Chapter 37. Nursing Care of Patients With Disorders of the Urinary System My Nursing Test Banks

Chapter 37. Nursing Care of Patients With Disorders of the Urinary System

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. A patient hospitalized for orthopedic surgery had a urinary catheter inserted. The patient later develops a urinary tract infection (UTI) and asks the nurse what caused it. What is the appropriate response by the nurse?
a. There was a change in the pH of your urine.
b. You probably did not void frequently enough.
c. Bacteria probably ascended the catheter, causing the infection.
d. There are always bacteria on your perineum that enter your urine.
____ 2. The nurse is reinforcing 24-hour fluid intake teaching for a patient to prevent further UTIs. Which amount should the patient state that indicates that teaching has been effective?
a. 1000 mL.
b. 1500 mL.
c. 3000 mL.
d. 5000 mL.
____ 3. The nurse is reviewing the history and physical of a patient who has an infection. What term should the nurse realize describes an infection of the kidneys?
a. Cystitis
b. Hepatitis
c. Urethritis
d. Pyelonephritis
____ 4. The nurse is reinforcing teaching provided to a patient about antibiotics prescribed for a UTI. Which patient statement indicates teaching has been effective?
a. I will take the antibiotics until my urine is no longer cloudy.
b. I will take the antibiotics whenever I feel discomfort from urinating.
c. I will take the antibiotics until they are gone regardless of symptoms.
d. I will take the antibiotics until my temperature has been normal for 3 days.
____ 5. The nurse is collecting data from a patient with suspected cancer of the bladder. What finding should the nurse recognize as the most common symptom of cancer of the bladder?
a. Pain
b. Hematuria
c. Urine retention
d. Burning on urination
____ 6. The nurse notes that the urine from a patient with an ileal conduit has mucus strands. What action should the nurse take?
a. Notify the physician.
b. Send a urine sample to the laboratory for culture.
c. Ask the patient about a history of UTIs.
d. Nothing, as the nurse understands that this is a normal finding.
____ 7. The nurse is reinforcing teaching provided to a patient about risk factors for the development of bladder cancer. What risk factor should the patient state that indicates understanding of this teaching?
a. Smoking
b. Hyperlipidemia
c. Diet high in calcium
d. Recurrent UTIs
____ 8. The nurse is caring for a patient who has renal calculi. Which action is essential for the nurse to take?
a. Strain all urine.
b. Limit fluids at night.
c. Record blood pressure.
d. Obtain a sterile urine specimen.
____ 9. The nurse is caring for a patient who has a nephrostomy tube. What action should the nurse take to maintain the integrity of this device?
a. Ensure tube is not kinked or clamped.
b. Limit fluids to 1000 mL per 24 hours.
c. Keep collection bag taped to abdomen.
d. Remove and clean the tube once daily.
____ 10. A patient hourly urine output is recorded. Which output rates should be brought to the attention of the registered nurse (RN) immediately?
a. 15 mL/hr
b. 40 mL/hr
c. 60 mL/hr
d. 80 mL/hr
____ 11. The nurse is caring for a patient who has an acute kidney injury. Which diagnostic test result should the nurse identify as most supporting this diagnosis?
a. Hematocrit 20% (normal 38% to 47%)
b. Uric acid 8 ng/dL (normal 2.5 to 5.5 ng/dL)
c. 24-hour creatinine clearance 5 mL/min (normal 100 mL/min)
d. Blood urea nitrogen 20 mg/100 mL (normal 8 to 25 mg/100 mL)
____ 12. A patient who has diabetic nephropathy asks the nurse, Why am I using smaller doses of insulin than I used to? What would be the best explanation by the nurse?
a. Insulin is now more potent than it used to be.
b. It would be best if you spoke with your physician about this.
c. You have probably decreased the amount of food you are eating.
d. Your kidneys are no longer breaking down the insulin as much as before.
____ 13. A patient with chronic kidney disease is very weak due to low hemoglobin. What should the nurse understand as the best explanation for the anemia?
a. Secretion of erythropoietin by the diseased kidney is reduced.
b. There is loss of red blood cells in the urine with kidney disease.
c. Chronic hypertension associated with chronic kidney disease suppresses the bone marrow.
d. Metabolic acidosis associated with chronic kidney disease increases red blood cell fragility.
____ 14. The nurse is caring for a patient with chronic kidney disease. Which data collection technique is the best one for the nurse to use to determine this patients fluid volume status?
a. Vital signs
b. Skin turgor
c. Daily weight
d. Intake and output
____ 15. A patient who is on hemodialysis for chronic kidney disease is prescribed sevelamer hydrochloride (Renagel) with meals. What explanation should be provided to the patient as the primary reason the medication is being given?
a. To prevent metabolic acidosis
b. To prevent gastrointestinal ulcer formation
c. To relieve gastric irritation from excess acid production
d. To prevent damage to bones from high phosphorus levels
____ 16. The nurse is collecting data from a patient who has returned from a dialysis session. After dialysis, the nurse should anticipate which patient finding?
a. Weight loss
b. Hypertension
c. Increased energy
d. Distended neck veins
____ 17. The nurse is reinforcing teaching provided to a patient with chronic kidney disease. Which patient statement indicates the need for further teaching?
a. I do not use salt substitute.
b. My fluid intake is restricted.
c. As long as I dont eat protein, Ill be okay.
d. Since Im on dialysis, I cannot eat just anything I want.
____ 18. The nurse is reinforcing teaching about the most serious side effect of peritoneal dialysis with a patient scheduled for the first treatment. Which side effect should the patient state that indicates correct understanding?
a. Peritonitis.
b. Paralytic ileus.
c. Respiratory distress.
d. Cramps in the abdomen.
____ 19. A patient with glomerulonephritis asks, How could I have gotten this? How should the nurse respond?
a. Has anyone in your family had glomerulonephritis?
b. Have you had a sore throat or skin infection recently?
c. Glomerulonephritis almost always follows a bladder infection.
d. Glomerulonephritis often results from having unprotected sex.
____ 20. A patient with glomerulonephritis develops acute kidney injury. Which form of kidney injury should the nurse realize has occurred with this patient?
a. Prerenal
b. Postrenal
c. Intrarenal
d. Suprabladder
____ 21. A 19-year-old patient reports flank pain and scanty urination. The nurse notices periorbital edema, and the urinalysis reveals white blood cells, red blood cells, albumin, and casts. What question would be most important for the nurse to include in data collection?
a. Is your vision blurred?
b. Are you sexually active?
c. Have you had any gastrointestinal problems lately?
d. Have you had a strep infection of the throat or skin recently?
____ 22. The nurse is reinforcing teaching provided to a patient about risk factors for prerenal injury. Which risk factor should the patient state that indicates understanding of this teaching?
a. Kidney stones.
b. Enlarged prostate.
c. Exposure to nephrotoxins agents.
d. Use of nonsteroidal anti-inflammatory drugs.
____ 23. The nurse is contributing to the plan of care for a patient who is having an intravenous pyelogram (IVP) done to diagnose possible bladder cancer. Which intervention should the nurse recommend be included for the patient after the procedure?
a. Document heart rhythm.
b. Monitor creatinine level.
c. Monitor arterial blood gases (ABGs).
d. Review thyroid-stimulating hormone (TSH) and T4 levels.
____ 24. The nurse is caring for an unstable patient with acute kidney injury. What therapy should the nurse expect to be ordered?
a. Hemodialysis
b. Urinary catheter
c. Peritoneal dialysis
d. Continuous renal replacement therapy (CRRT)
____ 25. A patient is diagnosed with end-stage kidney disease. The nurse realizes that what percentage of functioning nephrons have been lost in this patient?
a. 25%
b. 50%
c. 75%
d. 90%
____ 26. A patient has a glomerular filtration rate of 20 mL/min. For which stage of renal failure should the nurse plan care for this patient?
a. Mild
b. Slight
c. Severe
d. Moderate
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 27. The nurse is reinforcing teaching provided to a patient with a history of calcium oxalate kidney stones. The nurse recognizes that teaching has been effective if the patient avoids which foods? (Select all that apply.)
a. Bread
b. Cocoa
c. Lettuce
d. Spinach
e. Chicken
f. Instant coffee
____ 28. The nurse is monitoring a patient with chronic kidney disease. Which findings should the nurse realize indicates fluid overload? (Select all that apply.)
a. Periorbital edema
b. Crackles in the lungs
c. Postural hypotension
d. Increased blood pressure
e. Decreased pulse pressure
f. Auditory wheezes on inspiration
____ 29. The nurse is collecting data from a patient with a vascular access graft in the right arm for dialysis. What should the nurse do when assessing this patient? (Select all that apply.)
a. Auscultate for a bruit over the site.
b. Palpate for a thrill in the right arm.
c. Observe the tubing for bright red blood.
d. Feel for a brachial pulse on the affected arm.
e. Redress the arm daily, keeping the site sterile at all times.
____ 30. The nurse is reinforcing teaching provided to a patient about caring for a new fistula in the left arm for dialysis. Which patient statements indicates correct understanding? (Select all that apply.)
a. Do not sleep on my arm.
b. Keep my arm elevated at all times.
c. Keep a firm bandage on my arm.
d. Wear loose clothing on my left arm.
e. Avoid carrying heavy things with my left arm.
f. Do not allow blood pressures to be taken on my left arm.
____ 31. The nurse notes it is time to administer prescribed gentamicin (Garamycin) for a patient with acute kidney injury and suspected streptococcal pneumonia. Which action should the nurse take at this time? (Select all that apply.)
a. Hold medication.
b. Administer drug as ordered.
c. Administer half of the prescribed dose.
d. Consult physician about medication order.
e. Flush the tubing with heparin before infusing.
____ 32. A patient with chronic kidney disease has a serum potassium level of 6 mEq/L. Which action should the nurse take? (Select all that apply.)
a. Obtain consent for hemodialysis.
b. Administer the patient an antacid.
c. Place the patient on a cardiac monitor.
d. Give the patient a glass of orange juice.
e. Repeat laboratory test of electrolyte levels.
f. Inform RN to notify physician.
____ 33. The nurse is contributing to the plan of care for a patient who has chronic kidney disease. What possible effects of this condition should the nurse consider? (Select all that apply.)
a. Anemia
b. Cardiac dysrhythmias
c. Peripheral neuropathy
d. Increased bone density
e. Anorexia, nausea, vomiting
f. Increase in function of oil and sweat glands
____ 34. The nurse is reinforcing teaching provided to a patient with chronic kidney disease who is receiving hemodialysis three times a week at a hemodialysis center. Which statements should be included? (Select all that apply.)
a. You may feel weak and fatigued after the treatment.
b. You may not be able to eat before the treatment session.
c. You will need to be weighed before and after the session.
d. Your medication schedule will be the same on dialysis days.
e. Report any numbness, swelling, redness, or drainage from the dialysis access site.
f. You may experience some bleeding from the puncture site or a nosebleed. Report it if it doesnt stop within a few minutes.
____ 35. The nurse is reinforcing teaching provided to a patient with polycystic kidney disease. Which patient statements indicate a correct understanding of the teaching? (Select all that apply.)
a. It is a hereditary disease.
b. It affects women more than men.
c. Symptoms appear in early childhood.
d. Genetic counseling is appropriate for individuals with this diagnosis.
e. There is no effective treatment to stop the progression of the disease.
f. It is characterized by the formation of multiple grapelike cysts in the kidney.
____ 36. The nurse is contributing to the plan of care for a patient with chronic kidney disease. The nurse has recognized a growing body of evidence related to restricting protein intake. Which evidence should the nurse use to develop the plan of care? (Select all that apply.)
a. Protein requirements should be based on ideal body weight.
b. Increased protein is recommended for patients on hemodialysis.
c. Protein calorie malnutrition should be avoided for patients on hemodialysis.
d. Optimum nutritional status should be maintained for all patients with kidney disease.
e. All patients with renal compromise should limit protein intake to less than 0.5 g/kg/day.
f. Protein energy malnutrition is a predictor of mortality and morbidity for patients on dialysis.
____ 37. The nurse is contributing to a staff education program about the risks of smoking and conditions related to smoking. Which statements by a staff member indicate correct understanding of the teaching? (Select all that apply.)
a. Kidney stones
b. Kidney cancer
c. Bladder cancer
d. Hydronephrosis
e. Diabetic nephropathy
f. UTI
____ 38. The nursing home administrator for a skilled nursing facility is concerned because a large number of older residents are developing UTIs. What should the staff nurse explain about the development of UTIs in this population? (Select all that apply.)
a. Overuse of antibiotics
b. Diminished immune function
c. Enlarged prostate in older men
d. Presence of neurogenic bladder
e. Decline in estrogen in older women
____ 39. A 32-year-old female patient is diagnosed with uncomplicated cystitis. Which medications should the nurse expect to be prescribed for this patient? (Select all that apply.)
a. Ciprofloxacin (Cipro)
b. Aztreonam (Azactam)
c. Decadron (Solu-Medrol)
d. Nitrofurantoin (Macrodantin)
e. Sulfamethoxazole and trimethoprim (Bactrim, Septra)
____ 40. A patient with a UTI is concerned about the expectation to void every three hours. What should the nurse explain to the patient about voiding this frequently? (Select all that apply.)
a. Empties the bladder
b. Reduces urine stasis
c. Prevents reinfection
d. Cleanses the perineum
e. Lowers bacterial counts
____ 41. While participating in the creation of a teaching plan, the nurse suggests that a patient ingest cranberry juice every day to reduce the risk of developing a UTI. What information did the nurse use to make this suggestion? (Select all that apply.)
a. The fiber in cranberries reduces the amount of sediment in the urine.
b. Cranberries facilitate the removal of fluid from the interstitial spaces.
c. Compounds in cranberries inhibit the adherence of E. coli to the urogenital mucosa.
d. Cranberries reduce the incidence of UTIs in patients after renal transplants.
e. Cranberries contain a substance that prevents bacteria from sticking on the walls of the bladder.
____ 42. While collecting data, the nurse suspects that a patient is experiencing renal calculi. What did the nurse assess to come to this conclusion? (Select all that apply.)
a. Nausea
b. Flank pain
c. Fever and chills
d. Costovertebral tenderness
e. Pain radiating to the genitalia

Chapter 37. Nursing Care of Patients With Disorders of the Urinary System
Answer Section

MULTIPLE CHOICE

1. ANS: C
UTIs are almost always caused by an ascending infection, starting at the external urinary meatus and progressing toward the bladder and kidneys. Instrumentation, or having instruments or tubes inserted into the urinary meatus, is a predisposing cause. A. B. D. Change in urinary pH, infrequent voiding, and presence of bacteria are not predisposing causes for UTIs.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

2. ANS: C
To prevent UTIs, the patient should be encouraged to drink up to 3000 mL of fluid a day if there are no fluid restrictions from the physician. A. B. Less than 2 liters of fluid per day is not sufficient to prevent the onset of a UTI. D. There is no need for the patient to ingest 5 liters of fluid per day.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

3. ANS: D
Pyelonephritis is infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys. A. Cystitis is inflammation and infection of the bladder wall. B. Hepatitis is inflammation and infection of the liver. C. Urethritis is inflammation of the urethra.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

4. ANS: C
The patient should take the prescribed medication for a UTI until all medication has been taken. A. B. D. These statements indicate that teaching has not been effective.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Analysis

5. ANS: B
Cancer of the bladder usually causes painless hematuria. A. C. D. Pain, urine retention, and burning on urination are not the most common symptoms of bladder cancer.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

6. ANS: D
The urine from an ileal conduit contains mucus because it comes through the ileum, which normally secretes mucus. A. B. C. There is no need to notify the physician, send a specimen for culture, or ask the patient about a history of UTIs.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

7. ANS: A
There is a strong correlation between cigarette smoking and bladder cancer. B. C. D. Hyperlipidemia, high calcium diet, and recurrent UTIs are not identified as risk factors for the development of bladder cancer.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

8. ANS: A
The nurse should ensure that all urine is strained to detect passage of stones. B. This patient does not need to have fluids limited at night. C. Blood pressure does not need to be measured. D. A sterile urine specimen is not needed.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

9. ANS: A
For a nephrostomy tube, the nurse should ensure that it is draining adequately and is not kinked or clamped. B. Fluids do not need to be limited. C. The collection bag does not need to be taped to the abdomen. D. The tube is not to be removed and cleaned.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Application

10. ANS: A
The minimum urine output should be 30 mL/hr, so 15 mL/hr should be reported. B. C. D. These rates are adequate and do not need to be reported.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentCoordinated Care | Cognitive Level: Analysis

11. ANS: D
Of the tests listed a normal 24-hour creatinine clearance of 100 mL/min is the most accurate test for renal function. A value less than 100 mL/min indicates kidney disease. A. B. Hematocrit and uric acid levels are not used to diagnose kidney disease. D. Blood urea nitrogen test is also used to detect kidney disease however the value is within normal limits.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

12. ANS: D
As renal function decreases, the patient needs smaller doses of insulin because the kidney normally degrades insulin. A. Insulin is not more potent than it used to be. B. The nurse can explain why the dosage of insulin has changed. C. There is no evidence that the patient has changed the amount of food being ingested.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

13. ANS: A
In chronic kidney disease secretion of erythropoietin by the diseased kidney is reduced. B. C. D. This patient is not experiencing anemia because of a loss of red blood cells, chronic hypertension, or metabolic acidosis.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

14. ANS: C
The patient should have daily weights monitored, at the same time every day. Weight change is the best estimation of fluid balance. A. B. D. Vital signs, skin turgor, and intake and output are not the best measurements to indicate fluid balance.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

15. ANS: D
Hyperphosphatemia, a phosphorous level above 5 mg/dL, is associated with a low calcium level. These imbalances cause the bones to release calcium, causing patients to be prone to fractures. Sevelamer hydrochloride (Renagel) is a medication that binds with the phosphates in the stool and be eliminated. A. B. C. This medication does not prevent metabolic acidosis, gastrointestinal ulcer formation, or relieve gastric irritation.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

16. ANS: A
Based upon the fluid pulled off during dialysis, weight will be lost. C. Following a treatment, the patient normally feels weak and fatigued. B. Hypotension may occur due to the fluid loss. D. Fluid and electrolyte levels drop rapidly, so there is no fluid overload.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

17. ANS: C
Protein may be restricted when the patients kidneys are failing but increased if dialysis is started. A. B. D. These statements indicate that teaching has been effective.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

18. ANS: A
A major complication of peritoneal dialysis is peritonitis, which can be life threatening. The major cause of peritonitis is poor technique when connecting the bag of dialyzing solution to the peritoneal catheter. B. Paralytic ileus and respiratory distress are not associated with peritoneal dialysis. D. Abdominal cramps can occur with this type of dialysis however they are not the most serious side effect of this treatment.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

19. ANS: B
Glomerulonephritis can be caused by a variety of factors but is most commonly associated with a group A beta-hemolytic streptococcus infection following a streptococcal infection of the throat or skin. A. Glomerulonephritis is not contracted from another person. C. D. Glomerulonephritis is not caused by a bladder infection or having unprotected sex.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Application

20. ANS: C
Intrarenal kidney injury occurs when there is damage to the nephrons inside the kidney. Causes are ischemia, reduced blood flow, toxins, infectious processes leading to glomerulonephritis, trauma to the kidney, allergic reactions to radiograph dyes, and severe muscle injury. A. B. This patients kidney injury is not caused by a pre- or postrenal injury. D. Suprabladder is not a type of kidney injury.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

21. ANS: D
The patient has symptoms of glomerulonephritis, which can be caused by a variety of factors but is most commonly associated with a group. A beta-hemolytic streptococcus infection following a streptococcal infection of the throat or skin. A. B. C. Asking about blurred vision, sexual activity, and gastrointestinal problems would not be appropriate for this patients health problem.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

22. ANS: D
Prerenal injury causes include decreased blood pressure from dehydration, blood loss, shock, trauma to or blockage in the arteries to the kidneys, and NSAIDs and cyclooxygenase-2 inhibitors, which impair the autoregulatory responses of the kidney by blocking prostaglandin, which is necessary for renal perfusion. A. B. Kidney stones and enlarged prostate are risk factors for a postrenal injury. C. Nephrotoxic agents are risk factors for an intrarenal injury.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

23. ANS: B
The nurse should monitor creatinine levels to observe for renal damage after the IVP due to the dye that is used. A. C. D. Heart rhythm, arterial blood gases, and thyroid hormone levels do not need to be monitored after an IVP.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

24. ANS: D
Continuous renal replacement therapy (CRRT) is used to remove fluid and solutes in a con-trolled, continuous manner in unstable patients with AKI. Unstable patients may not be able to tolerate the rapid fluid shifts that occur in hemodialysis, so CRRT provides an alternative therapy that results in less dramatic fluid shifting. A. C. The patient is not stable enough for hemodialysis or peritoneal dialysis. B. A urinary catheter may or may not be indicated for this patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

25. ANS: D
End-stage renal disease (ESRD) occurs when 90% of the nephrons are lost. A. Renal disease is not diagnosed when 25% of functioning nephrons are lost. B. In the early, or silent stage (decreased renal reserve), the patient is usually without symptoms, even though up to 50% of nephron function may have been lost. C. The renal insufficiency stage occurs when the patient has lost 75% of nephron function and some signs of mild kidney disease are present.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

26. ANS: C
In severe renal failure the glomerular filtration rate is between 15 to 29 mL/min. A. In mild failure the rate is 60 to 89 mL/min. B. In slight failure the rate is greater than or equal to 90 mL/min. D. In moderate failure, the rate is 30 to 59 mL/min.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

MULTIPLE RESPONSE

27. ANS: B, D, F
A low oxalate diet restricts foods such as beets, rhubarb, spinach, cocoa, and instant coffee. A. C. E. Bread, lettuce, and chicken do not need to be restricted on this diet.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

28. ANS: A, B, D
Neck vein distention, periorbital edema, hypertension and crackles in the lungs are symptoms of fluid overload. C. E. F. Postural hypotension, decreased pulse pressure, and auditory wheezes on inspiration are not manifestations of fluid overload.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

29. ANS: A, B
Arteriovenous grafts are checked for patency by palpating for a thrill (a tremor) and auscultating for a bruit (swishing sound) at the site of the graft or fistula. C. The graft is under the skin so there is no tubing. D. The distal radial pulse should be checked. E. There is no dressing over the site.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

30. ANS: A, D, E, F
The fistula must be protected from clotting. This would be done by not sleeping on the arm, wearing loose clothing, avoiding carrying heavy items with the arm, and not permitting blood pressure to be assessed on the arm. B. C. The arm does not need to be elevated or have a firm bandage applied.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

31. ANS: A, D
The medication should be held until the physician can be consulted about the medication order, as this is a nephrotoxic agent and the patient already has renal damage. Another agent will likely be ordered. B. The medication should not be provided as ordered. C. The nurse cannot alter the prescribed dose of the medication. E. The tubing does not need to be flushed with heparin before administering this medication.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

32. ANS: C, F
As the kidneys lose their ability to excrete electrolytes, such as sodium, potassium, and magnesium, these substances accumulate at high levels in the blood and may cause life-threatening dysrhythmias. Notify the RN and physician for treatment orders, and place the patient on a cardiac monitor to detect dysrhythmias. A. The patient may or may not need dialyzed at this time. B. An antacid will not help reduce the potassium level. D. Orange juice has potassium and would be contraindicated for the patient at this time. E. The physician needs to prescribe repeat laboratory tests for the patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level: Application

33. ANS: A, B, C, E
Chronic kidney disease can lead to anemia, cardiac dysrhythmias, peripheral neuropathy, and anorexia, nausea, and vomiting. D. F. Chronic kidney disease does not cause increases in bone density or in the function of oil and sweat glands.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

34. ANS: A, B, C, E, F
Sessions cause fatigue and the need to rest. Eating may not be possible for some patients as digestion of food causes blood diversion to the gastrointestinal (GI) tract which can drop blood pressure as fluid is removed during dialysis. Weight must be monitored to determine effect of treatment. Side effects must be reported at the access site and if bleeding from the heparin occurs. D. Medications such as hypertensives may need to be held before dialysis.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

35. ANS: A, D, E, F
Polycystic kidney disease is a hereditary disorder that can result in kidney disease. Because this is a hereditary disorder, genetic counseling is appropriate. There is no treatment to stop the progression of polycystic kidney disease. Polycystic kidney disease is characterized by formation of multiple cysts in the kidney that can eventually replace normal kidney structures. B. The disease affects men and women equally. C. The patient generally first shows signs of the disease in adulthood.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

36. ANS: B, C, D, F
Protein energy malnutrition is a predictor for morbidity and mortality in patients on dialysis. For patients receiving hemodialysis, increased protein is recommended. It is advisable to avoid protein calorie malnutrition with patients on hemodialysis. Optimum nutritional status should be maintained for all patients with kidney disease. E. A protein-controlled diet is recommended or patients with kidney disease. A. Protein requirements are based on actual weight of the patient and not ideal body weight.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

37. ANS: B, C, E
Smoking is a risk factor for kidney cancer. There is a strong correlation between cigarette smoking and bladder cancer. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. A. D. F. No correlation between UTIs, kidney stones, or hydronephrosis and cigarette smoking has been established.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

38. ANS: B, C, D, E
Older adults have an increased incidence of UTIs due to diminished immune function and neurogenic bladder which fails to completely empty. Older men are predisposed to infection because an enlarged prostate obstructs urine flow. In older women, the decline in estrogen can also contribute to the risk of UTI. A. Overuse of antibiotics is not identified as a reason for UTI development in older patients.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Application

39. ANS: D, E
Treatment of uncomplicated cystitis is most often a combination of sulfa medication, such as sulfamethoxazole and trimethoprim (Bactrim, Septra), or nitrofurantoin (Macrodantin).
A. Complicated cystitis is often treated with ciprofloxacin (Cipro). B. Aztreonam (Azactam) may be used to treat UTIs. C. Decadron (Solu-Medrol) is a steroid and is not used to treat cystitis.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

40. ANS: A, B, C, E
Encourage voiding every 3 hours to empty the bladder, lower bacterial counts, reduce stasis, and prevent reinfection. D. Voiding every 3 hours for a UTI is not done to cleanse the perineum.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

41. ANS: C, D, E
In a systematic review of studies that compared the use of cranberries containing products to prevent UTI with placebo or nonplacebo controls, it was found that cranberry containing products are associated with a protective effect against UTIs. Cranberries contain a substance that can prevent bacteria from sticking on the walls of the bladder. Other compounds found in cranberries inhibit the adherence of E coli to the urogenital mucosa. It was also found that cranberries are effective in reducing the annual number of UTI episodes by 63.9% in clients after renal transplantation. A. Cranberries do not reduce the amount of sediment in urine. B. It is not known if cranberries facilitate the removal of fluid from the interstitial spaces.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

42. ANS: A, B, D, E
Symptoms of renal calculi include excruciating flank pain and renal colic. When a stone is lodged in the ureter, it is common to have pain radiate down to the genitalia. The pain results when the stone prevents urine from draining. The patient also may have costovertebral tenderness. Some people develop nausea because of the proximity of the gastrointestinal structures. C. Fever and chills are not manifestations of renal calculi.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

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