Deck 37: Nursing Care of Patients With Disorders of the Urinary System

Question 1

A patient who is on hemodialysis for chronic kidney disease is given 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 relieve gastric irritation from excess acid production
C)To prevent gastrointestinal ulcer formation
D)To prevent damage to bones from high phosphorus levels

Answer 1

To prevent damage to bones from high phosphorus levels

Question 2

The nurse is caring for a patient who has acute kidney injury. Which diagnostic test result would most support this diagnosis?

A)Blood urea nitrogen 20 mg/100 mL (normal 8 to 25 mg/100 mL)
B)24-hour creatinine clearance 5 mL/min (normal 100 mL/min)
C)Uric acid 8 ng/dL (normal 2.5 to 5.5 ng/dL)
D)Hematocrit 20% (normal 38% to 47%)

Answer 2

24-hour creatinine clearance 5 mL/min (normal 100 mL/min)

Question 3

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)"Your kidneys are no longer breaking down the insulin as much as before."
B)"Insulin is now more potent than it used to be."
C)"You have probably decreased the amount of food you are eating."
D)"It would be best if you spoke with your physician about this."

Answer 3

"Your kidneys are no longer breaking down the insulin as much as before."

Question 4

Which of these data collection techniques is the best determinant of a patient's fluid volume status that must be done on every patient with chronic kidney disease?

A)Intake and output
B)Vital signs
C)Daily weight
D)Skin turgor

Question 5

The nurse is reinforcing teaching of the most serious side effect of peritoneal dialysis. Which of these, if stated by a patient, indicates correct understanding?

A)"Cramps in the abdomen."
B)"Paralytic ileus."
C)"Peritonitis."
D)"Respiratory distress."

Question 6

The nurse is collecting data for a patient who has returned from a dialysis session.After dialysis, the nurse anticipates which of these patient findings?

A)Increased energy
B)Weight loss
C)Hypertension
D)Distended neck veins

Question 7

The nurse is caring for a patient who has a nephrostomy tube. What action should the nurse take?

A)Limit fluids to 1,000 mL per 24 hours.
B)Keep collection bag taped to abdomen.
C)Ensure tube is not kinked or clamped.
D)Remove and clean the tube once daily.

Question 8

The nurse is reviewing the history and physical of a patient who has an infection. What term would the nurse understand describes an infection of the kidneys?

A)Urethritis
B)Cystitis
C)Pyelonephritis
D)Hepatitis

Question 9

A patient with glomerulonephritis asks, "How could I have gotten this?" How should the nurse respond?

A)"Have you had a sore throat or skin infection recently?"
B)"Glomerulonephritis almost always follows a bladder infection."
C)"Glomerulonephritis often results from having unprotected sex."
D)"Has anyone in your family had glomerulonephritis?"

Question 10

A patient hourly urine output is recorded. Which of the following output rates should be brought to the attention of the registered nurse immediately?

A)15 mL/hr
B)40 mL/hr
C)60 mL/hr
D)80 mL/hr

Question 11

The nurse is reinforcing teaching on risk factors for the development of bladder cancer. Which of these, if stated by a patient, indicates a correct understanding?

A)Diet high in calcium
B)Smoking
C)Recurrent urinary tract infections
D)Hyperlipidemia

Question 12

The nurse empties urine from an ileal conduit appliance. The urine has strands of mucus in it. What action should the nurse take?

A)Notify the physician.
B)Send a urine sample to the laboratory for culture.
C)Nothing, as the nurse understands that this is a normal finding.
D)Ask the patient about a history of urinary tract infections.

Question 13

The nurse is reinforcing 24-hour fluid intake teaching for a patient to prevent further urinary tract infections. Which of the following amounts if stated by the client would indicate a correct understanding of the teaching?

A)"1.000 mL."
B)"1,000 mL."
C)"2,500 mL."
D)"3,000 mL."

Question 14

A patient with glomerulonephritis develops acute kidney injury. Which form of kidney injury has occurred?

A)Prerenal
B)Intrarenal
C)Postrenal

Question 15

The nurse is collecting data for a patient who has suspected cancer of the bladder. What finding would the nurse recognize as the most common symptom of cancer of the bladder?

A)Pain
B)Burning on urination
C)Urine retention
D)Hematuria

Question 16

A patient hospitalized for orthopedic surgery had a urinary catheter inserted. The patient later develops a urinary tract infection and asks the nurse what caused it. What is the appropriate response by the nurse?

A)"Bacteria probably ascended the catheter, causing the infection."
B)"You probably did not void frequently enough."
C)"There was a change in the pH of your urine."
D)"There are always bacteria on your perineum that enter your urine."

Question 17

The nurse is caring for a patient who has renal calculi. Which of these actions is essential for the nurse to take?

A)Record blood pressure.
B)Obtain a sterile urine specimen.
C)Strain all urine.
D)Limit fluids at night.

Question 18

The nurse is caring for a patient who has chronic kidney disease and is very weak due to low hemoglobin. Which of the following does the nurse understand is the best explanation for the anemia?

A)Chronic hypertension associated with chronic kidney disease suppresses the bone marrow.
B)Metabolic acidosis associated with chronic kidney disease increases red blood cell fragility.
C)There is loss of red blood cells in the urine with kidney disease.
D)Secretion of erythropoietin by the diseased kidney is reduced.

Question 19

The nurse is reinforcing teaching on antibiotic use for a urinary tract infection (UTI). Which of the following statements by the patient would indicate a correct understanding of the teaching?

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 my temperature has been normal for 3 days."
D)"I will take the antibiotics until they are gone regardless of symptoms."

Question 20

The nurse is reinforcing teaching for a patient who has 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 don't eat protein, I'll be okay."
D)"Since I'm on dialysis, I cannot eat just anything I want."

Question 21

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)Monitor arterial blood gases (ABGs).
B)Monitor creatinine level.
C)Document heart rhythm.
D)Review thyroid-stimulating hormone (TSH) and T4 levels.

Question 22

End-stage kidney disease occurs when ____________________% of nephrons are lost.

Question 23

The nurse is caring for a patient who has chronic kidney disease. Laboratory test results show a potassium level of 6 mEq/L. Which of the following actions would be most appropriate for the nurse to take? (Select all that apply.?

A)Repeat laboratory test of electrolyte levels.
B)Inform registered nurse to notify physician.
C)Administer the patient an antacid.
D)Give the patient a glass of orange juice.
E)Place the patient on a cardiac monitor.
F)Obtain consent for hemodialysis.

Question 24

The nurse is reinforcing teaching for a patient with a history of calcium oxalate kidney stones. The nurse recognizes that teaching has been effective if the patient avoids which of the following foods? (Select all that apply.?

A)Bread
B)Instant coffee
C)Cocoa
D)Chicken
E)Lettuce
F)Spinach

Question 25

The nurse is reinforcing teaching on how to care for a new fistula in the left arm for dialysis. Which of these patient statements indicates correct understanding? (Select all that apply.?

A)"Keep my arm elevated at all times."
B)"Do not sleep on my arm."
C)"Keep a firm bandage on my arm."
D)"Do not allow blood pressures to be taken on my left arm."
E)"Avoid carrying heavy things with my left arm."
F)"Wear loose clothing on my left arm."

Question 26

The nurse is contributing to a staff education program about the risks of smoking and conditions related to smoking. Which of the following statements by a staff member would indicate a correct understanding of the teaching? (Select all that apply.?

A)Kidney cancer
B)Bladder cancer
C)Urinary tract infection
D)Kidney stones
E)Diabetic nephropathy
F)Hydronephrosis
Completion
Complete each statement.

Question 27

When 50% of nephrons are lost, the creatinine level is ________________times normal.

Question 28

The nurse is collecting data for a patient who has a graft in the right arm for vascular access for dialysis. Which of the following actions would be most appropriate for the nurse to take? (Select all that apply.?

A)Observe the tubing for bright red blood.
B)Feel for a brachial pulse on the affected arm.
C)Auscultate for a bruit over the site.
D)Redress the arm daily, keeping the site sterile at all times.
E)Palpate for a thrill in the right arm.

Question 29

The nurse is caring for a patient who is unstable and has acute kidney injury. What therapy would the nurse expect to be ordered?

A)Hemodialysis
B)Peritoneal dialysis
C)Continuous renal replacement therapy (CRRT)
D)Urinary catheter
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 30

The nurse is contributing to the plan of care for a patient who has chronic kidney disease. The nurse has recognized a growing body of evidence related to restricting protein intake. Which of the following is evidence that should be used to develop the plan of care? (Select all that apply.?

A)All patients with renal compromise should limit protein intake to less than 0.5 g/kg/day.
B)Protein requirements should be based on ideal body weight.
C)Protein energy malnutrition is a predictor of mortality and morbidity for patients on dialysis.
D)Increased protein is recommended for patients on hemodialysis.
E)Protein calorie malnutrition should be avoided for patients on hemodialysis.
F)Optimum nutritional status should be maintained for all patients with kidney disease.

Question 31

The nurse notes it is time to administer prescribed gentamicin (Garamycin) for a patient with acute kidney injury and suspected streptococcal pneumonia. Which of the following actions would be most appropriate for the nurse to take? (Select all that apply.?

A)Administer drug as ordered.
B)Consult physician about medication order.
C)Hold medication.
D)Administer half of the prescribed dose.

Question 32

The nurse is reinforcing teaching for 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)"Report any numbness, swelling, redness, or drainage from the dialysis access site."
E)"You may experience some bleeding from the puncture site or a nosebleed. Report it if it doesn't stop within a few minutes."
F)"Your medication schedule will be the same on dialysis days."

Question 33

The nurse is reinforcing teaching for a patient who has polycystic kidney disease. Which of the following patient statements would indicate a correct understanding of the teaching? (Select all that apply.?

A)"It affects women more than men."
B)"It is a hereditary disease."
C)"There is no effective treatment to stop the progression of the disease."
D)"Symptoms appear in early childhood."
E)"It is characterized by the formation of multiple grapelike cysts in the kidney."
F)"Genetic counseling is appropriate for individuals with this diagnosis."

Question 34

The nurse is contributing to the plan of care for a patient who has chronic kidney disease. What are possible effects of this condition the nurse should consider? (Select all that apply.?

A)Anemia
B)Increase in function of oil and sweat glands
C)Peripheral neuropathy
D)Anorexia, nausea, vomiting
E)Cardiac dysrhythmias
F)Increased bone density

Question 35

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)"Have you had any gastrointestinal problems lately?"
B)"Have you had a strep infection of the throat or skin recently?"
C)"Are you sexually active?"
D)"Is your vision blurred?"

Question 36

The nurse is reinforcing teaching on risk factors for prerenal injury. Which of these, if stated by a patient, indicates correct understanding?

A)"Use of nonsteroidal anti-inflammatory drugs."
B)"Exposure to nephrotoxins agents."
C)"Enlarged prostate."
D)`"Kidney stones."

Question 37

The nurse is monitoring a patient with chronic kidney disease. Which of the following findings would indicate fluid overload? (Select all that apply.?

A)Auditory wheezes on inspiration
B)Periorbital edema
C)Increased blood pressure
D)Decreased pulse pressure
E)Crackles in the lungs
F)Postural hypotension