position

Check the clients blood pressure
Continue to monitor the third exchange
Irrigate the dialysis catheter
36. Edward, a 29-year-old diabetic, chose Continuous Ambulatory Peritoneal Dialysis (CAPD) as a
way of managing his end-stage renal disease. Edward chose CAPD because it helped him:
a.
b.
c.
d.
have control over his daily activities

control his blood pressure
avoid severe dietary restrictions
do all of the above
37.
Mr. Ken, a client diagnosed with End Stage Renal Disease is receiving a
peritoneal dialysis. Which assessment data would warrant immediate intervention by
the nurse on duty?
a. The dialysate being removed from the clients abdomen is clear
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b. The clients abdomen is soft, is non tender, and has bowel sounds
c. Inability to auscultate a bruit over a fistula
d. The dialysate instilled into the client was 1500 mL and that removed was1500 mL
38.
A nurse is providing dietary teaching to a client who was just started on
hemodialysis. Which instruction will the nurse provide to this client regarding protein
intake?
a.
b.
c.
d.
"You will need more protein now, because some protein is lost by dialysis."
"Your protein needs will not change, but you may take more fluids."
"You no longer need to be on protein restriction."
"Your protein intake will be adjusted according to your predialysis weight."
39. A patient returns to the intensive care unit following the placement of a new peritoneal
dialysis catheter. When performing peritoneal dialysis, Nurse Andy understands that with this
type of dialysis, the semipermeable membrane is the?
a. peritoneal lining
b. renal lining
c. abdominal contents
d. filter in the tubing
40. The physician encouraged the client to undergo hemodialysis, therefore an arteriovenous
fistula (AV fistula) was made for the client. Nursing care of this hemodialysis access includes:
a.
b.
c.
d.
Flushing the fistula with heparin solution every shift to maintain patency
Applying a pressure dressing after every blood draw from the AV fistula
Assessing the AV fistula for thrill and bruit every shift
Irrigating the tubing every 4 hours with normal saline
41. Mr. Gregorio was diagnosed to have kidney failure. As a mode of alleviating the signs and
symptoms associated with the disease, he was encouraged to have a hemodialysis. During the
session, Mr. Gregorio complains of dizziness and light-headedness. As a knowledgeable nurse,
which action should you implement first?
a.
b.
c.
d.
Bolus the client with 500 mL of normal saline.

Notify the health-care provider as soon as possible.
Place the client in the Trendelenburg position.
Turn off the dialysis machine immediately.
42. Nurse Bon teaches patient Donnie how to recognize signs and symptoms of infection in the
arteriovenous (AV) shunt by telling the patient to assess the shunt each day for
a.
b.
c.
d.
sluggish capillary refill time.

swelling at the shunt site.
absence of a bruit.
coolness of the involved extremity.
43. The nurse is preparing a nursing care plan for a patient with renal failure who is receiving
peritoneal dialysis. The nurse is aware that there is a risk for infection with this procedure. Which
of the following signs and symptoms would cause the nurse to suspect peritonitis?
a.
b.
c.
d.
confusion
urgency and frequency with voiding
disequilibrium syndrome
low-grade fever, abdominal pain, cloudy peritoneal drainage fluid
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44. The nurse is aware that certain interventions may help facilitate drainage of peritoneal
dialysis fluid during the peritoneal dialysis procedure. Which of the following actions by the nurse
is most appropriate in case the drainage is not flowing well during the procedure?
a. increasing the flow of the dialysate
b. placing warm heating pads on the abdomen
c. turning the patient from side to side, gently massaging the abdomen, elevating the head of
the bed
d. lying the patient flat in a prone position
45. Mr. Bob Marley who is receiving hemodialysis is being discharged home from the dialysis
center. Which instruction should the nurse teach Mr. Bob?
a.
b.
c.
d.
Encourage significant other to make decisions for the client.

Keep fingernails short and try not to scratch the skin.
Apply ice to the access site if it starts bleeding at home.
Notify the HCP if oral temperature is 102_F or greater.
46. During dialysis, nurse Cheng observes that the flow of dialysate stops before all the solution
has drained out. The appropriate intervention for nurse Cheng is to?
a.
b.
c.
d.
have the patient sit in a chair.

turn the patient from side to side.
reposition the peritoneal catheter.
have the patient walk.
URINARY TRACT INFECTIONS

47. After completing a comprehensive health history for a female client experiencing recurrent
urinary tract infections (UTI), a nurse determines that the client should be taught to reduce her
risk developing UTI by:
a.
b.
c.
d.
abstaining from sexual intercourse.

wearing good quality synthetic underwear.
taking tub baths rather than showers.
avoiding coffee and tea from her diet.
48. A 28-year-old female client seeks medical care for a possible infection. Her symptoms include
burning and pain on urination and frequent, urgent voiding of small amounts of urine. She is
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.
b.
c.
d.
phenazopyridine (Pyridium)
acetaminophen with codeine
ibuprofen (Motrin)
nitrofurantoin (Macrodantin)
49. Nurse Cyndy is assessing a 24-year-old woman who might have a urinary tract infection
(UTI). Which statement by the client suggests that UTI is likely?
a.
b.
c.
d.
I urinate large amounts.

I go for hours without the urge to urinate.
My urine has sweet smell.
It burns when I urinate.
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50. A client with a urinary tract infection is prescribed with Nalidixic acid (NegGram). On
evaluation of the client's record, the nurse notes that the client is taking warfarin sodium
(Coumadin) daily. As an efficient nurse, which prescription should you anticipate for this client?
a.
b.
c.
d.
A decrease in the usual dose of nalidixic acid (NegGram)

An increase in the warfarin sodium (Coumadin) dosage
A decrease in the warfarin sodium (Coumadin) dosage
Discontinuation of warfarin sodium (Coumadin)
51.
Nurse Melody identifies whom among the following hospitalized clients to be at
greatest risk for the development of a nosocomial urinary tract infection?
a. A 48-year-old suspected of Parkinsons disease who had been jogging prior to
admission.
b. A 75-year-old male who is undergoing chemotherapy for pancreatic cancer.
c. A 60-year-old obese female with cholecystitis
d. A 34-year-old male who drinks 2500 ml of fluids daily, following a fracture of a
fibula.
52. The nurse is studying the causes and risk factors of clients developing urinary tract infection.
The nurse is correct if which of the following clients is at greatest risk for developing a urinary
tract infection (UTI)?
a.
b.
c.
d.
An 18-year-old woman with asthma.

A 35-year-old woman with an arm fracture.
A 28-year-old woman with angina.
A 50-year-old postmenopausal woman.
53. The nurse is examining an 18-year-old female who is complaining of pain, frequency, and
urgency when urinating. After asking the parent to leave the room, which question should the
nurse asks the client?
a.
b.
c.
d.
What have you taken for the pain?

Are you sexually active?
Have you noticed any change in the color of the urine?
When was your last menstrual cycle?
54. Mrs. Nuqui, a female client in an outpatient clinic is being sent home with a diagnosis of
urinary tract infection (UTI). Which of the following instructions should the nurse teach Mrs.
Nuqui to prevent UTI recurrence?
a.
b.
c.
d.
Void immediately preceding sexual intercourse

Avoid coffee, tea, colas, and alcoholic beverages
Clean the perineum from back to front after a bowel movement
Take warm tub baths instead of hot showers daily
-LITHIASIS
55. Nurse James evaluates that a client, diagnosed with obstructing right ureterolithiasis, may
have passed the calculi in the urine when which outcome has been achieved?
a.
b.
c.
d.
Absence of colicky pain in the right lateral flank and groin

Absence of epigastric pain, nausea, and vomiting
No hematemesis or urinary tract infection (UTI)
Voiding clear amber urine greater than 30 ml per hour
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56. A client experiencing renal colic associated with nephrolithiasis was admitted to the medical
ward. The nurse on duty is preparing a plan of care for this client. Which of the following nursing
measures should receive priority in the clients care plan?
a.
b.
c.
d.
Monitor intake and output

Encourage ambulation
Strain urine
Administer morphine sulfate
57. A patient is admitted in the medical ward with a possible diagnosis of ureteral renal stone.
Which clinical manifestations would the nurse expect to assess for the client with a probable
diagnosis of this condition?
a.
b.
c.
d.
Nausea; vomiting; pallor; and cool, clammy skin.

Dull, aching flank pain and microscopic hematuria.
No symptoms.
Gross hematuria and dull suprapubic pain with voiding.
58. A patient is being discharged today after being treated for his calcium renal calculi. Which
statement indicates that the client diagnosed with calcium phosphate renal calculi understands
the discharge teaching for ways to prevent future calculi formation?
a.
b.
c.
d.
I
I
I
I
will walk about a mile every week and not exercise often.
should eat foods that contain cocoa and chocolate.
should increase my fluid intake, especially in warm weather.
should take one vitamin a day that has extra calcium.
59.
Which statement made by Manong Eddie who has kidney stones from
secondary hyperoxaluria indicates correct understanding of the role of dietary
therapy for his condition?
a.
b.
c.
d.
"I will avoid wine, meat, and shellfish."

"I will avoid all dairy products and vitamin D."
"I will avoid dark green leafy vegetables, chocolate, and nuts."
"No modifications are needed because this type of stone is not caused by diet"
60. The client admitted and diagnosed with a renal calculus has just returned from an
extracorporeal shock wave lithotripsy procedure and the nurse finds an ecchymotic
area on the clients right lower back. As a competent nurse, which is priority
intervention?
a.
b.
c.
d.
Documenting the observation as the only action

Applying ice to the site
Placing the client in the prone position
Notifying the physician
61. Nurse Archie is completing an admission assessment for a client suspected of having an
obstructing struvite calculus of the right ureter. During the assessment, which is the best
question for nurse Archie to ask the client?
a.
b.
c.
d.
Are you experiencing any left flank pain?

Do you like to drink cranberry, prune, or tomato juice?
Have you had a history of chronic urinary tract infections (UTIs)?
How often do you eat organ meats, poultry, fish, and sardines?
62. The patient with renal calculi was prescribed of Allopurinol, 200 mg/day to take at home.
Nurse Gardo is knowledgeable that he should explain to the patient about which of the following
side effects of this medication?
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a.
b.
c.
d.
Nasal congestion.
Maculopapular rash.
Dizziness.
Retinopathy.
63. A female patient with renal calculi also complains of pain in the groin and bladder, in addition
to nausea and severe flank pain. The nurse would conclude that these symptoms most likely
result from which of the following?
a.
b.
c.
d.
Nephritis.
Additional stone formation.
Referred pain.
Urine retention.
64.
The nurse is discussing to the patient who developed calculi due to increase
uric acid the modes of treatment for this kind of stone. Which drug will the nurse
administer to the client diagnosed with renal calculi from hyperuricemia?
a.
b.
c.
d.
Phenazopyridine (Pyridium)
Chlorothiazide (Diuril)
Captopril (Capoten)
Allopurinol (Zyloprim)
PYELONEPHRITIS
65. Which of the following symptoms would most likely indicate pyelonephritis?
a.
b.
c.
d.
Polyuria.
Ascites.
Nausea and vomiting.
Costovertebral angle tenderness.
66.
The nurse is collecting a nursing history from client admitted with acute
pyelonephritis. Which of the following question should Nurse Jing ask?
a.
b.
c.
d.
"Do you have pain when urinating?"

"Have you noticed any blood in your urine?"
"Do you find you are experiencing dribbling at the end of urinating?
"Have you experienced a decrease in your urinary output?"
67. The client diagnosed with chronic pyelonephritis is given a prescription for Bactrim,
trimethoprim sulfa, a sulfa antibiotic, twice a day for 90 days. Which statement is the scientific
rationale for prescribing this medication?
a.
b.
c.
d.
If the urine cannot be made bacteria free, the Bactrim will suppress bacterial growth
The physician is providing the client with enough medication to treat future infections
In three months the client should be rid of all bacteria in the urinary tract
The antibiotic will treat the bladder spasms that accompany a urinary tract infection
68. The nurse is caring for Karen who has a diagnosis of acute pyelonephritis. Which nursing
intervention is the most important?
a.
b.
c.
d.
Encouraging the client to drink cranberry juice to acidify the urine

Administering a sitz bath twice per day
Increasing fluid intake to 3 L/day
Using an indwelling urinary catheter to measure urine output accurately
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69. The nurse is caring for a 15-year-old pregnant client. The client weighs 106 lb and has a
history of pyelonephritis, which puts her at high risk for:
a.
b.
c.
d.
preterm labor
postterm labor
polyhydramnios
chromosomal abnormalities
CYSTITIS, URETHRITIS
70. The nurse teaches a patient who has cystitis methods to relieve her discomfort until the
antibiotic takes effect. Which of the following responses by the patient would indicate that she
understands the nurses instructions?
a.
b.
c.
d.
I
I
I
I
will
will
will
will
void every 5 to 6 hours.

take hot tub baths.
place ice packs on my perineum.
drink a cup of warm tea every hour.
71. A 29-year-old female patient comes to an ambulatory clinic in moderate distress with a
probable diagnosis of acute cystitis. Which of the following symptoms would the nurse most
likely expect the patient to report during the assessment?
a.
b.
c.
d.
Frequency and burning on urination.

Flank pain and nausea.
Fever and chills.
Hematuria.
72. A 52-year-old male client is seen by the physician for recurrent symptoms of cystitis. He is to
have a urine culture and sensitivity determination and a 24- hour urine collection for laboratory
analysis. The client should be informed that a urine culture study is required to:
a.
b.
c.
d.
Identify the causative organism

Analyze the elements present in the urine
Localize the site of the inflammatory process
Determine the presence of malignant cell
73.
The
client
with
severe
bacterial cystitis is prescribed to take cefadroxil (Duricef) and phenazopyridine
(Pyridium). What will the nurse teach this client regarding the drug regimen?
a.
b.
c.
d.
"Drink a liter of cranberry juice every day."

"Do not take these drugs with food or milk."
"Stop these drugs if you think you are pregnant."
"Do not be alarmed by the discoloration of your urine."
74.
a.
b.
c.
d.
Which client is at greatest risk for development of a bacterial cystitis?
Older male client with mild congestive heart failure

Middle-aged male client who is taking cyclophosphamide for cancer therap
Older female client not taking estrogen replacement
Middle-aged female client who has never been pregnant
75. The nurse correctly collects urine by which of the following methods to establish the
diagnosis of urethritis?
a. Collect all urine for 24 hours
b. Obtain the first voided specimen in the morning
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c. Obtain a specimen in the beginning and in the middle of the urine flow
d. Collect any voided specimen during the day
INCONTINENCE
76. Which of the following interventions would be most appropriate for a patient who has urge
incontinence?
a.
b.
c.
d.
Teach the patient intermittent self-catheterization technique.

Provide a bedside commode.
Have the patient urinate on a timed schedule.
Administer prophylactic antibiotics.
77. The primary goal of nursing care for a patient with stress incontinence is to
a.
b.
c.
d.
help the patient adjust to the frequent episodes of incontinence.

prevent the development of UTI.
eliminate all episode of incontinence.
decrease the number of incontinence episodes.
78. Which information would indicate to the nurse that teaching about treatment of urinary
incontinence has been effective?
a.
b.
c.
d.
The
The
The
The
client
client
client
client
explains how to perform pelvic floor exercises.

verbalizes the need to increase fluid intake.
attempts to retain the vaginal cone in place the entire day.
prepares a scheduled voiding plan.
NURSING PROCEDURES
79. The physician enters a computer order for the nurse to irrigate a client's nephrostomy tube
every four hours to maintain patency. The nurse irrigates the tube using sterile technique. After
irrigating the tube, the nurse decides that she can safely use the same irrigation set for her 8hour shift if she covers the set with a paper, sterile drape. This action by the nurse is:
a.
b.
c.
d.
appropriate because the irrigation set will only be used during an 8-hour period.
appropriate because the irrigation just checks for patency.
inappropriate because irrigation requires strict sterile technique.
inappropriate because the sterile drape must be cloth, not paper.
80. Which intervention would be the most important before attempting to catheterize a client?
a.
b.
c.
d.
Assess the clients sensation level and ability to void.

Verify that the client is not allergic to latex.
Evaluate the level of anxiety of the client.
Determine the clients history of catheter use.
81. A client with a genitourinary problem is being examined in the emergency department. When
palpating the client's kidneys, the nurse should keep in mind which anatomic fact?
a.
b.
c.
d.
The
The
The
The
average kidney is approximately 5 cm long and 2 to 3 cm wide.

kidneys are situated just above the adrenal glands.
kidneys lie between the 10th and 12th thoracic vertebrae.
left kidney usually is slightly higher than the right one.
82. The nurse is caring for an elderly client who has an indwelling catheter. Which data warrant
further investigation?
225
a.
b.
c.
d.
The
The
The
The
client has become confused and irritable.

clients temperature is 98.0F.
client has no discomfort or pain.
clients urine is clear and light yellow.
83.
An appropriate procedure for the nurse to use when pouching a non-continent
urinary diversion is to:
a.
b.
c.
d.
Remove the ureteral stents after 2 days

Dispose of the used pouches in the toilet
Empty the pouch when it is one-third to one-half full
Pouch the stoma with the client sitting up
84. Which intervention should the nurse implement when caring for the client with a
nephrostomy tube?
a.
b.
c.
d.
Clean the end of the tubing and the connecting tube with Betadine.
Assess the tube for kinks to prevent obstruction.
Clean the drainage system every day with bleach and water.
Change the dressing only if soiled by urine.
85.A client is experiencing a sudden decrease in systemic blood pressure. Which of

the following will occur within the kidney to help control this blood pressure drop?
a.
b.
c.
d.
Hydrostatic pressure will increase

Renal vessels will dilate
Glomerular filtration rate (GFR) will increase
Juxtaglomerular cells will release renin
86. The nurse should teach the patient with an ileal conduit to prevent urine leakage when
changing the appliance by using which of the following procedures?
a.
b.
c.
d.
Close the opening temporarily with a cellophane seal.

Avoid oral fluids for several hours before changing the appliance.
Insert a gauze wick into the stoma.
Suction the stoma before changing the appliance.
87. While assessing a patients urinary system, the nurse cannot palpate either
kidney. Which action should the nurse take next?
a.
b.
c.
d.
Document the information on the assessment form.

Obtain a urine specimen to check for hematuria.
Ask the patient about any history of recent sore throat.
Ask the health care provider about scheduling a renal ultrasound.
88. Shamu, with an ileal conduit, will be using a reusable appliance at home. The nurse should
teach the patient to clean the appliance routinely with which product?
a.
b.
c.
d.
Baking soda.
Soap.
Hydrogen peroxide.
Alcohol.
89.
Which of the following principles of catheter care should the nurse consider
before catheterizing a client?
a. Sprinkle powder in the perineal area and around the catheter insertion site.
b. Place a urinary catheter in a client who is geriatric to prevent urinary
226
incontinence.
c. Keep the catheter bag on the bed and at the level of the bladder.
d. Use a catheterization as a last resort.
DIAGNOSTIC PROCEDURES
90.
A large amount of protein in the urine was discovered when a patient used the
urine dipstick test. In relation to this result, the next action by the nurse should be?
a.
b.
c.
d.
Send a urine specimen to the laboratory to test for ketones and glucose.
Obtain a clean-catch urine for culture and sensitivity testing.
Check which medications the patient is currently taking.
Ask the patient about any family history of chronic renal failure.
91. Nurse Brenda is preparing a 24-year-old male client for an intravenous pyelogram (IVP).
Instructions imparted by Nurse Brenda must include clients restriction of?
a.
b.
c.
d.
Physical activity
Fluid intake
Use of any medications
Use of stimulants such as tobacco
92. The client has elevated blood urea nitrogen (BUN) level and an increased ratio of blood urea
nitrogen to creatinine. What is the nurses interpretation of these laboratory results?
a.
b.
c.
d.
The
The
The
The
client probably has a urinary tract infection

kidney may be hypoperfused
kidney may be damaged
client may be overhydrated
93. Nurse Barry is caring for Mr. Ron, a 51-year-old client who had undergone a renal biopsy. As
an efficient and competent nurse, Nurse Barry should observe Mr. Ron for signs/symptoms of?
a.
b.
c.
d.
Bleeding
Increased blood pressure
Changes in mental status
Increased activity
94.
The patient was ordered by the physician to undergo urine testing using
reagent strips. The nurse caring for this client would be correct if stated that an
appropriate procedure for urine testing with reagent strips for chemical properties of
the sample is to:
a.
b.
c.
d.
Obtain the first voided specimen in the morning

Place the strip in the urine and leave it in the sample for 3 minutes
Add a chemically active tablet to the urine and then test it with a reagent strip
Compare the color strip with the chart on the bottle at specified time intervals
95.
The patient suspected to have urethritis was admitted yesterday in the medical
ward and was ordered by the resident on duty (ROD) for urine testing. The nurse
correctly collects urine by which of the following methods to establish the diagnosis of
urethritis?
a.
b.
c.
d.
Collect any voided specimen during the day.

Collect all the urine for 24 hours.
Obtain the first voided specimen in the morning.
Obtain a specimen in the beginning and in the middle of the urine flow.
227
96.
Mr. Freeza was ordered by the physician to have double-voided urine
specimen. To obtain a double-voided urine specimen, the nurse should instruct the
client to:
a.
b.
c.
d.
Discard the first sample, then wait half an hour and void again
Void first and then self-catheterize to obtain the specimens
Save two separate specimens from the first voiding in the morning
Add two specimens together from the morning and evening voiding
97. The client is reporting chills, fever, and left costovertebral pain. Which diagnostic test would
the nurse expect the physician to order first?
a.
b.
c.
d.
An intravenous pyelogram for renal calculi

A CT scan of the kidneys
A sonogram of the kidney
A midstream urine for culture
98. A client is scheduled for a renal clearance test. The nurse should explain that this test is done
to assess the kidneys' ability to remove a substance from the plasma in:
a.
b.
c.
d.
24 hours
30 minutes
1 minute
1 hour
99. A female client with suspected renal dysfunction is scheduled for excretory urography. Nurse
Yorak reviews the history for conditions that may warrant changes in client preparation.
Normally, a client should be mildly hypovolemic before excretory urography. Which history
finding would call for the client to be well hydrated instead?
a.
b.
c.
d.
Gout
Myasthenia gravis
Cystic fibrosis
Multiple myeloma
100. 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.
b.
c.
d.
check the clients pedal pulses frequently.

apply pressure to the puncture site for 30 minutes.
remove the dressing on the puncture site after vital signs stabilize.
keep the clients knee on the affected side bent for 6 hours.
228
ANSWERS AND CONCEPT ILLUMINATIONS
229
1. ANSWER: C.
CONCEPT ILLUMINATION
Nephrotic syndrome can be caused by systemic illness, glomerulonephritis or an acute allergic
response. It involves a collection of symptoms such as marked proteinuria, generalized edema,
hypoalbuminemia and hypercholesteronemia. Medical management includes steroids, diuretics
and immunosuppressives. Corticosteroids such as Prednisone helps in reducing proteinuria, thus
alleviates edema and functions to decrease the inflammation. Diuretics aid in fluid excretion
thereby minimizing edema experienced by the client.
2. ANSWER: D.
The highest priority of the nurse during a childs long-term steroid therapy is infection
prevention. Steroids can mask infection and it also suppresses the normal immune response,
therefore, for children who must take long-term steroids, one way to control infections is to keep
them away from others who are ill or infectious. This precaution is necessary because routine
immunizations must be delayed while on steroid therapy. Gastric distress is a known side effect
of long-term therapy. Attempts to prevent this side effect from becoming a complication of the
drug therapy include taking the medication with food. Weight gain is also considered a known
side effect of long-term steroid therapy. Attempts to prevent this side effect from becoming a
complication of the drug therapy include restricting the sodium content in the diet. Another side
effect is hyperglycemia. Prevention of this side effect includes decreasing sweets and sugars in
the diet. In some instances, insulin therapy may be needed to decrease the hyperglycemia.
3. ANSWER: C.
Flank pain in a patient with nephrotic syndrome may indicate renal vein thrombosis,
thus anticoagulant medications are needed. Antibiotics are used to treat a patient
with flank pain caused by pyelonephritis. Antibiotics are not used to treat flank pain
caused by nephrotic syndrome. Antihypertensives are used if the patient has high
blood pressure. Corticosteroids may be used to treat nephrotic syndrome by
decreasing proteinuria but will not resolve a thrombosis.
4. ANSWER: B.
One of the classic signs of acute glomerulonephritis of sudden onset is Periorbital edema. 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.
5. ANSWER: C.
All of the following are the recommended treatments for acute glomerulonephritis (AGN) except
giving the client a high in potassium diet. Remember that the diet of a client with AGN should be
low in potassium (not high).
6. ANSWER: A.
Laboratory findings common in a client with acute glomerulonephritis include Proteinuria, colacolored urine because of hematuria, thick sediments of RBC, WBC and all kinds of casts and
increased Anti-streptolysin O titers (ASO titers). Patients with acute glomerulonephritis do not
usually have polyuria in their laboratory findings.
7. ANSWER: B.
The normal Glomerular filtration rate (GFR) is approximately 120 mL per minute. If the GFR is
decreased to 40 mL per minute, the kidneys are functioning at about one-third filtration capacity,
which indicates the clients condition has gotten worse. Normal blood urea nitrogen (BUN) levels
230
are 7-18 mg/dL or 8-20 mg/dL for clients older than age 60 years. Normal creatinine levels are
0.6-1.2 mg/dL. Normal creatinine clearance is 85-125 mL per minute for males and 75-115 mL
per minute.
8. ANSWER: C.
Hemolytic streptococci (Group A Beta hemolytic streptococci), common in throat infections, can
initiate an immune reaction that damages the glomeruli causing glomerulonephritis. Tub baths
may be linked to urethritis not glomerulonephritis. Fluid restriction is moderated and adjusted as
the client improves: fluid intake helps prevent urinary stasis. Activity helps prevent urinary stasis
and therefore encouraged.
9. ANSWER: A.
The PRN Sublingual Procardia must be given immediately to lower the clients blood
pressure as quickly as possible to prevent aggravation and complications of the
disease condition, and this should be the nurses first priority. Administration of oral
diuretics may also be done, but oral diuretics do not work as rapidly as the sublingual
antihypertensive. When notifying the physician, the first thing he/she will want to
know is if the PRN antihypertensive has been administered. Attempting to calm the
client would be ineffective during this time; therefore, administration of the PRN
medication should be immediately done.
10. ANSWER: D.
Protein breaks down into urea and nitrogenous wastes, which increases the workload of the
kidneys. Therefore minimizing protein would be helpful in preventing nitrogenous wastes
deposition in the body (azotemia) at the same time decreasing the burden exerted to the
kidneys. The other options do not explain the reason for decreasing protein in the clients diet.
11. ANSWER: B.
Anemia is one of the usual complications of end stage renal disease (ESRD). Due to the damage
kidneys in ESRD, it fails to secrete erythropoietin, which is responsible in blood production in the
bone marrow causing anemia. As a nurse, you would anticipate that the physician would order
erythropoietin to stimulate the bone marrow to produce RBCs thereby alleviating anemia.
Erythropoietin is a biologic response modifier produced by the kidneys in response to a low red
blood cell count in the body. It stimulates the body to produce more RBCs.
12. ANSWER: D.
Intrinsic renal failure (intra-renal) results from direct damage to the kidneys, such as from
nephrotoxic injury caused by contrast media, antibiotics, corticosteroids, or bacterial toxins. Poor
perfusion to the kidneys may result in prerenal failure. Damage to the epithelial cells of the renal
tubules results from nephrotoxic injury, not damage to the adrenal cortex. Obstruction of the
urinary collecting system may cause post-renal failure.
13. ANSWER: A.
The kidneys need to produce vitamin D for the gastrointestinal system to absorb calcium.
Because in chronic renal failure the kidneys lose the capability to activate vitamin D, calcium is
not absorbed resulting to hypocalcemia. The low calcium triggers the release of parathyroid
hormone, which also releases phosphate, contributing to the high phosphate levels.
Erythropoietin is a hormone produced by the kidneys that affects the red blood cell. Low calcium
levels are not related to an osmotic diuresis.
14. ANSWER: C.
231
Decreased serum calcium, blood pH 7.2, potassium 6.5 mEq/L are usually seen on the laboratory
findings of a client with chronic renal failure. Chronic renal failure is usually the end result of
gradual tissue destruction resulting to loss of renal function. With the loss of renal function, the
kidneys ability to regulate fluid and electrolyte levels will result to problems in acid base balance.
Serum Ca decreases as the kidneys fail to produce vitamin D causing hypocalcemia;
furthermore, the parathyroid hormone is stimulated in response to the low calcium levels, which
also triggers the release of phosphate, elevating the serum phosphate levels. Because of this
phenomenon, potassium and hydrogen ions are retained causing acidosis and hyperkalemia.
15. ANSWER: B.
The normal serum protein is 6.0 to 8.0 g/dL. In end stage renal disease (ESRD), clients often
have low plasma protein from malnutrition and protein restriction. This reduces plasma oncotic
pressure (pressure that pulls back the fluid into the capillaries) resulting to fluid retention in the
interstitial space. Although edema can result from increased capillary hydrostatic pressure,
decreased plasma oncotic pressure, and increased capillary permeability, the low serum protein
suggests reduced plasma oncotic pressure is the most likely cause of the edema. Because the
clients kidneys are unable to excrete electrolytes, a higher level of serum electrolytes (not
decreased serum electrolytes) is present in ESRD.
16. ANSWER: D.
In chronic renal failure the hormone, erthythropoietin, which stimulates red blood cell
production, is not produced. Because of this occurrence, Epogen is prescribed by the
physician to stimulate RBC production in the bones to alleviate anemia. Hemodilution
can produce a drop in hematocrit; however, sodium would also be lower, which is not
in this case because it is stated that the electrolytes of the client are within normal
limits. Renal clients need to monitor their protein intake. Hemolysis does not occur
as RBCs do not move outside the clients own blood vessels.
17. ANSWER: A.
A urine output, which remains near-normal levels, is categorized as non-oliguric form
of acute renal failure. The clients urine output is 1000ml/day, which is near normal
levels, therefore he is considered under non-oliguric type of ARF.
18. ANSWER: B.
Pre-renal kidney disease is characterized by a decrease blood flow to the kidney. These
include systemic causes, such as low blood volume, low blood pressure, thrombosis, embolism
and heart failure, as well as local changes to the blood vessels supplying the kidney. A crushing
lower leg fracture predisposes the client to thrombosis and embolism, which can cause pre-renal
kidney disease.
19. ANSWER: A.
Postrenal renal failure is identified by focusing on urinary obstructive problems.
Symptoms include changes in the urine stream or difficulty starting urination and
feelings of urgency. This may be related to benign prostatic hyperplasia, kidney stones,
obstructed urinary catheter, bladder stone and ureteral or renal malignancy.
20. ANSWER: B.
Hypovolemia, wide fluctuations in serum sodium and potassium levels would be seen in the
second phase of acute renal failure. The second phase of ARF is known as the diuretic phase or
high output phase. The diuresis can result in an output of up to 10L/day of diluted urine. Fluids
and electrolytes loss could occur during this phase, which causes hypovolemia at the same time
fluctuations in electrolyte levels especially potassium and sodium.
232
21. ANSWER: A.
ANSWER: A
The correct response by the nurse would be based from the fact that oliguric phase of acute
renal failure usually lasts one to two weeks.
22. ANSWER: C.
Usually the amount of protein permitted in the diet for clients with renal failure (usually below
50g) depend on the extent of kidney function: excess protein causes an increase in urea
concentration (waste products), which should be avoided because it can further stress the
kidneys. Adequate calories are also provided to prevent tissue catabolism that also results in an
increase in metabolic waste products. A low protein diet is prescribed to decrease the amount of
waste products handled by the damaged kidneys. Urea is a waste product of protein metabolism.
In clients with kidney failure, the kidneys are incapable in eradicating the waste products of a
high protein diet such as urea.
23. ANSWER: D.
Hypotension, which causes a decreased blood supply (hypoperfusion) to the kidneys, is one of
the most common causes of pre-renal failure. Due to the insufficient blood flow to the kidneys, a
decrease in renal perfusion would occur, causing failure of the kidneys to function (pre-renal
failure).
24. ANSWER: C.
Polystyrene sulfonate, a cation-exchange resin, causes the body to excrete potassium through
the GIT or feces. In the intestines, particularly the colon, the sodium of the resin is partially
replaced by potassium. The potassium is then eliminated when the resin is eliminated with the
feces. Although the result is to increase potassium excretion, the specific method of action is the
exchange of sodium ions for potassium ions.
25. ANSWER: B.
The normal urine output per hour is 30 ml. In 24 hours the urine output must range from 720ml1440ml, therefore a 24-hour urine output 240ml is too small. As urine output decreases, the
serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering
cardiac arrhythmias.
26. ANSWER: C.
A client with chronic renal failure is at risk for fluid imbalance, dehydration if the kidneys fail to
concentrate urine or fluid and sodium retention if the kidneys fail to produce urine due to
decrease glomerular filtration rate. 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, and secondary to inability of the kidneys to excrete hydrogen ions.
27. ANSWER: D.
Common causes of acute renal failure are renal ischemia precipitated by hypovolemia or heart
failure and crushing injury. Ileostomy clients do not experience hypovolemia to the extent that
would lead to renal failure. Clients with pancreatitis are not known to develop renal failure.
Femoral fractures are more likely to lead to fat embolism rather that renal failure.
28. ANSWER: B.
233
Cyclosporine has known to have immunosuppressive effects and is thereby used to halt the
immune system after an organ transplant to prevent acute organ rejection. Its
immunosuppressive effects prevent autoimmune responses, which could lead to the rejection of
the transplanted organ such as the kidneys. Because of the drugs capability to alter the immune
response, it predisposes the client from infection.
29. ANSWER: D.
Antithymocyte globulin (ATG) is used to induce immunosuppression immediately after an organ
transplant. Its purpose is to bind with the peripheral lymphocytes and mononuclear cells to
remove them from circulation and prevent them from being able to reject the new organ.
30. ANSWER: C.
Azathioprines (Imuran), Prednisones or Cyclosporines (Sand Immune) are given in clients that
have undergone kidney transplantation in order to suppress their immune responses thereby
preventing acute organ rejection.
31. ANSWER: A.
Immunosuppression therapy for a client with kidney transplantation would be continued for life.
This is to prevent rejection of the transplanted organ and at the same time prolong the effect of
the new organ. Because this therapy last a lifetime, clients undergoing this therapy is always at
risk for infection, therefore, infection precautions are always encouraged in the care for these
clients.
32. ANSWER: B.
An episode of acute rejection does not automatically mean the client will lose the transplanted
organ. Proper management and immediate interventions could reverse the rejection.
Pharmacologic manipulation of host immune responses at this time can limit damage to the
organ thereby allowing the graft to be maintained.
33. ANSWER: C.
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.
34. ANSWER: D.
This is the correct explanation of peritoneal dialysis (PD), in which it removes toxic substances
from the body. In peritoneal dialysis, glucose is added to the dialysate solution to increase the
osmotic pressure of the dialysate thereby causing the fluid to move from the blood into the
dialysate along with wastes and electrolytes. Peritoneal Dialysis can be dangerous and may
cause death if not done with adequate supervision of body fluid and electrolyte balance.
35. ANSWER: A.
In peritoneal dialysis, normally, the outflow is more than the inflow because the outflow already
contains the substances, which must be excreted from the body such as waste products and
excess fluids. If the outflow is less than the inflow, the nurse should change the position of the
client to shift abdominal fluid and hopefully move the catheter into contact with the fluid in the
abdomen. Although vital signs are monitored, the blood pressure is not a concern at this time.
The catheter does not need to be irrigated at this situation. Monitoring the third exchange is an
assessment, but this does not correct the current nursing problem.
234
36. ANSWER: D.
Continuous Ambulatory Peritoneal Dialysis (CAPD) is a form of dialysis treatment that is
performed at home. Treatments can be done as you go about your regular daily activities. You
are not restricted by the use of a machine. CAPD allow you to be independent and to perform
treatments on a flexible schedule. By choosing Continuous Ambulatory Peritoneal
Dialysis (CAPD), severe dietary restrictions are avoided, blood pressure is well
maintained and daily activities are controlled by the patient.
37. ANSWER: D.
Because the client has an End Stage Renal Disease (ESRD), which is characterized by
fluid retention, the excess fluid must be removed from the body so the output of the
dialysis should be more than the amount instilled. If the inflow is equal to the outflow
or the inflow is more than the outflow, an immediate intervention by the nurse is
needed. Peritoneal dialysis is administered through a catheter inserted into the
peritoneal cavity; a fistula is used for hemodialysis. Peritonitis, which is characterized
by the inflammation of the peritoneum, is a serious complication that would result in
a hard, rigid abdomen. Therefore, a soft abdomen would not warrant immediate
intervention. The dialysate return is normally colorless or straw-colored, but it should
never be cloudy, which indicates an infection.
38. ANSWER: A.
When renal disease has progressed and requires treatment with dialysis, increased
protein is prescribed in the diet to compensate for protein losses through dialysis.
39. ANSWER: A.
In peritoneal dialysis, the peritoneum is considered the semipermeable membrane. Therefore,
clients who undergo peritoneal dialysis have a high risk in developing peritonitis (rigid board- like
abdomen) because the peritoneum is used as the semi permeable membrane.
40. ANSWER: C.
The venous access site must be evaluated at least every 8 hours (every shift) for the presence of
bruit and thrill. Absence of a palpable thrill or audible bruit may indicate blockage or clotting in
the access device. Clotting can occur if the patient has an infection anywhere in the body (serum
viscosity is increased) or if the blood pressure has decreased. No blood should be drawn from the
AV fistula nor should any constricting bands or pressure dressings be applied on the site. No
medications or injections should be administered via the AV fistula other than what is
administered during the dialysis session. The AV fistula is a surgically constructed hemodialysis
access beneath the skin. There is no tubing except for dialysis sessions.
41. ANSWER: C.
The nurse should place the clients chair with the head lower than the body or with the foot part
elevated, which will shunt blood to the brain, which will cause increase in brain tissue perfusion;
this is the Trendelenburg position. Placing the patient in the trendelenberg position may alleviate
the dizziness and lightheadedness felt by the client.
42. ANSWER: B.
Signs of an external access shunt infection include redness (rubor), heat (calor), pain or
tenderness (dolor), swelling (tumor), and drainage from around the shunt site. The absence of a
bruit indicates closing or obstruction of the shunt. Sluggish capillary refill time and coolness of
the extremity indicates decreased blood flow to the extremity.
235
43. ANSWER: D.
Peritonitis is a grave, but manageable, complication of peritoneal dialysis. It is characterized by
the inflammation of the peritoneum. Signs of peritonitis include low-grade fever, abdominal pain
when fluid is being inserted (rigid board-like abdomen), and cloudy peritoneal drainage fluid.
44. ANSWER: C.
If the fluid drains slowly, the catheter tip may be buried in the omentum or clogged with fibrin.
Turning the patient from side to side, elevating the head of the bed, and gently massaging the
abdomen may facilitate proper drainage of the dialysis fluid.
45. ANSWER: B.
Uremic frost is a complication of kidney failure, which results when the skin attempts to take
over the function of the kidneys. The skin tries to release the excess urea through skin pores,
thereby causing urea deposition in the skin (uremic frost). This condition is characterized by skin
itchiness and scratching the skin may result in skin breakage. Alteration in the skin integrity may
cause infection.
46. ANSWER: B.
Fluid return with peritoneal dialysis is usually accomplished by gravity flow. Actions that improve
gravity flow include turning the client from side to side, elevating the head of the bed, and
slightly massaging the abdomen. The client is usually confined to a recumbent position during
the dialysis. The nurse should not attempt to reposition the catheter.
47. ANSWER: D.
Caffeine-containing beverages, such as coffee, tea, and cocoa, and alcoholic beverages are
considered bladder irritants and therefore should be avoided. Beverages containing caffeine are
proven to increase the risk for developing urinary tract infections. Showers, rather than tub
baths, are recommended. Synthetic underwear and constricting clothing, such as tight jeans and
leggings, should be avoided. Abstinence is unnecessary although the client should urinate after
intercourse to possibly flush out microorganisms in the urinary meatus.
48. ANSWER: A.
Phenazopyridine (Pyridium) 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. Nitrofurantoin is a urinary antiseptic
with no analgesic properties. While ibuprofen and acetaminophen with codeine are analgesics,
they do not exert a direct and specific effect on the urinary mucosa.
49. ANSWER: D.
Urinary Tract Infection is usually characterized by dysuria (painful urination) or burning sensation
during urination. Voiding large volumes of urine is not associated with UTI. The client with UTI
often reports frequent voiding of small amounts of urine (not large amounts). The client with a
UTI may also complain of feelings of urgency to void. When an infection is present, the urine
may be foul smelling. Urine with a sweet acetone odor is often associated with diabetic
ketoacidosis.
50. ANSWER: C.
Nalidixic acid, in lower concentrations, acts as a bacteriostatic agent; meaning, it inhibits growth
and reproduction of certain microorganisms. In the other hand, when used in higher
236
concentrations, it acts as a bactericidal agent, which is, killing bacteria instead of merely
inhibiting their growth. Nalidixic acid can intensify the effects of oral anticoagulants such as
warfarin by displacing these agents from binding sites on plasma protein. When nalidixic acid is
combined with an oral anticoagulant, a decrease in the anticoagulant dosage may be necessary.
51. ANSWER: B.
Although nosocomial urinary infections may occur in any hospitalized client, the
incidence is significantly increased by the clients overall state of health. A client who
is old, male, and has a terminal cancer receiving chemotherapy is usually
immunosuppressed because of treatments (chemotherapeutic drugs) and therefore at
greatest risk in developing nosocomial infection.
52. ANSWER: D.
Women after menopausal stage are usually more prone to urinary tract infection. As a woman
ages, urinary stasis may develop due to a loss of pelvic muscle tone and prolapse (displacement
or dropping) of the bladder or uterus. Reduced estrogen levels in the menopausal stage may
lead to decreased levels of vaginal Lactobacilli bacteria, which protect the urinary tract against
infection. A decreased in these lactobacilli increases the risk for a woman to develop UTI. In
addition, several chronic diseases such as diabetes mellitus and impaired immunity increase the
risks for UTI development. Angina, asthma, and fractures do not increase the risk of UTI.
53. ANSWER: B.
The presenting symptoms are associated with cystitis, a bladder infection that may be caused by
sexual intercourse resulting from the introduction of bacteria into the urethra during the
physical/sexual act. A teenager may not want to divulge this information in front of the parent or
guardian. The nurse in front of a parent can ask the other choices (pain relief interventions, color
changes in urine, last menstrual cycle) without affecting the accuracy of the clients answer.
54. ANSWER: B.
Coffee, tea, cola, and alcoholic beverages (caffeine containing products) are urinary tract
irritants and therefore should be avoided in preventing UTI recurrence. The perineum should be
cleaned from front to back after a bowel movement to prevent fecal contamination of the
urethral meatus (not back to front). Clients are encouraged to take showers instead of tub baths
to prevent bacteria in the bath water from entering the urethra and urinary meatus. Voiding
immediately after, not before, sexual intercourse flushes out bacteria from the urethra that
might have been introduced during sexual act.
55. ANSWER: A.
Ureterolithiasis is a condition characterized by a calculus obstructing the ureter. Symptoms of
ureteral urinary stone obstruction (ureterolithiasis) include abdominal or flank pain (usually
severe), hematuria, and renal colic. As the stone moves along the ureter, it produces flank pain
radiating to the genitalia and groin. The pain is from the spasm of the ureter and ureter wall
anoxia from the pressure of the stone. The absence of the colicky pain indicates the stone may
have been excreted. The kidneys will continue to produce urine and the client should be voiding
at least 30 mL per hour even with the presence of calculi. Hematemesis may occur accompanied
with gastrointestinal problems but absence of these symptoms does not mean that the stones
are already excreted. UTI may occur from the calculis irritation to the ureter, but an absence of
UTI does not mean the stone has been excreted in the urine. Although nausea and vomiting are
signs and symptoms associated with ureterolithiasis, epigastric pain is common for clients who
have cholelithiasis.
56. ANSWER: D.
237
Renal colic is an excruciating pain that occurs when a stone passes into the ureter, therefore the
priority of the nurse is to alleviate the pain being experienced by the patient. Straining the urine,
monitoring intake and output, and encouraging ambulation are all appropriate interventions in
the management of renal calculi, but administering an analgesic takes the highest priority for a
client experiencing renal colic.
57. ANSWER: A.
Ureteral renal stone (ureterolithiasis) is a stone formed at the ureters, which causes severe flank
pain with possible radiation to the adjacent areas like the groin and genitalia. The severe flank
pain associated with a stone in the ureter often causes a sympathetic response with associated
nausea; vomiting; pallor; and cool, clammy skin.
58. ANSWER: C.
An increased fluid intake that ensures 23 L of urine a day prevents the stone-forming salts from
becoming concentrated enough to precipitate a calcium phosphate calculi formation. Increasing
the oral fluid intake helps dilute the blood and the urine thus preventing calcium stone
formations.
59. ANSWER: C.
Secondary hyperoxaluria (excessive oxalate) is caused by too much ingestion of foods
containing large amounts of oxalate, such as spinach, rhubarb, Swiss chard, collard
greens, cocoa, beets, wheat germ, pecans, peanuts, okra, chocolate, and lime peel.
Dairy products and excessive vitamin D predisposes the client to calcium phosphate
stone formation (not oxalate), while wine, meat and shellfish increases the risk for uric
acid stones development (not oxalate).
60. ANSWER: B.
The shock waves can cause bleeding into the tissues through which the waves pass
resulting to ecchymosis (bruising). Application of ice causes vasoconstriction, which
could minimize the extent and discomfort of bruising and bleeding.
61. ANSWER: C.
A frequent UTI is a predisposing factor in developing struvite stones (type of alkaline stones) and
therefore the best question for the nurse to ask during admission assessment. These stones are
commonly referred to as infection stones because they form in alkaline urine that is rich in
ammonia. Though assessing pain is a priority, pain associated with a calculus in the right ureter
would be in the right (not left) flank. The client with struvite stones would be instructed to
increase intake of cranberries, prunes, plums, and tomatoes because they acidify the urine (acidash diet) because struvite is an alkaline stone. Juice preference is a good question to ask the
client when planning health teachings but is not the best question during the admission
assessment. Organ meats, poultry, fish, gravies, red wines, sardines, goose, and venison are
high in purines and associated with uric acid stones not struvite stones.
62. ANSWER: B.
To treat renal calculi composed of uric acid, allopurinol is usually used. Some of the 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. Retinopathy, nasal congestion, and dizziness are not side
effects of allopurinol.
63. ANSWER: C.
238
The pain associated with renal colic due to calculi formation is often referred to the groin and
bladder in female clients and to the testicles in male clients. This is known as referred pain.
Referred pain, also known as reflective pain is defined as pain perceived at a location other than
the site of the painful stimulus. Nausea, vomiting, abdominal cramping, and diarrhea may also
be present in conjunction with renal calculi formation.
64. ANSWER: D.
Allopurinol inhibits the enzyme that converts purine metabolites into uric acid,
thereby reducing the amount of uric acid present in the system, which could
precipitate into stones. The other drugs listed would not be effective.
65. ANSWER: D.
Common symptoms of pyelonephritis include CVA tenderness, burning, urinary urgency or
frequency, chills, fever and fatigue.
66. ANSWER: A.
Dysuria, or painful urination, does occur in acute pyelonephritis. Blood in the urine
and dribbling at the end of urinating are not clinical manifestations. An increased
urinary output, and not a decreased output, occurs in pyelonephritis.
67. ANSWER: A.
Some clients develop a chronic infection and must receive antibiotic therapy as a routine daily
medication to suppress the bacterial growth. The prescription will be refilled after the 90 days
and continued. Physicians do not usually give PRN prescriptions for antibiotics. Clients who
develop chronic infections may never be free of the bacteria. Antibiotics may be indirectly treat
bladder spasms are caused by an infection, but this is not the reason for prescribing the
antibiotic in this manner.
68. ANSWER: C.
Acute pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or
both kidneys. Infecting bacteria are normal intestinal and fecal floras that grow readily in urine.
Encouraging the client to drink cranberry juice to acidify urine is helpful but is not the most
important intervention. Administering a sitz bath would increase the likelihood of fecal
contamination. Using an indwelling urinary catheter could cause further contamination. The most
important nursing intervention is to increase fluid intake to 3L per day. Doing so helps empty the
bladder of contaminated urine and prevents calculus formation.
69. ANSWER: A.
This client has three risk factors for preterm labor: age younger than 16, pyelonephritis, and
weight of less than 110 lb. These risk factors are not associated with polyhydramnios,
chromosomal abnormalities, or postterm labor.
70. ANSWER: B.
Hot tub baths promote relaxation and help relieve urgency, discomfort, and spasm. Applying
heat to the perineum is more helpful than cold because heat reduces inflammation.
71. ANSWER: A.
The classic symptoms of cystitis are severe burning, urgency, and frequent urination. Systemic
symptoms such as fever and nausea and vomiting, are more likely to accompany pyelonephritis
than cystitis. Hematuria may occur, but it is not as common as frequency and burning.
239
72. ANSWER: B.
A urine culture determines bacterial count and identifies infecting bacteria for best choice of
antibiotic. A bacterial count of more than 100,000 indicates treatable infection. Sensitivity may
be added to the culture to determine antibacterial sensitivity or resistance. This is especially
important in recurrent or complicated infections.
73. ANSWER: D.
Phenazopyridine discolors urine most commonly to deep reddish orange. Many clients
think they have blood in their urine when they see this. In addition, the urine can
permanently stain clothing.
74. ANSWER: C.
Females, at any age, are more susceptible to cystitis than men because of their
shorter urethra. The middle-aged female client who has never been pregnant would
not have a risk potential as high as the older female client who is using hormone
replacement therapy. Postmenopausal women who are not on hormone replacement
therapy are at an increased risk for bacterial cystitis because of changes in the cells of
the urethra and vagina.
75. ANSWER: C.
Obtaining a urine specimen in the beginning and again in the middle of the urine flow (split urine
collections) for the purpose of performing a culture is the correct procedure for diagnosing
urethritis.
76. ANSWER: A.
Instructing the client to void at regularly scheduled intervals can help decrease the frequency of
incontinence episodes. Providing a bedside commode does not decrease the number of
incontinence episodes and does not help the client who lead an active lifestyle.
77. ANSWER: C.
The primary goal of nursing care is to decrease the number of incontinence episodes and the
amount of urine expressed in an episode. Behavioral interventions and medications are the
nonsurgical management methods used to treat stress incontinence.
78. ANSWER: D.
There are several plans for training the bladder to decrease frequency and incontinence. One
plan is to schedule each voiding 2 to 3 hours apart, and when the client has remained
consistently dry, the interval is increased by about 15 minutes.
79. ANSWER: C.
Irritating a nephrostomy tube requires strict sterile technique; therefore, reusing the irrigation
set (even if covered by a sterile drape) is inappropriate. Bacteria can proliferate inside the
syringe and irrigation container. The material in which the sterile drape is made is irrelevant
because a sterile drape does not deter bacterial growth in the irrigation equipment.
80. ANSWER: B.
The nurse should always assess for allergies for latex prior to inserting a latex catheter or using
a drainage system because if the client is allergic to latex, use of it could cause a life-threatening
reaction. This is the most important intervention.
240
81. ANSWER: D.
The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each
kidney. The average kidney measures approximately 11 cm long, 5 to 5.8 cm wide, and 2.5 cm
thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on
either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar
vertebrae.
82. ANSWER: A.
When an elderly clients mental status changes to confused and irritable, the nurse should seek
the etiology, which may be a UTI secondary to an indwelling catheter. Elderly clients often do not
present with classic signs and symptoms of infection.
83. ANSWER: C.
Pouches should be emptied when one-third to one-half full because weight of urine in
pouch may weaken or dislodge skin seal. Immediately after surgery, ureteral stents
are in place and remain for up to 10 to 14 days. The physician then removes the
stents. Properly dispose of used pouch and soiled equipment according to facility
policy. Position client standing or supine and drape. Some clients may prefer to do
pouch change while sitting because this may make it easier for them to see stoma.
However, when skin barrier and pouch are applied in sitting position, skin may have
folds and wrinkles.
84. ANSWER: B.
The nephrostomy tube should never be clamped or have kinks because an obstruction can cause
pyelonephritis.
85. ANSWER: D.
A drop in systemic blood pressure often triggers the juxtaglomerular cells to release
renin. Renin acts on angiotensinogen to release angiotensin I, which is in turn
converted to angiotensin II. Angiotensin II activates vascular smooth muscle
throughout the body, which causes systemic blood pressure to rise. Thus, the renin
angiotensin mechanism is a factor in renal autoregulation, even though its main
purpose is the control of systemic blood pressure.
86. ANSWER: C.
Inserting a gauze wick into the stoma helps prevent urine leakage when changing the appliance.
The stoma should not be sealed or suctioned. Oral fluids do not need to be avoided.
87. ANSWER: A.
The kidneys are protected by the abdominal organs, ribs, and muscles of the back and
may not be palpable under normal circumstances, so no action except to document
the assessment information is needed. Asking about a recent sore throat, checking for
hematuria, or obtaining a renal ultrasound may be appropriate when assessing for
renal problems for some patients, but there is nothing in the stem to indicate that
they are appropriate for this patient.
88. ANSWER: B.
A reusable appliance should be routinely cleaned with soap and water.
241
89. ANSWER: D.
Catheterization may be used as a last resort after all noninvasive measure to promote
urination, such as encouraging ambulation and fluids, have failed. Catheterization
should not be used for clients who are geriatric to prevent urinary incontinence. The
catheter bag should always be kept below the level of the bladder. Applying powder
to the perineal area and around the catheter insertion site should never be used,
because this practice promotes infection.
90. ANSWER: C.
Normally the urinalysis will show zero to trace amounts of protein, but some
medications may give false-positive readings. Therefore, the nurse must ask the
current medications being taken by the client. The other actions by the nurse may be
appropriate, but checking for medications that may affect the dipstick accuracy
should be done first.
91. ANSWER: B.
An intravenous pyelogram (IVP) also known as pyelography or intravenous urogram (IVU) is a
radiological procedure used to visualize abnormalities of the urinary system, including the
kidneys, ureters, and bladder. The procedure involves an injection of x-ray contrast medium
given to the patient via a needle or cannula into the vein, typically in the arm. The contrast is
then excreted or removed from the bloodstream via the kidneys, and the contrast media
becomes visible on x-rays almost immediately after injection. Before the procedure, the patient
is placed on an NPO (food and fluid restriction) post-midnight and may be instructed to take a
mild laxative the night before the procedure. Allergies to barium and iodine such as shellfish and
seafood must also be assessed before the procedure.
92. ANSWER: B.
When dehydration or renal hypoperfusion exist, the BUN level rises more rapidly than the serum
creatinine level, causing the ratio to be increased, even when no renal dysfunction is present.
93. ANSWER: A.
A renal biopsy is obtained through needle insertion into the lobe of the kidney, which can lead to
hemorrhage. Therefore, the competent nurse needs to watch for signs and symptoms of
bleeding. After the procedure, the nurse should also instruct the client to remain still for 4 to 12
hours. Mental status changes (unless the client is bleeding heavily) or increases in blood
pressure are not usually related to renal biopsy.
94. ANSWER: D.
Urine testing with reagent strips is done by removing the color strip immediately from
container, time for number of seconds specified on container (specified time
intervals), and compare color of strip with color chart. Remember that stagnant urine
stored in bladder overnight or for long periods does not reveal the amount of glucose
and ketones excreted by kidney at time of testing. In addition, the strip must be
removed from urine container after 1minute (no need to wait for 3 minutes); excess
urine can dilute reagents. Note that the change in color of the reagent strip placed in
the urine indicates the presence of any of these substances, no need to add any
chemically active tablets.
95. ANSWER: D.
Obtaining a urine specimen in the beginning and again in the middle of the urine
flow (split urine collections) for the purpose of performing a culture and sensitivity
242
(C/S) is the correct procedure for establishing the diagnosis of urethritis.
96. ANSWER: A.
To collect a double-voided urine specimen, the nurse should ask the client to collect
random urine specimen and discard, drink a glass of water, and collect another
specimen 30 to 45 minutes later. First voiding in the morning is considered stagnant
urine. Stagnant urine stored in bladder overnight or for long periods does not reveal
amount of glucose and ketones excreted by kidney at time of testing. A fresh
specimen should be used. Therefore, adding two specimens together from the
morning and evening voiding is also unlikely. Remember that in collecting doublevoided urine, self- catheterization is not needed.
97. ANSWER: D.
Fever, chills, and costovertebral pain are symptoms of a urinary tract infection (acute
pyelonephritis), which requires a urine culture first to confirm the diagnosis. An intravenous
pyelogram (IVP) is rarely used to determine pyelonephritis because the results are negative 75%
of the time in clients diagnosed with acute pyelonephritis. A CT scan might be ordered if other
tests have not been conclusive. A sonogram of the kidney might be ordered if the client has
recurrent UTIs to determine if a physical obstruction is causing the recurrent infections but not as
the first diagnostic procedure.
98. ANSWER: D.
The renal clearance test determines the kidneys' ability to remove a substance from the plasma
in 1 minute. It does not measure the kidneys' ability to remove a substance over a longer period.
99. ANSWER: D.
Fluid depletion before excretory urography is contraindicated in clients with multiple myeloma,
severe diabetes mellitus, and uric acid nephropathy. These conditions can seriously compromise
renal function in fluid-depleted clients with reduced renal perfusion.
100. ANSWER: A.
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. The client should be kept on bed rest for several
hours so the puncture site can seal completely.
243

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210

URINARY TRACT INFECTIONS

Corticosteroids, Prednisone and Aspirin

decreases serum calcium levels

Monitor CBC daily to assess for bleeding.

Poor perfusion to the kidneys

Lack of vitamin D normally created by the kidneys

BUN 35 to 40 mg/dl, potassium 3.5 mEq/L, pH 7.35, decreased serum calcium

Increased capillary hydrostatic pressure.

Hypovolemia, no fluctuation in serum sodium and potassium levels.

one to two weeks.

release hydrogen ions for sodium loss.

an increased serum calcium level secondary to kidney failure.

Middle age male with elevated temperature and chronic pancreatitis.

enhance the immune system preventing rejection

weakness, tingling, and cardiac arrhythmias.

Change the clients position

have control over his daily activities

Bolus the client with 500 mL of normal saline.

sluggish capillary refill time.

Encourage significant other to make decisions for the client.

have the patient sit in a chair.

URINARY TRACT INFECTIONS

abstaining from sexual intercourse.

I urinate large amounts.

A decrease in the usual dose of nalidixic acid (NegGram)

An 18-year-old woman with asthma.

What have you taken for the pain?

Void immediately preceding sexual intercourse

Absence of colicky pain in the right lateral flank and groin

Monitor intake and output

Nausea; vomiting; pallor; and cool, clammy skin.

"I will avoid wine, meat, and shellfish."

Documenting the observation as the only action

Are you experiencing any left flank pain?

"Do you have pain when urinating?"

Encouraging the client to drink cranberry juice to acidify the urine

void every 5 to 6 hours.

Frequency and burning on urination.

Identify the causative organism

"Drink a liter of cranberry juice every day."

Which client is at greatest risk for development of a bacterial cystitis?

Older male client with mild congestive heart failure

Teach the patient intermittent self-catheterization technique.

help the patient adjust to the frequent episodes of incontinence.

explains how to perform pelvic floor exercises.

Assess the clients sensation level and ability to void.

average kidney is approximately 5 cm long and 2 to 3 cm wide.

client has become confused and irritable.

Remove the ureteral stents after 2 days

85.A client is experiencing a sudden decrease in systemic blood pressure. Which of

Hydrostatic pressure will increase

Close the opening temporarily with a cellophane seal.

Document the information on the assessment form.

client probably has a urinary tract infection

Obtain the first voided specimen in the morning

Collect any voided specimen during the day.

An intravenous pyelogram for renal calculi

check the clients pedal pulses frequently.

ANSWERS AND CONCEPT ILLUMINATIONS

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