1 . The nurse is planning care for the client, who is scheduled for an IVP.

Which intervention
should the nurse plan to implement?
A. Teach that a warm, flushing sensation may occur as the dye is injected.
B. Prepare the client for urinary catheterization before the procedure.
C. Keep the client NPO after the procedure until test results are obtained.
D. Ambulate the client in the hall to promote excretion of the dye.

ANSWER: A

A. The nurse should teach that the client may experience a warm, flushing sensation up the arm or
upper body and have a strange taste as the dye is injected.
B. Urinary catheterization is needed only if the client is unable to void.
C. The client should increase intake of fluids alter the WP to promote clearance of the dye.
D. The client is usually allowed activity as tolerated, but fluids, not ambulation, promote dye
excretion.

2. The nurse is assessing the client’s right groin puncture site after a renal angiogram finds a
saturated, bloody dressing and blood pooling on the sheets. What should be the nurse’s
priority?
A. Remove the dressing to further assess the puncture site.
B. Reinforce the dressing with a compression dressing.
C. Glove and apply firm pressure directly over the dressing.
D. Have the client flex the right leg to control the bleeding.

ANSWER: C

A. Direct pressure is required to control bleeding before removing the dressing to check the
puncture site.
B. A compression dressing is insufficient to control arterial bleeding, although it can be used to
prevent further bleeding.
C. The assessment suggests arterial bleeding, so 5 minutes of direct pressure should be applied to
the site first. A saturated dressing with blood pooling indicates the client is hemorrhaging.
D. Flexing the leg is contraindicated. It can dislodge an already partially formed clot and initiate
further bleeding.

3. The nurse notes bright red blood and clots in the client’s urine after a cystoscopy. Which is
the most appropriate initial action by the nurse?
A. Irrigate the client’s bladder.
B. Notify the health care provider.
C. Apply heat over the client’s bladder.
D. Give the prescribed antispasmodic agent.

ANSWER: B
 A. Although the HCP may prescribe a bladder irrigation, this should not be the nurse’s initial action.
B. Blood-tinged urine is expected after a cystoscopy, but bright red bleeding and clots are
abnormal and should be reported to the HCP. Hemorrhage is a complication of cystoscopy.
C. Heat may decrease the client’s discomfort but may increase bleeding.
D. An antispasmodic medication will reduce the pain from spasms and contractions of the bladder
and sphincter but will not control bleeding.

4. The nurse is caring for the client experiencing a possible hospital-acquired bladder
infection. Which nursing action should the nurse perform first?
A. Obtain a urine specimen for culture and sensitivity.
B. Administer the prescribed antibiotic medication.
C. Teach the client to wipe the perineum front to back.
D. Prepare the client for removal of the urinary catheter.

ANSWER: A

A. Urine should be obtained for culture and sensitivity (C&S) to identify the causative organism, the
number of bacteria present, and the antibiotic that would be most effective. Urine should be
collected before antibiotic treatment begins to avoid affecting results.
B. The nurse should first obtain the urine for C&S. Once the results of the urine culture are
obtained (24 to 48 hours), the antibiotic may need to be changed to one to which the causative
organism is sensitive.
C. Although the cheat should be taught to wipe the perineum from front to back, this is not the
first action.
D. If a urinary catheter is in place, it may need to be removed, but the C&S should be obtained first.

5. The nurse is caring for the female client experiencing recurrent UTIs. Which statement
would best help the client reduce her risk for another UTI?
A. “Eliminate caffeine and tea from your diet.”
B. “Take tub baths rather than showering.”
C. “Wear good-quality synthetic underwear.”
D. “Abstain from having sexual intercourse.”

ANSWER: A

A. Caffeine-containing beverages, such as coffee, tea, and cocoa, and alcoholic beverages irritate
the bladder and should be eliminated from the diet.
B. Showers, rather than tub baths, are recommended.
C. Synthetic underwear and constricting clothing, such as tight jeans, should be avoided.
D. Abstinence is unnecessary. The cheat should urinate after intercourse.

6. The client is concerned about having brown-colored urine after starting nitrofurantoin for
treating a UTI. Which response by the nurse is most appropriate?
 A. “Your urine is too concentrated. Take only one- half the dose of nitrofurantoin.”
B. “Stop taking nitrofurantoin and make an appointment to have a urine culture.”
C. “Nitrofurantoin normally does discolor urine; continue taking it as prescribed.”
D. “Drink at least 500 mL of fluid every 3 hours to lighten the color of your urine.”

ANSWER: C

A. Concentrated urine would be dark amber, not necessarily brown-colored. A medication dose
should not be changed without first consulting with the HCP.
B. A urine culture would have been completed before treatment was initiated. Another urine
culture is not indicated at this time.
C. The chemical makeup of the antibiotic nitrofurantoin (Furadantin) produces a harmless brown
color to the urine. Nitrofurantoin should be discontinued only after the client’s symptoms are
alleviated or the prescribed dose is completed.
D. Although increasing fluid intake will lighten the urine color, the urine will remain brown-colored
from nitrofurantoin.

7. The client with acute pyelonephritis of the left kidney is hospitalized. The nurse should
monitor for which most frequently occurring symptom?
A. Low-grade fever
B. Bradycardia
C. Left-sided flank pain
D. Right quadrant rebound tenderness

ANSWER: C

A. A high fever, rather than a low-grade fever, occurs with acute pyelonephritis.
B. Tachycardia, not bradycardia, occurs due to the elevated temperature.
C. Flank pain on the affected side with eostovertebral angle tenderness frequently occurs with
acute pyelonephritis due to inflammation.
D. Rebound tenderness in the right lower quadrant could indicate appendicitis.

8. During a teaching session with the client, the nurse shows the client an illustration
indicating the area of inflammation during a bout of left-sided pyelonephritis. Identify this
area of inflammation with an X.
Pyelonephritis is an inflammation, usually from an infection, that occurs in the renal parenchyma and
collecting system, including the renal pelvis.

9. The client is hospitalized with nephrotic syndrome and has 3+ pitting edema in all
extremities. Which laboratory test result should the nurse associate with this condition?
A. Elevated protein in the urine
B. Elevated serum albumin
C. Low serum lipid levels
D. Multiple cysts in the kidneys

ANSWER: A

A. In nephrotic syndrome proteinuria occurs because larger molecules are able to pass through the
glomerular membrane into the urine and then be excreted.
B. Serum albumin levels are likely to be decreased because large amounts of protein are lost in the
urine.
C. Altered liver activity may occur with nephritic syndrome, resulting in increased lipid production
and hyperlipidemia (not low lipid levels).
D. Multiple cysts in the kidneys occur with polycystic kidney disease and not nephrotic syndrome.

1 O. The nurse is caring for the client diagnosed with obstructing left ureterolithiasis. The
nurse evaluates that the client may have passed the calculi in the urine when which outcome
has been achieved?
A. Voiding clear amber urine greater than 30 mL per hour
B. No evidence of hematemesis or urinary tract infection
C. Absence of epigastric pain, nausea, and vomiting
D. Absence of colicky pain in the left lateral flank and groin

ANSWER: D
 A. Voiding greater than 30 mL per hour does not indicate that the stone has passed. The kidneys
will continue to produce urine, and the ureter will dilate, causing colicky pain.
B. Hematemesis occurs with GI problems. UTI may occur from the calculi’s irritation to the ureter,
but an absence of UTI does not mean the stone has passed.
C. Absence of epigastric pain, nausea, and vomiting is an outcome for the client with cholecystitis
because it describes the pain characteristics of cholecystitis.
D. Passage of a stone along the ureter produces flank pain and spasms of the ureter (colicky pain).
The absence of the colicky pain indicates the stone may have been excreted.

1 1 . The nurse is completing an admission assessment of the client with a possible

obstructing struvite calculus of the right ureter. Which is the best question for the nurse to
ask?
A. “Are you experiencing any pain in your left flank?”
B. “Do you like to drink cranberry, prune, or tomato juice?”
C. “Have you had a history of chronic urinary tract infections?”
D. “How often do you eat organ meats, poultry, fish, and sardines?”

ANSWER: C

A. Although assessing pain is a priority, pain associated with a calculus in the right ureter would be
in the right (not left) flank or costovertebral area.
B. Asking the client about juice preferences is irrelevant. The client with a UTI would be instructed
to increase intake of cranberries, prunes, plums, and tomatoes because these acidify the urine.
This is a good question to ask the client when planning teaching but is not the best question
during the admission assessment.
C. A frequent UTI is a predisposing factor for struvite stones. These stones are commonly referred
to as “infection stones” because they form in alkaline urine that is rich in ammonia.
D. Organ meats, poultry, fish, gravies, red wines, sardines, goose, and venison are high in purines.
These can contribute to the development of uric acid, not struvite, stones.

1 2. The nurse is admitting a hospitalized client who has a renal calculi. Which should be the
nurse’s priority?
A. Encourage the client to increase the amount of oral fluids.
B. Obtain necessary supplies to measure and strain all urine.
C. Assess the location and the severity of the client’s pain.
D. Obtain consent for extracorporeal shock wave lithotripsy (ESWL).

ANSWER: C
 A. Increasing fluids will promote passage of the renal stone through the ureter and decrease pain,
but it is not the priority.
B. Urine should be measured and strained, but this is not priority.
C. Assessment of the client’s pain is priority. Severe colic pain, which is most severe in the first 24
to 36 hours, can cause a vasovagal reaction with syncope and hypotension. Pain can also
interfere with the client’s admission process.
D. ESWL may be prescribed after other measures to assist the client to pass the stone are
ineffective.

1 3. Laboratory analysis reveals that the client passed a calcium oxalate stone. To prevent
the formation of future stones, the nurse should instruct the client to avoid consuming which
food?
A. Cheese
B. Lettuce
C. Chocolate
D. Beans

ANSWER: C

A. Cheese is high in purine and should be avoided I cases of uric acid stones.
B. Lettuce does not increase urinary oxalate excretion.
C. Foods that increase urinary oxalate excretion include chocolate, nuts, tea, spinach, strawberries,
wheat bran, and beets.
D. Beans are high in purine and should be avoided in cases of uric acid stones.

1 4. The nurse is planning care for the client who is to undergo extracorporeal shock wave
lithotripsy (ESWL). Which actions should the nurse include in the plan of care immediately
following the procedure? Select all that apply.
A. Instruct on the need to measure and strain all urine.
B. Give no fluids or foods for 24 hours post ESWL.
C. Check for flank ecchymosis on the affected side.
D. Assess the incision for clean, dry, and intactness.
E. Remove the stent that was placed during ESWL.

ANSWER: A, C

A. Urine is strained to monitor the passage of stone fragments.

B. Fluids and foods are given as soon as the client has recovered from the effects of the sedative.
Drinking large amounts of fluid will assist with passage of the stone fragments.
C. The flank should be checked for bruising. Some bruising may occur on the flank of the affected
side after ESWL because sound, laser, or dry shock-wave energies are used to break the stone
into small fragments.
D. There is no incision with ESWL. A small incision is made during percutaneous ultrasonic
lithotripsy.
 E. A stent is occasionally placed in the ureter before ESWL to dilate the ureter and ease passage of
the stone fragments. Stent placement prevents the stone from coming in contact with the
ureteral mucosa, thereby reducing pain. The stent is not removed until stone fragments have
passed.

15. The nurse is caring for the female client experiencing new-onset urge urinary
incontinence. Which interventions should the nurse implement? Select all that apply.
A. Ensure that the client is taken to the bathroom every 4 hours.
B. Give diuretics at supper time so the bladder is empty at night.
C. Turn on the water or flush the toilet to assist the client to void.
D. Avoid caffeine and foods or beverages that contain aspartame.
E. Instruct the client on inserting vaginal weights for daytime use.

ANSWER: C, D

A. An initial toileting schedule should be every 1 to 2 hours.

B. Diuretics should be given early in the day, prefer- ably at: breakfast time to avoid interrupting
sleep.
C. A type of urge urinary incontinence includes detrusor muscle hyperactivity with impaired
contractility. The client is incontinent or voids a small volume of urine, is unable to void the
remainder, and then has incontinence after leaving the bathroom. Turning on the water utilizes
the power of suggestion to promote voiding.
D. Caffeine and aspartame are bladder irritants that increase detrusor muscle activity.
E. Vaginal weights (vaginal cone therapy) are helpful in strengthening the pelvic and bladder
muscles. These can improve the ability to hold the urine until reaching a bathroom.

1 6. The client has xerostomia secondary to oxybutynin use for treating urge incontinence.
Which interventions should the nurse implement to relieve xerostomia?
A. Have the client bathe in tepid water.
B. Offer sugar-free candy or gumdrops.
C. Massage the client’s skin with lotion.
D. Place a fan by the client at a low setting.

ANSWER: B

A. Bathing in tepid water will not relieve xerostomia (a dry mouth).

B. The nurse should offer sugar-free candy or gumdrops; sucking on these will relieve xerostomia
(a dry mouth).
C. Using lotion will relieve itching but will not relieve xerostomia (a dry mouth).
D. Placing a fan by the client at a low setting may help with dyspnea or diaphoresis, but it will not
relieve xerostomia (a dry mouth). It can increase the client’s feeling of a dry mouth.
1 7. The female client, being treated for stress incontinence with vaginal cone therapy, calls a
clinic to report that she is experiencing burning on urination, chills, and fever. Which is the
best instruction by the nurse?

A. “Take acetaminophen to relieve the pain and reduce your fever.”

B. “Come to the clinic. We need to complete a urine culture and sensitivity.”
C. “Discontinue the use of the vaginal weights to see if the symptoms subside.”
D. “Drink cranberry juice and increase your fluid intake for the next 48 hours.”

ANSWER: B

A. 1 . Although pain and temperature reduction are important, the client needs treatment for a
possible infection.
B. 2. The client has symptoms of an infection, likely cystitis or a UTI, and should be seen in the
clinic. The urine culture will establish the number and types of organisms present and help
determine appropriate antibiotic therapy.
C. 3. The method of vaginal insertion of the weights may be the underlying cause of the infection,
but discontinuing their use will not resolve the symptoms.
D. 4. Drinking cranberry juice acidifies the urine and is thought to prevent the attachment of
bacteria to the bladder wall. Fluids will help to “flush” the urinary tract; these measures do not
treat the infection.

1 8. The HCP writes orders for the newly hospitalized client who has polycystic kidney
disease (PKD) and dull flank pain, nocturia, and low urine specific gravity dilute urine.
Which admission order should the nurse clarify with the HCP?
A. Fluid intake of at least 2000 mL daily
B. Restrict sodium intake to 500 mg daily
C. Initiate referral for genetic counseling
D. Metoprolol 12.5 mg (oral) bid

ANSWER: B

A. When renal impairment results in decreased urine concentration with nocturia and low urine
specific gravity, the client should drink at least 2 liters of fluid daily to prevent dehydration.
B. The client with PKD can have salt wasting and should not be on a sodium-restricted diet (500
mg). A low-sodium diet may be prescribe to control hypertension.
C. Children of parents who have the autosomal dominant form of PKD (the most common form)
have a 50% chance of inheriting the gene that causes the disease; a genetic counseling referral is
appropriate.
D. BP control is necessary to slow the progression of the renal dysfunction and reduce
cardiovascular complications.
1 9. The nurse is assessing the client with polycystic kidney disease (PKD). The nurse should
consider that a cyst may have ruptured when collecting which client information?
A. Reports a decrease in pain
B. Voids cola-colored urine
C. Passes stools that are bloody
D. Has a decreased serum creatinine level

ANSWER: B

A. Sharp, intermittent pain (not decreased pain) occurs when a cyst ruptures.
B. If a cyst ruptures, bleeding occurs, and the client could have bright red or cola-colored urine.
C. Bloody stools would indicate a Gland not a renal problem.
D. Serum creatinine is a measure of renal function. As kidney function deteriorates, serum
creatinine and BUN levels rise.

20. The nurse is caring for the client who was newly diagnosed with renal cell carcinoma.
The nurse should assess for which specific symptoms?
A. Hematuria and nocturia
B. Abdominal pain and dysuria
C. Flank pain and hematuria
D. Suprapubic pain and foul-smelling urine

ANSWER: C

A. Hematuria and nocturia are nonspecific symptoms that could be associated with other renal
problems, such as BPH.
B. Abdominal pain is not associated with renal cell carcinoma unless it has metastasized.
Metastasis is not addressed in the question. Painful urination (dysuria) could indicate a lower
urinary tract problem, such as cystitis or a bladder infection.
C. Specific symptoms of renal cell carcinoma include flank pain, gross hematuria, and a palpable
renal mass.
D. Suprapubic pain and foul-smelling urine could indicate an infection.

2 1 . The client is scheduled for .a cystectomy with an ileal conduit for urinary diversion.
Which explanation should the nurse provide when the client asks about postsurgery
urination?
A. “The normal urinary flow is maintained with this type of surgery.”
B. “Doing kegel exercises may help you achieve urinary continence.”
C. “Bladder retraining will be taught later during your recovery.”
D. “A urine collection bag is placed over the stoma that will be created.”

ANSWER: D
 A. The normal urinary flow is not maintained. A stoma will be formed when the ileal conduit is
created for the urinary diversion.
B. An ileal conduit creates a noncontinent stoma. Kegel exercises will have no effect on muscle
strengthening because the bladder is removed during cystectomy.
C. Bladder retraining will have no effect on bladder control because the bladder is removed during
cystectomy.
D. An ileal conduit collects urine in a portion of the intestine that opens onto the skin surface as a
stoma. After the creation of a stoma, the client must wear a pouch to collect urine.

22. The nurse is caring for the client who had continent urinary diversion surgery with
creation of a Kock pouch. Which intervention should the nurse include in the care?
A. Insert a catheter in the pouch every 4 to 6 hours to drain the urine.
B. Cleanse the skin around the stoma with alcohol and water every day.
C. Encourage sleeping on the side of the stoma for good urine drainage.
D. Apply the stoma pouch so that it fits snugly to avoid urine leakage.

ANSWER: A

A. A Kock pouch is a continent internal ileal reservoir that should be catheterized every 4 to 6
hours to drain the urine.
B. Alcohol is drying and can result in skin breakdown.
C. Sleeping on the side of the stoma is unnecessary. Urine will flow from the ureters into the
reservoir regardless of the client’s position.
D. A stoma pouch would not be required. The client may initially have a plastic catheter in the
stoma until the incision heals.

23. The female nurse is preparing to empty the urostomy bag of a female client who is
Muslim. Which statement would be most respectful of the client?
A. “Do you want your spouse in the room when I empty the urine from this bag?"
B. “You need to increase your fluid intake. What beverages do you like to drink?”
C. “I need to move the covers to the side in order to empty the bag. Can I do this now?”
D. “You didn’t eat any lunch, and you need protein for healing. What foods can you eat?”

ANSWER: C

A. There is no indication in the stem that the client has a spouse.

B. The situation is about respect, not increasing the fluid intake.
C. Muslim men and women are reluctant to expose their bodies. The nurse requesting permission
before uncovering any part of the body is showing respect.
D. Although asking about food preferences is important because the client may abstain from pork
and gelatin made from pork, the manner in which the nurse asks the client is condescending.
24. The client has an Indiana pouch that requires intermittent urinary catheterizntion.
Which type of stoma should the nurse expect when preparing the client for catheterization?

ANSWER: B

A. Option 1 is an ileal conduit. The urine is diverted by implanting the ureters into a loop of the
ileum, and one end is brought out through the abdominal wall. A urostomy bag is used to collect
the urine.
B. In an Indiana pouch, the ureters are implanted into a segment of the ileum and cecum, and a
pouch is created. Urine is drained intermittently by inserting a catheter into the stoma.
C. Option 3 shows a sigmoid colostomy where a segment of the colon is brought outside the
abdominal wall. It is a diversion for excreting feces when a lower portion of the large intestine
has been removed.
D. Option 4 shows an ileostomy where a segment of the ileum is brought through the abdominal
wall. It is a diversion for excreting feces when the large intestine, and at times a portion of the
small bowel, has been removed.

25. The nurse is providing teaching to the client with a noncontinent urostomy created
during urinary diversion. Which information should the nurse include?
A. Wear clothing that is tight-fitting.
B. Intermittently catheterize the stoma.
C. The stoma will be red and protruding.
D. Push on the stoma daily to keep it flat.

ANSWER: C
 A. The client should be taught to avoid restrictive clothing that could impair blood supply to the
stoma and the flow of urine.
B. A noncontinent urostomy drains urine continu- ally, so there is no need for intermittent
catheterization unless complications such as a stricture occur with the stoma.
C. The nurse should teach that the ideal urinary stoma is symmetrical, has no skin breakdown,
protrudes about 1.5 cm, and has healthy, moist red mucosa.
D. Pressure on the stoma may impair circulation.

26. The NA reports to the nurse that urine in the client’s urostomy bag is dark amber colored
with a large amount of thick mucus. Which should be the nurse’s instruction to the NA?
A. Obtain a urine specimen for culture.
B. Change the client’s urostomy bag.
C. Offer the client fluids more often.
D. Ambulate the client in the hall.

ANSWER: C

A. Even though the urine is concentrated, there is no indication of an infection. A culture is

unnecessary.
B. Changing the client’s urostomy bag is unnecessary.
C. An intestinal segment is used to create an ileal conduit. It continues to secrete mucus because of
the irritating effect of the urine. Increasing the amount of fluids will flush the mucus from the
client’s ileal conduit.
D. Arnbulation may improve circulation, but increased amounts of fluids are needed.

27. The client has a nephrostomy tube in place after a partial nephreetomy. Which actions
should the nurse include when caring for a nephrostomy tube? Select all that apply.
A. Clamp and unclamp the tube every four hours.
B. Irrigate with 30 mL of sterile saline solution daily.
C. Observe for cloudy, foul-smelling urinary drainage.
D. Keep the nephrostomy tube below kidney level.
E. Record nephrostomy and urinary tube output separately.

ANSWER: C, D, E

A. Clamping, compressing, or kinking the tube can cause renal damage.

B. Irrigation should be performed if prescribed, using no more than 5 mL of sterile solution.
Irrigation may cause overdistention and renal damage.
C. The output and surrounding tissue should be assessed for signs of infection.
D. The nephrostomy tube is draining urine from the kidney, so the tube must be kept below the
flank level to prevent backflow of urine.
 E. The nephrostomy tube drains urine from the affected kidney. The urinary drainage catheter
drains urine from the bladder (collected from the other kidney). These should be recorded
separately to evaluate kidney function, but the hourly urine output should be monitored by
adding the two amounts together.

28. The nurse is caring for four clients. Which client requires further nursing assessment
due to risk of prerenal failure?
A. The client diagnosed with renal calculi
B. The client undergoing an IV pyelograrn
C. The client who has congestive heart failure
D. The client who had a transfirsion reaction

ANSWER: C

A. Renal calculi can cause postrenal failure.

B. An IV pyelogram can cause intra- or infrarenal renal failure (these are interchangeable terms)
because the dye load can be toxic to the kidney.
C. CHF can cause prerenal failure due to cardiac pump problems, volume depletion from fluid
restriction or diuretics, or vasodilation from beta blocker medications. If the kidneys are not
adequately perfused, the resulting hypoperfusion decreases GFR.
D. A transfusion reaction can cause an intra- or infrarenal failure because of the hemoglobinuria
produced by the breakdown of the wrong type of RBCs in the body.

29. The nurse assesses that the client with ARF has a serum potassium level of 6.8 mEq/L.
Which medications, if prescribed, should the nurse plan to administer now? Select all that
apply.
A. Erytlrropoietin
B. Regular insulin
C. 0.45% saline bolus
D. Calcium gluconate
E. Sodium polystyrene sulfonate

ANSWER: D

A. Erythropoietin triggers the production of RBCs by bone marrow. It is used to treat anemia, which
is common in renal failure. It will not have an effect in treating hyperkalemia.
B. Regular insulin forces the potassium into the cells, temporarily lowering serum potassium levels.
It should be given new if prescribed.
C. 5% to 50% dextrose (not 0.45% saline bolus) is given along with regular insulin and calcium
gluconate to force the potassium into the cells.
D. Calcium gluconate raises the threshold for cardiac muscle excitation, thereby reducing the
incidence of life-threatening dysrhythmias that can occur with hyperkalemia.
E. Sodium polystyrene sulfonate (Kayexalate) is cation-exchange resin that removes potassium by
exchanging it with sodium ions in the large intestine.
30. Three weeks after developing ARF following trauma, the hospitalized client has a
significantly increased urinary output. Which assessment finding should the nurse report to
the HCP immediately?

A. Absence of adventitious breath sounds

B. A drop in BP and increase in pulse rate
C. A 3-pound weight loss over 24 hours
D. A serum potassium level of 3.7 mEq/L

ANSWER: B

A. Adventitious breath sounds are abnormal breath sounds; absence of these is a normal finding.
B. A decrease in BP and increase in pulse rate are physiological responses to a decrease in
circulating blood volume that occurs in the diuretic phase of ARF. Uncorrected dehydration will
complicate the client’s recovery.
C. Weight loss is an expected finding with diuresis.
D. A serum potassium level of 3.7 mEq/L is WNL of 3.5—5.0 mEq/L.

31. The client with CRF receives a hemodialysis treatment. The client’s weight before dialysis
was 83 kg and alter dialysis is 80 kg. How many liters should the muse estimate that the
client lost during the hemodialysis treatment?

___________ liters (Record your answer as a whole number.)

ANSWER: C

Because 1 kg of weight is equivalent to 1 liter of fluid, a weight loss of 3 kg would be approximately 3

liters of fluid loss.

32. The nurse is planning meals for the client on hemodialysis and fluid restriction
secondary to ARF. Which afternoon snack should the nurse include?
A. Large banana
B. Glass of milk
C. Ham sandwich
D. A small apple

ANSWER: D

A. Bananas are high in potassium. Potassium is restricted because clients with oliguria are unable
to eliminate it.
B. Fluid is usually restricted to 500 mL plus the previous day’s output to prevent fluid overload; a
glass is 240 mL. Milk has a significant amount of potassium and phosphorus and should be
avoided. Small amounts of rice milk or soy milk are alternatives.
 C. Ham is high in sodium, which is restricted to minimize sodium and fluid retention.
D. A small apple is low in potassium and an acceptable snack. Other snack options include grapes,
celery, or 1 pita bread with 2 oz turkey (not processed meats). The amount of protein the client
can have is increased when on hemodialysis.

33. The nurse is caring for the client who developed ARF. Which findings support the nurse’s
conclusion that the client is in the recovery phase of ARF? Select all that apply.
A. Increased urine specific gravity
B. Increased serum creatinine level
C. Decreased serum potassium level
D. Absence of nausea and vomiting
E. Absence of muscle twitching

ANSWER: A. C. D, E

A. During the recovery phase of ARF, urine specific gravity increases because of the kidneys’ ability
to concentrate urine and excrete electrolytes.
B. The client should have a decreased, not increased, serum creatinine level in the recovery period.
C. Potassium is decreased because of the kidneys’ ability to excrete potassium.
D. Nausea, vomiting, and diarrhea are common in ARF because of accumulation of nitrogenous
wastes. An absence of these indicates that the client is in the recovery phase of ARF.
E. Neurologically, the client in ARF may have muscle twitching, drowsiness, headache, and seizures
because of the electrolyte imbalances and accumulation of metabolic wastes. In the recovery
period, the client should not have muscle twitching.

34. The experienced nurse is orienting the new nurse to the care of clients with CRF. Which
statement made by the new nurse should the experienced nurse correct?
A. “The client with CRF is starting on peritoneal dialysis and should have a high-protein diet."
B. “The amount of outflow from peritoneal dialysis should equal the amount that was instilled.”
C. “I should hold the client’s dose of lisinopril because the client is going for hemodialysis now.”
D. “I will ensure that the client with CRF has more carbohydrates because protein is restricted.”

ANSWER: B

A. During peritoneal dialysis (PD), protein moves out of the blood with the waste products and into
the dialysate fluid, which is discarded. A high- protein diet is necessary to replace the losses.
B. In PD the amount of outflow should be more than what was instilled because fluid is being
removed. This statement should be corrected by the experienced nurse.
C. Antihypertensive medications, such as lisinopril (Prinivil), should not be given before
hemodialysis. Hypotension can occur when fluid is removed.
D. With CRF, kilocalories are supplied by carbohydrates and fat. Inadequate nonprotein kilocalories
will lead to tissue breakdown and aggravate uremia.
35. After a diagnosis of CRF, the client was started on epoetin alfa. Which finding indicates
that the medication has been effective?
A. Decrease in serum creatinine levels
B. Increase in white blood cells
C. Increase in serum hematocrit
D. Decrease in blood pressure

ANSWER: C

A. Epoetin alfa (Epogen) does not have a direct effect on serum creatinine levels.
B. Elevated WBCs could indicate that the client has an infection. Epoetin alfa does not affect WBCS.
C. Epoetin alfa (Epogen) stimulates RBC production and increases Hct. Initial effects should be seen
in 1 to 2 weeks, and normal Het should be achieved within 2 to 3 months.
D. As the Hct increases, there can be a transient increase in BP.

36. ABGs are prescribed for the client with CRF who has hypotension, cold and clammy skin,
and dysrhythmias. The nurse should notify the HCP to report that the client is experiencing
which imbalance?

A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis

ANSWER: C

A. Respiratory acidosis would result in a decreased pH, an increased Paco2, and a normal or
decreased HCO3.
B. Respiratory alkalosis would result in an increased pH, a decreased Paco2, and a normal or
decreased HCO3.
 C. In metabolic acidosis, the pH and HC03 are decreased, and the Paco2 is normal (or decreased if
compensation is occurring). In compensation, the client would be hyperventilating to decrease
the Paco, and conserve the HCO3. In CRF, metabolic acidosis occurs because the kidneys are
unable to excrete the increased amounts of acids. The inability of the kidney tubules to excrete
ammonia Mg) and to reabsorb sodium bicarbonate (N aHC03) causes the decreased acid
secretion. The decreased excretion of phosphates and other organic acids contributes to the
accumulation of acids.
D. Metabolic alkalosis would result in an increased pH, an increased HCO3, and a normal or
increased Paco2.

37. The 75-year-old client is hospitalized with ESRD. Which finding in the client’s medical
record should the nurse associate with the diagnosis of ESRD?
A. A urinary output of less than 100 mL in 24 hours
B. A glomcrular filtration rate less than 15 mIJmin/ 1.73 m2
C. A serum creatinine level greater than 12.0 mg/dL
D. A serum blood urea nitrogen greater than 100 mg/dL

ANSWER: B

A. Anuria is defined as a urine output of less than 100 mL/24 hr and is not used to define ESRD.
B. ESRD is defined as a GFR of less than 15. Creatinine clearance (based on urinary creatinine in a
timed specimen and a serum creatinine level) is a calculated measure of GFR.
C. Serum creatinine levels (normal 0.5—1.2 mg/L) are elevated with renal failure but do not define
ESRD.
D. Serum BUN is elevated in renal failure but is not used to define ESRD.

38. The client diagnosed with ESRD states to the nurse, “I don‘t think I want to be on dialysis
anymore; it's just too painful for me.” What is the most appropriate response by the nurse?
A. “Why do you think staying on dialysis is so painful for you?”
B. “You feel that dialysis is painful for you. Tell me more about that.”
C. “It really isn’t hard to stay on dialysis. You can sleep during these.”
D. “You should stay on dialysis so you won’t get worse or even die.”

ANSWER: B

A. Asking a “why” question is asking for information that the client may not be able to express.
B. Paraphrasing the client’s statement encourages the client to verbalize feelings and conveys that
the message is understood. An open-ended response allows for a more lengthy response from
the client.
C. Telling the client that dialysis treatment “isn’t really hard” devaluates the client’s feelings.
D. Telling the client what to do, giving advice, and threatening the client blocks therapeutic
communication.
39. The nurse is caring for the client with CRF. Which statement should the nurse document
as an appropriate outcome in the plan of care?
A. Eats three large meals daily without nausea
B. Daily weight gain of no more than 3 pounds
C. Reduced serum albumin levels within 1 week
D. No evidence of bleeding

ANSWER: D

A. The client with CRF has the potential for imbalanced nutrition due to anorexia, nausea, and
stomatitis secondary to the effects of urea excess on the GI system. The client should consume
small, frequent meals, not large meals.
B. The client with CRF is at risk for fluid volume excess because of the kidneys’ inability to excrete
water. A 3-lb weight gain in one day indicates fluid retention.
C. The client with CRF has the potential for imbalanced nutrition because of a protein-restricted
diet. Serum albumin levels should be WNL.
D. No evidence of bleeding is an appropriate client outcome. The client with CRF is at risk for
bleeding because of impaired platelet function.

40. The NA reports to the nurse that the client with CRF has “white crystals” and dry, itchy
skin. Based on this information, which instruction should the nurse give to the NA?
A. Apply the prescribed antipruritic cream.
B. Offer the client a glass of warm milk.
C. Prepare a tepid-water bath for the client.
D. Assess the skin for areas of breakdown.

ANSWER: C

A. Although an antipruritic cream could be applied to relieve itching, applying the medication
would not be within the scope of practice of the NA.
B. Fluid intake is usually restricted for the client with CRF.
C. Bathing the client in cool water will remove crystals, decrease itching, and promote client
comfort. The crystals (uremic frost) and itching are from irritating toxins and deposits of
calcium-phosphate precipitates on the skin.
D. Assessment is not within the scope of practice of the NA.

41 . The cheat has a newly placed left forearm internal arteriovenous (AV) fistula for
hemodialysis. Which interventions should the nurse plan to implement? Select all that apply.
A. Tell the NA to take the BP on the right arm
B. Palpate for a thrill over the left forearm fistula
C. Aspirate blood from the fistula for lab tests
D. Check left radial pulse, finger movement, and sensation
E. Instruct about the hand exercises that start in about a week
ANSWER: A. B, D. E

A. A BP should not be taken on the arm with the AV fistula because it could damage the fistula.
B. An AV fistula is created by the anastomosis of an artery to a vein. A thrill is the arterial blood
rushing into the vein. Its presence indicates that the fistula is not occluded.
C. Aspirating for blood can damage the fistula because it takes 4 to 6 weeks to mature.
D. CMS is important to assess because complications of the fistula creation include impairment of
circulation and nerve damage.
E. Hand exercises such as squeezing a rubber ball help the fistula to mature. These are not started
until the incision heals. The fistula is not used until it matures in about 4 to 6 weeks.

42. A nursing home resident returns to the facility after receiving a hemodialysis treatment.
Which symptom observed by the charge nurse suggests that the client has developed
disequilibrium syndrome?
A. Shortness of breath with a nonproductive cough
B. Pitting edema in both of the hands and feet
C. Inability to palpate a thrill in the arteriovenous (AV) fistula
D. Headache with a decreased level of consciousness

ANSWER: D

A. Shortness of breath is a symptom associated with fluid volume excess-

B. Pitting edema is associated with fluid volume excess.
C. Loss of a palpable thrill is associated with a thrombosed AV fistula.
D. Rapid changes in fluid volume and BUN levels during hemodialysis can result in disequilibrium
syndrome. Symptoms include headache and decreased level of consciousness from the
associated cerebral edema and increased ICP.

43. After determining that the client with CRF has no signs of an infection, the nurse initiates
the first peritoneal dialysis treatment for the client. During the infusion of the dialysate, the
client reports abdominal pain. How should the nurse best respond to the situation?
A. Raise the bed to a high Fowler’s position.
B. Stop the infusion rate until the pain goes away.
C. Ask when the client last had a bowel movement.
D. Explain that the pain will subside after a few exchanges.

ANSWER: D

A. Positioning the client supine in a low Fowler’s position reduces intra-abdominal pressure.
B. The infusion should not be stopped or slowed; the pain, due to initial peritoneal irritation, will
subside only after a few exchanges.
C. A full bowel may cause slowing during inflow of the dialysate solution, and the client may feel
pressure, but not pain. This is not the best response by the nurse.
 D. Peritoneal irritation, from the inflow of the dialysate, commonly causes pain during the first few
exchanges and usually subsides within 1 to 2 weeks. The nurse should monitor for signs of
peritonitis, such as cloudy effluent and abdominal pain.

44. The client has been on hemodialysis for the past 5 years. The client’s spouse calls the
clinic because the client has stopped eating, is taking long naps, and refuses to talk. Which
conclusion made by the nurse about the client’s behavior is most accurate?
A. The client may be feeling depressed.
B. The client is expressing displacement.
C. The client has become noncompliant.
D. The client now has activity intolerance.

ANSWER: A

A. The most accurate interpretation of the client’s behavior is that the client may be feeling
depressed. Emotional signs and symptoms of depression include tiredness, sadness, emptiness,
or numbness. Behavioral signs include irritability, inability to concentrate, difficulty making
decisions, crying, sleep disturbance, social withdrawal, and loss of sexual desire. Physical signs
include anorexia, weight loss, constipation, headache, and dizziness.
B. Displacement is releasing pent-up feelings on persons less threatening than those who initially
aroused the feelings.
C. Noncompliance is behaviors or actions that would be contraindicated for a particular situation.
For example, rather than stopping eating, the client might eat foods that are to be avoided and
drink more fluids than allocated.
D. The defining characteristics of activity intolerance, such as dyspnea, fatigue, or weakness, are
not noted in the stem.

45. The nurse is assessing the client receiving peritoneal dialysis. Which finding suggests
that the client may be developing peritonitis?
A. Abdominal numbness
B. Cloudy dialysis output
C. Radiating sternal pain
D. Decreased WBC count

ANSWER: B

A. The client would experience abdominal tenderness and pain with peritonitis, not numbness.
B. Cloudy dialysate output suggests peritonitis.
C. Abdominal pain rather than stemal pain occurs with peritonitis.
D. WBCs would increase (not decrease) in the presence of an infection.
46. The nurse is caring for four cheats. For which cheat should the nurse anticipate
treatment with continuous renal replacement therapy (CRRT)?
A. The cheat who has an increased serum creatinine level after receiving vancomyein IV to treat a
wound infection
B. The client who is in stage 4 chronic kidney disease (CKD) as a complication of type 1 diabetes
mellitus
C. The client who had an acute MI during coronary artery bypass graft (CABG) surgery and
develops ARF
D. The client who can no longer have peritoneal dialysis (PD) due to thickening of the peritoneal
membrane

ANSWER: C

A. The client who develops reduced renal function after receiving vancomycin requires medical
support and observation but does not necessarily require dialysis.
B. A diabetic client with CKD is a candidate for hemodialysis or peritoneal dialysis.
C. CRRT is hemofiltration used to treat ARF in critically ill clients who have an unstable BP and
cardiac output, such as the client who developed ARF post MI and CABG surgery. CRRT is
performed continuously to avoid rapid shifts in fluids and electrolytes.
D. The client who can no longer tolerate PD can be treated with hemodialysis.

47. The cheat who had a kidney transplant has newly prescribed medications. Which
prescribed medication should the nurse administer for BP control?
A. Digoxin
B. Tacrolimus
C. Aralodipine
D. Epoctin alfa

ANSWER: C

A. Digoxin (Lanoxin) is a cardiac glycoside used as an isotropic antidysrhythmic agent.

B. Tacrolimus (Prograf) is an immunosuppressant.
C. Amlodipine (Norvasc) is a calcium channel blocking and antihypertensive agent. Anti
hypertensive agents are used to maintain optimum perfusion in the transplanted kidney and to
control hypertension, an adverse effect associated with immunosuppressants.
D. Epoetin alfa (Procrit) is given to treat anemia.

48. The nurse is assessing the client following a kidney transplant from a live donor. The
nurse should notify the HCP to report a possible complication of urine leakage when which
findings are noted?
A. Urine output 15 mL/hour; serum creatinine 3.4 mg/dL; lower abdominal discomfort
B. Urine output 200 mL/hour; serum creatinine 1.2 mg/dL; incisional discomfort
C. Urine output 20 mL/hour; elevated temperature; tenderness over the transplanted kidney
D. Urine output 0 mL for one hour, then 300 mL/hour; erratic output; incisional discomfort
ANSWER: A

A. The complication of urine leaks manifest as diminished urine output, an increase in serum
creatinine, and lower abdominal or suprapubic discomfort. It most commonly occurs at the site
of the anastomosis.
B. A normal, functioning kidney, from a live donor, produces large amounts of dilute urine. A
reduction of serum creatinine and incisional discomfort are expected after renal transplant.
C. Oliguria, fever, and swelling or tenderness over the transplanted kidney could be a Sign of
kidney rejection.
D. A kidney from a cadaver donor may not function for 2 or 3 weeks, during which time anuria,
oliguria, or polyuria may be present.

49. The nurse is caring for a group of clients on a hospital unit with the assistance of the LPN.
Which aspect of client care would be most appropriate for the nurse to delegate to the LPN?
A. Completing the admission for the client who has flank pain
B. Preparing the client for a newly prescribed renal biopsy
C. Administering sevelamer hydrochloride to the cheat with CRF
D. Observing the cheat self-cathcterizc a continent ileal reservoir

ANSWER: C

A. The client being admitted with acute flank pain needs an admission and pain assessment that
should be performed by the RN.
B. The client with a newly prescribed renal biopsy will need teaching that should be completed by
the RN.
C. Administering medications is within the scope of practice for the LPN. Sevelamer hydrochloride
(Renagel) binds dietary phosphorus in the intestinal tract.
D. Although “observing” would be within the scope of practice of the LPN, “evaluating” client
performance is not.

50. The nurse is admitting the client with possible renal trauma after an MVA. Prioritize the
nurse's actions when caring for the client.
A. Teach the client signs of a UTI
B. Palpate both flanks for asymmetry
C. Assess for pain in the flank area
D. Prepare the client for a CT scan
E. Inspect the abdomen and the urethra for gross bleeding

ANSWER: C, E, B, D, A

C. Assess for pain in the flank area. This is priority. Unrelieved pain can prolong the stress response.

E. Inspect the abdomen and the urethra for gross bleeding. If gross bleeding is present, the abdomen
should not be palpated.
B. Palpate both flanks for asymmetry. Lack of symmetry may indicate renal damage.

D. Prepare the client for a CT scan. Preparation for tests should occur after the physical examination is
completed.

A. Teach the client signs of a UTI. Physiological needs should be met before psychosocial needs such as
teaching are met.