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NCLEX Urinary/Renal

Function/Disorder and Electrolyte


Imbalance
A client with urinary incontinence asks the nurse for
suggestions about managing this condition. Which
suggestion would be most appropriate?
a) "Make sure to eat enough fiber to prevent
constipation."
b) "Try drinking coffee throughout the day."
c) "Use scented powders to disguise any odor."
d) "Limit the number of times you urinate during the
day."
a) "Make sure to eat enough fiber to prevent
constipation."
Explanation: Suggestions to manage urinary
incontinence include avoiding constipation such as
eating adequate fiber and drinking adequate amounts of
fluid. Scented powders, lotions, or sprays should be
avoided because they can intensify the urine odor,
irritate the skin, or cause a skin infection. Stimulants
such as caffeine, alcohol, and aspartame should be
avoided. The client should void regularly, approximately
every 2 to 3 hours to ensure bladder emptying.

A client is frustrated and embarrassed by urinary


incontinence. Which measure should the nurse include
in a bladder retraining program?
a) Restricting fluid intake to reduce the need to void
b) Establishing a predetermined fluid intake pattern for
the client
c) Encouraging the client to increase the time between
voidings
d) Assessing present voiding patterns
D) Assessing present voiding patterns
Explanation: The guidelines for initiating bladder
retraining include assessing the client's present intake
patterns, voiding patterns, and reasons for each
accidental voiding. Lowering the client's fluid intake
won't reduce or prevent incontinence. The client should
be encouraged to drink 1.5 to 2 L of water per day. A
voiding schedule should be established after
assessment.

A nursing instructor is reviewing with the class the


steps in urine formation. Place in the correct order
from first to last the sequence the instructor would
present.
-Filtrate enters Bowman's capsule
-Plasma filtered through glomerulus
-Formed urine drains from the collecting tubules, into
the renal pelvis, and down each ureter to the bladder
-Filtrate moves through tubular system of the nephron
and is either reabsorped or excreted
-Plasma filtered through glomerulus
-Filtrate enters Bowman's capsule
-Filtrate moves through tubular system of the nephron
and is either reabsorped or excreted
-Formed urine drains from the collecting tubules, into
the renal pelvis, and down each ureter to the bladder

A client is admitted for treatment of chronic renal


failure (CRF). The nurse knows that this disorder
increases the client's risk of:
a) a decreased serum phosphate level secondary to
kidney failure.
b) an increased serum calcium level secondary to
kidney failure.
c) water and sodium retention secondary to a severe
decrease in the glomerular filtration rate.
d) metabolic alkalosis secondary to retention of
hydrogen ions.
C) water and sodium retention secondary to a severe
decrease in the glomerular filtration rate.
Explanation: The client with CRF is at risk for fluid
imbalance dehydration if the kidneys fail to
concentrate urine, or fluid retention if the kidneys fail to
produce urine. Electrolyte imbalances associated with
this disorder result from the kidneys' inability to excrete
phosphorus; such imbalances may lead to
hyperphosphatemia with reciprocal hypocalcemia. CRF
may cause metabolic acidosis, not metabolic alkalosis,
secondary to inability of the kidneys to excrete
hydrogen ions.

Which is the correct term for the ability of the kidneys


to clear solutes from the plasma?
a) Glomerular filtration rate (GFR)
b) Renal clearance
c) Specific gravity
d) Tubular secretion
B) Renal Clearance
Explanation: Renal clearance refers to the ability of the
kidneys to clear solutes from the plasma. GFR is the
volume of plasma filtered at the glomerulus into the

kidney tubules each minute. Specific gravity reflects the


weight of particles dissolved in the urine. Tubular
secretion is the movement of a substance from the
kidney tubule into the blood in the peritubular capillaries
or vasa recta.

The client presents with nausea and vomiting, absent


bowel sounds, and colicky flank pain. The nurse
interprets these findings as consistent with:
a) Urethritis
b) Ureteral colic
c) Interstitial cystitis
d) Acute prostatitis
B) Ureteral colic

A client is admitted with nausea, vomiting, and


diarrhea. His blood pressure on admission is 74/30 mm
Hg. The client is oliguric and his blood urea nitrogen
(BUN) and creatinine levels are elevated. The
physician will most likely write an order for which
treatment?
a) Start I.V. fluids with a normal saline solution bolus
followed by a maintenance dose.
b) Administer furosemide (Lasix) 20 mg I.V.
c) Encourage oral fluids.
d) Start hemodialysis after a temporary access is
obtained.
A) Start IV fluids with normal saline solution bolus
followed by a maintenance dose.
Explanation: The client is in prerenal failure caused by
hypovolemia. I.V. fluids should be given with a bolus of
normal saline solution followed by maintenance I.V.
therapy. This treatment should rehydrate the client,
causing his blood pressure to rise, his urine output to
increase, and the BUN and creatinine levels to
normalize. The client wouldn't be able to tolerate oral
fluids because of the nausea, vomiting, and diarrhea.
The client isn't fluid-overloaded so his urine output won't
increase with furosemide, which would actually worsen
the client's condition. The client doesn't require dialysis
because the oliguria and elevated BUN and creatinine
levels are caused by dehydration.

Which of the following would the nurse expect to find


when reviewing the laboratory test results of a client
with renal failure?
a) Increased red blood cell count
b) Decreased serum potassium level
c) Increased serum calcium level
d) Increased serum creatinine level

D) Increased serum creatinine level


Explanation: In renal failure, laboratory blood tests
reveal elevations in BUN, creatinine, potassium,
magnesium, and phosphorus. Calcium levels are low.
The RBC count, hematocrit, and hemoglobin are
decreased.

A nurse assesses a client shortly after living donor


kidney transplant surgery. Which postoperative finding
must the nurse report to the physician immediately?
a) Serum sodium level of 135 mEq/L
b) Serum potassium level of 4.9 mEq/L
c) Temperature of 99.2 F (37.3 C)
d) Urine output of 20 ml/hour
D) Urine output of 20 ml/hour
Explanation: Because kidney transplantation carries the
risk of transplant rejection, infection, and other serious
complications, the nurse should monitor the client's
urinary function closely. A decrease from the normal
urine output of 30 ml/hour is significant and warrants
immediate physician notification. A serum potassium
level of 4.9 mEq/L, a serum sodium level of 135 mEq/L,
and a temperature of 99.2 F are normal assessment
findings.

A nurse is reviewing the history and physical


examination of a client with a suspected malignant
tumor of the bladder. Which finding would the nurse
identify as the most common initial symptom?
a) Urinary retention
b) Painless hematuria
c) Fever
d) Frequency
A) Painless hematuria
Explanation: The most common first symptom of a
malignant tumor of the bladder is painless hematuria.
Additional early symptoms include UTI with symptoms
such as fever, dysuria, urgency, and frequency. Later
symptoms are related to metastases and include pelvic
pain, urinary retention (if the tumor blocks the bladder
outlet), and urinary frequency from the tumor occupying
bladder space.

After teaching a group of students about how to


perform peritoneal dialysis, which statement would
indicate to the instructor that the students need
additional teaching?
a) "The effluent should be allowed to drain by gravity."
b) "It is important to use strict aseptic technique."
c) "The infusion clamp should be open during

infusion."
d) "It is appropriate to warm the dialysate in a
microwave."
D) It is appropriate to warm the dialysate in a
microwave
Explanation: The dialysate should be warmed in a
commercial warmer and never in a microwave oven.
Strict aseptic technique is essential. The infusion clamp
is opened during the infusion and clamped after the
infusion. When the dwell time is done, the drain clamp is
opened and the fluid is allowed to drain by gravity into
the drainage bag.

Which of the following is a characteristic of a normal


stoma?
a) Painful
b) No bleeding when cleansing stoma
c) Dry in appearance
d) Pink color
D) Pink color
Explanation: Characteristics of a normal stoma include a
pink and moist appearance. It is insensitive to pain
because it has no nerve endings. The area is vascular
and may bleed when cleaned.

To assess circulating oxygen levels, the 2001 Kidney


Disease Outcomes Quality Initiative: Management of
Anemia Guidelines recommends the use of which of
the following diagnostic tests?
a) Hemoglobin
b) Hematocrit
c) Arterial blood gases
d) Serum iron levels
A) Hemoglobin
Explanation: Although hematocrit has always been the
blood test of choice to assess for anemia, the 2001
Kidney Disease Outcomes Quality Initiative:
Management of Anemia Guidelines, recommend that
anemia be quantified using hemoglobin rather than
hematocrit measurements. Hemoglobin is
recommended as it is more accurate in the assessment
of circulating oxygen than hematocrit. Serum iron levels
measure iron storage in the body. Arterial blood gases
assess the adequacy of oxygenation, ventilation, and
acid-base status.

A nurse is reviewing the history of a client who is


suspected of having glomerulonephritis. Which of the
following would the nurse consider significant?
a) History of hyperparathyroidism

b) History of osteoporosis
c) Recent history of streptococcal infection
d) Previous episode of acute pyelonephritis
C) Recent hx of streptococcal infection
Explanation: Glomerulonephritis can occur as a result of
infections from group A beta-hemolytic streptococcal
infections, bacterial endocarditis, or viral infections such
as hepatitis B or C or human immunodeficiency virus
(HIV). A history of hyperparathyroidism or osteoporosis
would place the client at risk for developing renal
calculi. A history of pyelonephritis would increase the
client's risk for chronic pyelonephritis.

A client presents at the testing center for an


intravenous pyelogram. What question should the
nurse ask to ensure the safety of the client?
a) "Have you any artificial joints?"
b) "Do you have a pacemaker?"
c) "Do you have any allergies?"
d) "Who has come with you today?"
C) Do you have any allergies?
Explanation: Many contrast dyes contain iodine.
Therefore, it is essential for the nurse to determine
whether the client has any allergies, especially to iodine,
shellfish, and other seafood.

Which type of incontinency refers to the involuntary


loss of urine due to medications?
a) Overflow
b) Urge
c) Reflex
d) Iatrogenic
D) Iatrogenic
Explanation: Iatrogenic incontinence is the involuntary
loss of urine due to medications. Reflex incontinence is
the involuntary loss of urine due to hyperreflexia in the
absence of normal sensations usually associated with
voiding. Urge incontinence is the involuntary loss of
urine associated with a strong urge to void that cannot
be suppressed. Overflow incontinence is the involuntary
loss of urine associated with overdistention of the
bladder.

The nurse is to check residual urine amounts for a


client experiencing urinary retention. Which of the
following would be most important?
a) Catheterize the client immediately after the client
voids.
b) Check for residual after the client reports the urge
to void.

c) Set up a routine schedule of every 4 hours to check


for residual urine.
d) Record the volume of urine obtained.
A) Catheterize the client immediately after the client
voids
Explanation: To obtain accurate residual volumes, it is
important that clients void first and that catheterization
occur immediately after the attempt. The nurse should
record both the volume voided (even if it is zero) and
the volume obtained by catheterization. Intermittent
catheterizations are performed based on a schedule,
usually 3 to 4 times per day. Residual urine refers to the
amount remaining in the bladder after voiding. It is
essential that the client voids.

The client asks the nurse about the functions of the


kidney. Which should the nurse include when
responding to the client? Select all that apply.
a) Vitamin D synthesis
b) Secretion of prostaglandins
c) Vitamin B production
d) Secretion of insulin
e) Regulation of blood pressure
A) Vitamin D synthesis
B) Secretion of prostaglandins
E) Regulation of blood pressure
Explanation: Functions of the kidney include secretion of
prostaglandins, regulation of blood pressure, and
synthesis of aldosterone and vitamin D. The pancreas
secretes insulin. The body does not produce Vitamin B.

A client is scheduled for a creatinine clearance test.


The nurse should explain that this test is done to
assess the kidneys' ability to remove a substance from
the plasma in:
a) 1 hour.
b) 24 hours.
c) 1 minute.
d) 30 minutes.
C) 1 minute
Explanation: The creatinine clearance test determines
the kidneys' ability to remove a substance from the
plasma in 1 minute. It doesn't measure the kidneys'
ability to remove a substance over a longer period.

A client with renal failure is undergoing continuous


ambulatory peritoneal dialysis. Which nursing
diagnosis is the most appropriate for this client?
a) Impaired urinary elimination
b) Toileting self-care deficit

c) Risk for infection


d) Activity intolerance
C) Risk for infection
Explanation: The peritoneal dialysis catheter and regular
exchanges of the dialysis bag provide a direct portal for
bacteria to enter the body. If the client experiences
repeated peritoneal infections, continuous ambulatory
peritoneal dialysis may no longer be effective in clearing
waste products. Impaired urinary elimination, Toileting
self-care deficit, and Activity intolerance may be
pertinent but are secondary to the risk of infection.

When preparing a client for hemodialysis, which of the


following would be most important for the nurse to do?
a) Check for thrill or bruit over the access site.
b) Warm the solution to body temperature.
c) Inspect the catheter insertion site for infection.
d) Add the prescribed drug to the dialysate.
A) Check for thrill or bruit over the access site. When
preparing a client for hemodialysis, the nurse would
need to check for a thrill or bruit over the vascular
access site to ensure patency. Inspecting the catheter
insertion site for infection, adding the prescribed drug to
the dialysate, and warming the solution to body
temperature would be necessary when preparing a
client for peritoneal dialysis.

A physician orders cystoscopy and random biopsies of


the bladder for a client who reports painless
hematuria. Test results reveal carcinoma in situ in
several bladder regions. To treat bladder cancer, the
client will have a series of intravesical instillations of
bacillus Calmette-Gurin (BCG), administered 1 week
apart. When teaching the client about BCG, the nurse
should mention that this drug commonly causes:
a) delayed ejaculation.
b) hematuria.
c) impotence.
d) renal calculi.
B) hematuria
Intravesical instillation of BCG commonly causes
hematuria. Other common adverse effects of BCG
include urinary frequency and dysuria. Less commonly,
BCG causes cystitis, urinary urgency, urinary
incontinence, urinary tract infection, abdominal cramps
or pain, decreased bladder capacity, tissue in urine,
local infection, renal toxicity, and genital pain. BCG isn't
associated with renal calculi, delayed ejaculation, or
impotence.

A client undergoes extracorporeal shock wave


lithotripsy. Before discharge, the nurse should provide
which instruction?
a) "Be aware that your urine will be cherry-red for 5 to
7 days."
b) "Increase your fluid intake to 2 to 3 L per day."
c) "Apply an antibacterial dressing to the incision
daily."
d) "Take your temperature every 4 hours."
B) Increase your fluid intake to 2 to 3 L per day
The nurse should instruct the client to increase his fluid
intake. Increasing fluid intake flushes the renal calculi
fragments through and prevents obstruction of the
urinary system. Measuring temperature every 4 hours
isn't needed. Lithotripsy doesn't require an incision.
Hematuria may occur for a few hours after lithotripsy
but should then disappear.

A client develops decreased renal function and


requires a change in antibiotic dosage. On which factor
should the physician base the dosage change?
a) Therapeutic index
b) GI absorption rate
c) Liver function studies
d) Creatinine clearance
D) Creatinine clearance
The physician should base changes to antibiotic dosages
on creatinine clearance test results, which gauge the
kidney's glomerular filtration rate; this factor is
important because most drugs are excreted at least
partially by the kidneys. The GI absorption rate,
therapeutic index, and liver function studies don't help
determine dosage change in a client with decreased
renal function.

A history of infection specifically caused by group A


beta-hemolytic streptococci is associated with which of
the following disorders?
a) Acute glomerulonephritis
b) Acute renal failure
c) Nephrotic syndrome
d) Chronic renal failure
A) Acute glomerulonephritis
Acute glomerulonephritis is also associated with
varicella zoster virus, hepatitis B, and Epstein-Barr virus.
Acute renal failure is associated with hypoperfusion to
the kidney, parenchymal damage to the glomeruli or
tubules, and obstruction at a point distal to the kidney.
Chronic renal failure may be caused by systemic
disease, hereditary lesions, medications, toxic agents,
infections, and medications. Nephrotic syndrome is

caused by disorders such as chronic glomerulonephritis,


systemic lupus erythematosus, multiple myeloma, and
renal vein thrombosis.

The nurse is caring for the client following surgery for


a urinary diversion. The client refuses to look at the
stoma or participate in its care. The nurse formulates a
nursing diagnosis of:
a) Disturbed body image
b) Situational low self esteem
c) Anticipatory grieving
d) Deficient knowledge: stoma care
A) Disturbed body image
The client is exhibiting defining characteristics of
disturbed body image.

A client admitted with a gunshot wound to the


abdomen is transferred to the intensive care unit after
an exploratory laparotomy. I.V. fluid is being infused at
150 ml/hour. Which assessment finding suggests that
the client is experiencing acute renal failure (ARF)?
a) Urine output of 250 ml/24 hours
b) Temperature of 100.2 F (37.8 C)
c) Serum creatinine level of 1.2 mg/dl
d) Blood urea nitrogen (BUN) level of 22 mg/dl
A) Urine output of 250 ml/24 hours
ARF, characterized by abrupt loss of kidney function,
commonly causes oliguria, which is characterized by a
urine output of 250 ml/24 hours. A serum creatinine
level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of
22 mg/dl or a temperature of 100.2 F (37.8 C) wouldn't
result from this disorder.

A nurse is reviewing the laboratory test results of a


client with renal disease. Which of the following would
the nurse expect to find?
a) Decreased blood urea nitrogen (BUN)
b) Decreased potassium
c) Increased serum albumin
d) Increased serum creatinine
D) Increased serum creatinine
In clients with renal disease, the serum creatinine level
would be increased. The BUN also would be increased,
serum albumin would be decreased, and potassium
would likely be increased.

Which type of medication may be used in the


treatment of a patient with incontinence to inhibit
contraction of the bladder?

a) Anticholinergic agent
b) Over-the-counter decongestant
c) Tricyclic antidepressants
d) Estrogen hormone
A) Anticholinergic agent
Anticholinergic agents are considered first-line
medications for urge incontinence. Estrogen decreases
obstruction to urine flow by restoring the mucosal,
vascular, and muscular integrity of the urethra. Tricyclic
antidepressants decrease bladder contractions as well
as increase bladder neck resistance. Stress incontinence
may be treated using pseudoephedrine and
phenylpropanolamine, ingredients found in over-thecounter decongestants.

Retention of which electrolyte is the most lifethreatening effect of renal failure?


a) Potassium
b) Calcium
c) Phosphorous
d) Sodium
A) Potassium
Retention of potassium is the most life-threatening
effect of renal failure.

After teaching a group of students about the types of


urinary incontinence and possible causes, the
instructor determines that the student have
understood the material when they identify which of
the following as a cause of stress incontinence?
a) Obstruction due to fecal impaction or enlarged
prostate
b) Bladder irritation related to urinary tract infections
c) Increased urine production due to metabolic
conditions
d) Decreased pelvic muscle tone due to multiple
pregnancies
D) Decreased pelvic muscle tone due to multiple
pregnancies
Stress incontinence is due to decreased pelvic muscle
tone, which is associated with multiple pregnancies,
obstetric injuries, obesity, menopause, or pelvic disease.
Transient incontinence is due to increased urine
production related to metabolic conditions. Urge
incontinence is due to bladder irritation related to
urinary tract infections, bladder tumors, radiation
therapy, enlarged prostate, or neurologic dysfunction.
Overflow incontinence is due to obstruction from fecal
impaction or enlarged prostate.

After undergoing retropubic prostatectomy, a client


returns to his room. The client is on nothing-by-mouth
status and has an I.V. infusing in his right forearm at a
rate of 100 ml/hour. The client also has an indwelling
urinary catheter that's draining light pink urine. While
assessing the client, the nurse notes that his urine
output is red and has dropped to 15 ml and 10 ml for
the last 2 consecutive hours. How can the nurse best
explain this drop in urine output?
a) It's an abnormal finding that requires further
assessment.
b) It's a normal finding caused by blood loss during
surgery.
c) It's an abnormal finding that will correct itself when
the client ambulates.
d) It's a normal finding associated with the client's
nothing-by-mouth status.
A) It's an abornmal finding that requires further
assessment.
The drop in urine output to less than 30 ml/hour is
abnormal and requires further assessment. The
reduction in urine output may be caused by an
obstruction in the urinary catheter tubing or deficient
fluid volume from blood loss. The client's nothing-bymouth status isn't the cause of the low urine output
because the client is receiving I.V. fluid to compensate
for the lack of oral intake. Ambulation promotes
urination; however, the client should produce at least 30
ml of urine/hour.

The nurse is caring for a client who is scheduled for


the creation of an ileal conduit. Which statement by
the client provides evidence that client teaching was
effective?
a) "My urine will be eliminated with my feces."
b) "A catheter will drain urine directly from my kidney."
c) "I will not need to worry about being incontinent of
urine."
d) "My urine will be eliminated through a stoma."
D) My urine will be eliminated through a stoma
An ileal conduit is a non-continent urinary diversion
whereby the ureters drain into an isolated section of
ileum. A stoma is created at one end of the ileum,
exiting through the abdominal wall.

Nursing management of the client with a urinary tract


infection should include:
a) Teaching the client to douche daily
b) Discouraging caffeine intake
c) Administering morphine sulfate
d) Instructing the client to limit fluid intake

B) Discouraging caffeine intake


Strategies for preventing urinary tract infection include
proper perineal hygiene, increased fluid intake, avoiding
urinary tract irritants (including caffeine), and
establishing a frequent voiding regimen.

The most common presenting objective symptoms of a


urinary tract infection in older adults, especially in
those with dementia, include?
a) Hematuria
b) Change in cognitive functioning
c) Back pain
d) Incontinence
B) Change in cognitive functioning
The most common objective finding is a change in
cognitive functioning, especially in those with dementia,
because these patients usually exhibit even more
profound cognitive changes with the onset of a UTI.
Incontinence, hematuria, and back pain are not the most
common presenting objective symptoms.

Which of the following would be included in a teaching


plan for a patient diagnosed with a urinary tract
infection?
a) Drink coffee or tea to increase diuresis
b) Use tub baths as opposed to showers
c) Void every 4 to 6 hours
d) Drink liberal amount of fluids
D) Drink liberal amounts of fluids
Patients diagnosed with a UTI should drink liberal
amounts of fluids. They should void every 2 to 3 hours.
Coffee and tea are urinary irritants. The patient should
shower instead of bathe in a tub because bacteria in the
bath water may enter the urethra.

The following catheterization procedures are used to


treat clients with urinary retention. Which procedure
would the nurse identify as carrying the greatest risk
to the client?
a) Clean intermittent catheterization
b) Suprapubic cystostomy tube
c) Permanent drainage with a urethral catheter
d) Cred voiding procedure
C) Permanent drainage with a urethral catheter
Permanent drainage with a urethral catheter carries the
greatest risk. It may also increase the risk for bladder
stones, renal diseases, bladder infections, and urosepsis,
a severe systemic infection by microorganisms in the
urinary tract invading the bloodstream. Clean
intermittent catheterization has the fewest

complications and is the preferred treatment for urinary


retention. The Cred voiding procedure is used in the
case of clients who have lost control over their nervous
systems, secondary to injury or disease.

A client with urinary tract infection is prescribed


phenazopyridine (Pyridium). Which of the following
instructions would the nurse give the client?
a) "This medication will prevent re-infection."
b) "This medication should be taken at bedtime."
c) "This medication will relieve your pain."
d) "This will kill the organism causing the infection."
C) This medication will relieve your pain
Phenazopyridine (Pyridium) is a urinary analgesic agent
used for the treatment of burning and pain associated
with UTIs.

A nurse has been asked to speak to a local women's


group about preventing cystitis. Which of the following
would the nurse include in the presentation?
a) Need to urinate after engaging in sexual intercourse
b) Need to wear underwear made from synthetic
material
c) Importance of urinating every 4 to 6 hours while
awake
d) Suggestion to take tub baths instead of showers
A) Need to urinate after engaging in sexual intercourse
Measures to prevent cystitis include voiding after sexual
intercourse, wearing cotton underwear, urinating every
2 to 3 hours while awake, and taking showers instead of
tub baths.

Which of the following is a factor contributing to UTI in


older adults?
a) Low incidence of chronic illness
b) Sporadic use of antimicrobial agents
c) Immunocompromise
d) Active lifestyle
C) Immunocompromise
Factors that contribute to urinary tract infection in older
adults include immunocompromise, high incidence of
chronic illness, immobility, and frequent use of
antimicrobial agents.

You are caring for a 72-year-old client who has been


admitted to your unit for a fluid volume imbalance. You
know which of the following is the most common fluid
imbalance in older adults?
a) Hypovolemia
b) Dehydration

c) Hypervolemia
d) Fluid volume excess
B) Dehydration
The most common fluid imbalance in older adults is
dehydration. Because of reduced thirst sensation that
often accompanies aging, older adults tend to drink less
water. Use of diuretic medications, laxatives, or enemas
may also deplete fluid volume in older adults. Chronic
fluid volume deficit can lead to other problems such as
electrolyte imbalances. Therefore, options A, C, and D
are incorrect.

To evaluate a client for hypoxia, the physician is most


likely to order which laboratory test?
a) Red blood cell count
b) Sputum culture
c) Total hemoglobin
d) Arterial blood gas (ABG) analysis
D) ABGs
Red blood cell count, sputum culture, total hemoglobin,
and ABG analysis all help evaluate a client with
respiratory problems. However, ABG analysis is the only
test that evaluates gas exchange in the lungs, providing
information about the client's oxygenation status.

Which of the following would be a potential cause of


respiratory acidosis?
a) Vomiting
b) Hyperventilation
c) Diarrhea
d) Hypoventilation
D) Hypoventilation
Respiratory acidosis is always due to inadequate
excretion of CO, with inadequate ventilation, resulting in
elevated plasma CO concentration, which causes
increased levels of carbonic acid. In addition to an
elevated PaCO, hypoventilation usually causes a
decrease in PaO.

Which of the following is the most common cause of


symptomatic hypomagnesemia?
a) Alcoholism
b) IV drug use
c) Sedentary lifestyle
d) Burns
A) Alcoholism
Alcoholism is currently the most common cause of
symptomatic hypomagnesemia. IV drug use, sedentary
lifestyle, and burns are not the most common causes of
hypomagnesemia.

When evaluating arterial blood gases (ABGs), which


value is consistent with metabolic alkalosis?
a) PaCO 36
b) HCO 21 mEq/L
c) O saturation 95%
d) pH 7.48
A) PaCO 36
Metabolic alkalosis is a clinical disturbance
characterized by a high pH and high plasma bicarbonate
concentration. The HCO value is below normal. The
PaCO value and the oxygen saturation level are within a
normal range

Which of the following is a correct route of


administration for potassium?
a) IV (intravenous) push
b) Oral
c) Intramuscular
d) Subcutaneous
B) Oral
Potassium may be administered through the oral route.
Potassium is never administered by IV push or
intramuscularly to avoid replacing potassium too quickly.
Potassium is not administered subcutaneously.

A nurse reviews the arterial blood gas (ABG) values of


a client admitted with pneumonia: pH, 7.51; PaCO2, 28
mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L.
What do these values indicate?
a) Metabolic alkalosis
b) Metabolic acidosis
c) Respiratory alkalosis
d) Respiratory acidosis
C) Respiratory Alkalosis
A client with pneumonia may hyperventilate in an effort
to increase oxygen intake. Hyperventilation leads to
excess carbon dioxide (CO2) loss, which causes alkalosis
indicated by this client's elevated pH value. With
respiratory alkalosis, the kidneys' bicarbonate (HCO3-)
response is delayed, so the client's HCO3- level remains
normal. The below-normal value for the partial pressure
of arterial carbon dioxide (PaCO2) indicates CO2 loss
and signals a respiratory component. Because the
HCO3- level is normal, this imbalance has no metabolic
component. Therefore, the client is experiencing
respiratory alkalosis.

You are caring for a client with severe hypokalemia.


The physician has ordered IV potassium to be

administered at 10 mEq/hr. The client complains of


burning along their vein. What should you do?
a) Change the electrolyte.
b) Switch to an oral formulation.
c) Increase the speed of transfusion.
d) Dilute the infusion.
D) Dilute the infusion
Treatment of severe hypokalemia requires treatment
with IV infusion of potassium. Clients may experience
burning along the vein with IV infusion of potassium in
proportion to the infusion's concentration. If the client
can tolerate the fluid, consult with the physician about
diluting the potassium in a larger volume of IV solution.
Oral potassium may not be enough in severe cases
hypokalemia. Hypokalemia requires treatment with
potassium and not any other electrolyte.

Below which serum sodium level may convulsions or


coma can occur?
a) 140 mEq/L
b) 135 mEq/L
c) 142 mEq/L
d) 145 mEq/L
B) 135 mEq/L
Normal serum concentration level ranges from 135 to
145 mEq/L. When the level dips below 135 mEq/L, there
is hyponatremia. Manifestations of hyponatremia include
mental confusion, muscular weakness, anorexia,
restlessness, elevated body temperature, tachycardia,
nausea, vomiting, and personality changes. Convulsions
or coma can occur if the deficit is severe. Values of 140,
142, and 145 mEq/L are within the normal range.

The calcium level of the blood is regulated by which


mechanism?
a) Androgens
b) Adrenal gland
c) Parathyroid hormone (PTH)
d) Thyroid hormone (TH)
C) PTH
The serum calcium level is controlled by PTH and
calcitonin. The thyroid hormone, adrenal gland, or
androgens do not regulate the calcium level in the
blood.

Russell Thompkins, a 77-year-old retired male, visits


your general practice office twice monthly to maintain
control of his congestive heart failure. He measures his
weight daily and phones it to your office for his
medical record. In a 24-hour period, how much fluid is

Russell retaining if his weight increases by two


pounds?
a) One liter
b) 1250 ml
c) 1500 ml
d) 500 ml
A) One liter
A 2-lb weight gain in 24 hours indicates that the client is
retaining 1L of fluid.

A client has the following arterial blood gas (ABG)


values: pH, 7.12; partial pressure of arterial carbon
dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-),
15 mEq/L. These ABG values suggest which disorder?
a) Metabolic alkalosis
b) Metabolic acidosis
c) Respiratory acidosis
d) Respiratory alkalosis
B) Metabolic acidosis
This client's pH value is below normal, indicating
acidosis. The HCO3- value also is below normal,
reflecting an overwhelming accumulation of acids or
excessive loss of base, which suggests metabolic
acidosis. The PaCO2 value is normal, indicating absence
of respiratory compensation. These ABG values
eliminate respiratory alkalosis, respiratory acidosis, and
metabolic alkalosis.

To compensate for decreased fluid volume


(hypovolemia), the nurse can anticipate which
response by the body?
a) Bradycardia
b) Tachycardia
c) Increased urine output
d) Vasodilation
B) Tachycardia
Fluid volume deficit, or hypovolemia, occurs when the
loss of extracellular fluid exceeds the intake of fluid.
Clinical signs include oliguia, rapid heart rate,
vasoconstriction, cool and clammy skin, and muscle
weakness. The nurse monitors for rapid, weak pulse and
orthostatic hypotension.

A client comes to the emergency department with


status asthmaticus. His respiratory rate is 48
breaths/minute, and he is wheezing. An arterial blood
gas analysis reveals a pH of 7.52, a partial pressure of
arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of
70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L.
What disorder is indicated by these findings?

a) Metabolic acidosis
b) Respiratory alkalosis
c) Metabolic alkalosis
d) Respiratory acidosis
B) Respiratory Alkalosis
Respiratory alkalosis results from alveolar
hyperventilation. It's marked by a decrease in PaCO2 to
less than 35 mm Hg and an increase in blood pH over
7.45. Metabolic acidosis is marked by a decrease in
HCO3? to less than 22 mEq/L, and a decrease in blood
pH to less than 7.35. In respiratory acidosis, the pH is
less than 7.35 and the PaCO2 is greater than 45 mm Hg.
In metabolic alkalosis, the HCO3? is greater than 26
mEq/L and the pH is greater than 7.45.

A client hospitalized for treatment of a pulmonary


embolism develops respiratory alkalosis. Which clinical
findings commonly accompany respiratory alkalosis?
a) Nausea or vomiting
b) Hallucinations or tinnitus
c) Light-headedness or paresthesia
d) Abdominal pain or diarrhea
C) Light-headedness or paresthesia
The client with respiratory alkalosis may complain of
light-headedness or paresthesia (numbness and tingling
in the arms and legs). Nausea, vomiting, abdominal
pain, and diarrhea may accompany respiratory acidosis.
Hallucinations and tinnitus rarely are associated with
respiratory alkalosis or any other acid-base imbalance.

The normal serum value for potassium is


a) 96 to 106 mEq/L.
b) 135 to 145 mEq/L.
c) 3.5 to 5.5 mEq/L.
d) 8.5 to 10.5 mg/dL.
C) 3.5-5.5 mEq/L
Serum potassium must be within normal limits to
prevent cardiac dysrhythmia. Normal serum sodium is
135 to 145 mEq/L. Normal serum chloride is 96 to 106
mEq/L. Normal total serum calcium is 8.5 to 10

A client is taking spironolactone (Aldactone) to control


her hypertension. Her serum potassium level is 6
mEq/L. For this client, the nurse's priority should be to
assess her:
a) electrocardiogram (ECG) results.
b) neuromuscular function.
c) bowel sounds.
d) respiratory rate.

A) ECG results
Although changes in all these findings are seen in
hyperkalemia, ECG results should take priority because
changes can indicate potentially lethal arrhythmias such
as ventricular fibrillation. It wouldn't be appropriate to
assess the client's neuromuscular function, bowel
sounds, or respiratory rate for effects of hyperkalemia.

A physician orders regular insulin 10 units I.V. along


with 50 ml of dextrose 50% for a client with acute
renal failure. What electrolyte imbalance is this client
most likely experiencing?
a) Hyperglycemia
b) Hypercalcemia
c) Hyperkalemia
d) Hypernatremia
C) Hyperkalemia
Administering regular insulin I.V. concomitantly with 50
ml of dextrose 50% helps shift potassium from the
extracellular fluid into the cell, which normalizes serum
potassium levels in the client with hyperkalemia. This
combination doesn't help reverse the effects of
hypercalcemia, hypernatremia, or hyperglycemia.

A client in the emergency department reports that he


has been vomiting excessively for the past 2 days. His
arterial blood gas analysis shows a pH of 7.50, partial
pressure of arterial carbon dioxide (PaCO2) of 43 mm
Hg, partial pressure of arterial oxygen (PaO2) of 75
mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based
on these findings, the nurse documents that the client
is experiencing which type of acid-base imbalance?
a) Respiratory acidosis
b) Respiratory alkalosis
c) Metabolic alkalosis
d) Metabolic acidosis
C) Metabolic Alkalosis
A pH over 7.45 with a HCO3- level over 26 mEq/L
indicates metabolic alkalosis. Metabolic alkalosis is
always secondary to an underlying cause and is marked
by decreased amounts of acid or increased amounts of
base HCO3-. The client isn't experiencing respiratory
alkalosis because the PaCO2 is normal. The client isn't
experiencing respiratory or metabolic acidosis because
the pH is greater than 7.35.

Patients diagnosed with hypervolemia should avoid


sweet or dry food because:
a) It obstructs water elimination.
b) It can cause dehydration.

c) It can lead to weight gain.


d) It increases the client's desire to consume fluid.
D) It increases the client's desire to consume fluid
The management goal in hypervolemia is to reduce fluid
volume. For this reason, fluid is rationed, and the client
is advised to take limited amount of fluid when thirsty.
Sweet or dry food can increase the client's desire to
consume fluid. Sweet or dry food does not obstruct
water elimination nor does it cause dehydration. Weight
regulation is not part of hypervolemia management
except to the extent that it is achieved on account of
fluid reduction.

Your client has a diagnosis of hypervolemia. What


would be an important intervention that you would
initiate?
a) Give medications that promote fluid retention.
b) Limit sodium and water intake.
c) Teach client behaviors that decrease urination.
d) Assess for dehydration.
B) Limit sodium and water intake
Implement prescribed interventions such as limiting
sodium and water intake and administering ordered
medications that promote fluid elimination. Assessing
for dehydration and teaching to decrease urination
would not be appropriate interventions.

Which of the following solutions is hypotonic?


a) 0.45% NaCl
b) 5% NaCl
c) 0.9% NaCl
d) Lactated Ringer's solution
A) 0.45% NaCl
Half-strength saline is hypotonic. Lactated Ringer's
solution is isotonic. Normal saline (0.9% NaCl) is
isotonic. A solution that is 5% NaCl is hypertonic.

Which of the following are the insensible mechanisms


of fluid loss?
a) Bowel elimination
b) Urination
c) Nausea
d) Breathing
D) Breathing
Loss of fluid from sweat or diaphoresis is referred to as
insensible loss because it is unnoticeable and
immeasurable. Losses from urination and bowel
elimination are measurable.

A group of nursing students are studying for a test


over acid-base imbalance. One student asks another
what the major chemical regulator of plasma pH is.
What should the second student respond?
a) Renin-angiotensin-aldosterone system
b) Bicarbonate-carbonic acid buffer system
c) Sodium-potassium pump
d) ADH-ANP buffer system
B) Bicarbonate-carbonic acid buffer system
The major chemical regulator of plasma pH is the
bicarbonate-carbonic acid buffer system. Therefore
options A and C are incorrect. Option D does not exist, it
is only a distractor for this question.

Which of the following is considered an isotonic


solution?
a) 3% NaCl
b) 0.9% normal saline
c) Dextran in NS
d) 0.45% normal saline
B) 0.9% Normal Saline
An isotonic solution is 0.9% normal saline (NaCl).
Dextran in NS is a colloid solution, 0.45% normal saline
is a hypotonic solution, and 3% NaCl is a hypertonic
solution.

An elderly client takes 40 mg of Lasix twice a day.


Which electrolyte imbalance is the most serious
adverse effect of diuretic use?
a) Hypophosphatemia
b) Hypernatremia
c) Hypokalemia
d) Hyperkalemia
C) Hypokalemia
Hypokalemia (potassium level below 3.5 mEq/L) usually
indicates a defict in total potassium stores. Potassiumlosing diuretics, such as loop diuretics, can induce
hypokalemia.

A client with Guillain-Barr syndrome develops


respiratory acidosis as a result of reduced alveolar
ventilation. Which combination of arterial blood gas
(ABG) values confirms respiratory acidosis?
a) pH, 7.25; PaCO2 50 mm Hg
b) pH, 7.35; PaCO2 40 mm Hg
c) pH, 7.40; PaCO2 35 mm Hg
d) pH, 7.5; PaCO2 30 mm Hg
B) oh, 7.25; PaCO2 50 mm Hg
In respiratory acidosis, ABG analysis reveals an arterial
pH below 7.35 and partial pressure of arterial carbon

dioxide (PaCO2) above 45 mm Hg. Therefore, the


combination of a pH value of 7.25 and a PaCO2 value of
50 mm Hg confirms respiratory acidosis. A pH value of
7.5 with a PaCO2 value of 30 mm Hg indicates
respiratory alkalosis. A ph value of 7.40 with a PaCO2
value of 35 mm Hg and a pH value of 7.35 with a PaCO2
value of 40 mm Hg represent normal ABG values,
reflecting normal gas exchange in the lungs.

A nurse correctly identifies a urine specimen with a pH


of 4.3 as being which type of solution?
a) Alkaline
b) Acidic
c) Basic
d) Neutral
B) Acidic
Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals
acidic urine pH. A pH above 7.0 is considered an alkaline
or basic solution. A pH of 7.0 is considered neutral.

A client has a serum calcium level of 7.2 mg/dl. During


the physical examination, the nurse expects to assess:
a) Trousseau's sign.
b) Hegar's sign.
c) Homans' sign.
d) Goodell's sign.
A) Trossaeu's sign
This client's serum calcium level indicates
hypocalcemia, an electrolyte imbalance that causes
Trousseau's sign (carpopedal spasm induced by inflating
the blood pressure cuff above systolic pressure).
Homans' sign (pain on dorsiflexion of the foot) indicates
deep vein thrombosis. Hegar's sign (softening of the
uterine isthmus) and Goodell's sign (cervical softening)
are probable signs of pregnancy.

A nurse is caring for a client with metastatic breast


cancer who is extremely lethargic and very slow to
respond to stimuli. The laboratory report indicates a
serum calcium level of 12.0 mg/dl, a serum potassium
level of 3.9 mEq/L, a serum chloride level of 101
mEq/L, and a serum sodium level of 140 mEq/L. Based
on this information, the nurse determines that the
client's symptoms are most likely associated with
which electrolyte imbalance?
a) Hypocalcemia
b) Hyperkalemia
c) Hypokalemia
d) Hypercalcemia

D) Hypercalcemia
The normal reference range for serum calcium is 9 to 11
mg/dl. A serum calcium level of 12 mg/dl clearly
indicates hypercalcemia. The client's other laboratory
findings are within their normal ranges, so the client
doesn't have hypernatremia, hypochloremia, or
hypokalemia.

Which of the following electrolytes is a major cation in


body fluid?
a) Potassium
b) Bicarbonate
c) Chloride
d) Phosphate
A) Potassium
Potassium is a major cation that affects cardiac muscle
functioning. Chloride is an anion. Bicarbonate is an
anion. Phosphate is an anion.

Which conditions lead to chronic respiratory acidosis in


older adults?
a) Thoracic skeletal change
b) Overuse of sodium bicarbonate
c) Decreased renal function
d) Erratic meal patterns
A) Thoracic skeletal change
Poor respiratory exchange as the result of chronic lung
disease, inactivity, or thoracic skeletal changes may
lead to chronic respiratory acidosis. Decreased renal
function in older adults can cause an inability to
concentrate urine and is usually associated with fluid
and electrolyte imbalance. A poor appetite, erratic meal
patterns, inability to prepare nutritious meals, or
financial circumstances may influence nutritional status,
resulting in imbalances of electrolytes. Overuse of
sodium bicarbonate may lead to metabolic alkalosis.

A client with a suspected overdose of an unknown


drug is admitted to the emergency department.
Arterial blood gas values indicate respiratory acidosis.
What should the nurse do first?
a) Prepare for gastric lavage.
b) Monitor the client's heart rhythm.
c) Obtain a urine specimen for drug screening.
d) Prepare to assist with ventilation.
D) Prepare to assist with ventilation
Respiratory acidosis is associated with hypoventilation;
in this client, hypoventilation suggests intake of a drug
that has suppressed the brain's respiratory center.
Therefore, the nurse should assume the client has

respiratory depression and should prepare to assist with


ventilation. After the client's respiratory function has
been stabilized, the nurse can safely monitor the heart
rhythm, prepare for gastric lavage, and obtain a urine
specimen for drug screening.

A priority nursing intervention for a client with


hypervolemia involves which of the following?
a) Monitoring respiratory status for signs and
symptoms of pulmonary complications.
b) Establishing I.V. access with a large-bore catheter.
c) Encouraging the client to consume sodium-free
fluids.
d) Drawing a blood sample for typing and
crossmatching.
A) Monitoring respiratory status for signs ans symptoms
of pulmonary complications
Hypervolemia, or fluid volume excess (FVE), refers to an
isotonic expansion of the extracellular fluid. Nursing
interventions for FVE include measuring intake and
output, monitoring weight, assessing breath sounds,
monitoring edema, and promoting rest. The most
important intervention in the list involves monitoring the
respiratory status for any signs of pulmonary
congestion. Breath sounds are assessed at regular
intervals.

A 57-year-old homeless female with a history of


alcohol abuse has been admitted to your hospital unit.
She was admitted with signs and symptoms of
hypovolemia - minus the weight loss. She exhibits a
localized enlargement of her abdomen. What condition
could she be presenting?
a) Hypovolemia
b) Pitting edema
c) Third-spacing
d) Anasarca
C) Third spacing
Third-spacing describes the translocation of fluid from
the intravascular or intercellular space to tissue
compartments, where it becomes trapped and useless.
The client manifests signs and symptoms of
hypovolemia with the exception of weight loss. There
may be signs of localized enlargement of organ cavities
(such as the abdomen) if they fill with fluid, a condition
referred to as ascites.

Which set of arterial blood gas (ABG) results requires


further investigation?
a) pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and

HCO3- 22 mEq/L
b) pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and
HCO3- 26 mEq/L
c) pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and
HCO3- 18 mEq/L
d) pH 7.38, partial pressure of arterial carbon dioxide
(PaCO2) 36 mm Hg, partial pressure of arterial oxygen
(PaO2) 95 mm Hg, bicarbonate (HCO3-) 24 mEq/L
C)pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and
HCO3- 18 mEq/LThe ABG results pH 7.49, PaCO2 30 mm
Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L indicate
respiratory alkalosis.
The pH level is increased, and the HCO3- and PaCO2
levels are decreased. Normal values are pH 7.35 to 7.45;
PaCO2 35 to 45 mm Hg; HCO3- 22 to 26 mEq/L.

The nurse is caring for a client who is exhibiting


symptoms of tachypnea and circumoral paresthesias.
What should be the nurse's first course of action?
a) Stop mechanical ventilation.
b) Find and correct the cause of tachypnea.
c) Administer cardiopulmonary resuscitation (CPR).
d) Give a dose of aspirin.
B) Find and correct the cause of tachypnea
Tachypnea or rapid breathing may result from various
reasons including acute anxiety, high fever,
thyrotoxicosis, early salicylate poisoning, hypoxemia, or
mechanical ventilation. The rapid breathing expels more
CO2 than necessary. This causes a deficit in carbonic
acid, leading to respiratory alkalosis. Circumoral
paresthesia is one of the symptoms. The first course of
action is to detect and treat the cause of tachypnea. The
nurse has to maintain mechanical ventilation if the client
is dependent on it. CPR administration is required only if
the client's condition needs it. Aspirin is not advised as
early aspirin poisoning may be a cause of the
tachypnea.

A 64-year-old client is brought in to the clinic with


thirsty, dry, sticky mucous membranes, decreased
urine output, fever, a rough tongue, and lethargy.
Serum sodium level is above 145 mEq/L. Should the
nurse start salt tablets when caring for this client?
a) No, start with the sodium chloride IV.
b) No, sodium intake should be restricted.
c) Yes, this will correct the sodium deficit.
d) Yes, along with the hypotonic IV.
B) No, sodium intake should be restricted
The symptoms and the high level of serum sodium
suggest hypernatremia, (excess of sodium). It is
necessary to restrict sodium intake. Salt tablets and

sodium chloride IV can only worsen this condition but


may be required in hyponatremia (sodium deficit).
Hypotonic solution IV may be a part of the treatment but
not along with the salt tablets.

A client with pancreatic cancer has the following blood


chemistry profile: Glucose, fasting: 204 mg/dl; blood
urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl;
Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride:
99 mEq/L; CO2: 33 mEq/L. Which result should the
nurse identify as critical and report immediately?
a) Potassium
b) Sodium
c) Chloride
d) CO2
A) Potassium
The nurse should identify potassium: 2.2 mEq/L as
critical because a normal potassium level is 3.8 to 5.5
mEq/L. Severe hypokalemia can cause cardiac and
respiratory arrest, possibly leading to death.
Hypokalemia also depresses the release of insulin and
results in glucose intolerance. The glucose level is above
normal (normal is 75 to 110 mg/dl) and the chloride
level is a bit low (normal is 100 to 110 mEq/L). Although
these levels should be reported, neither is lifethreatening. The BUN (normal is 8 to 26 mg/dl) and
creatinine (normal is 0.8 to 1.4 mg/dl) are within normal
range.

When a client's ventilation is impaired, the body


retains which substance?
a) Carbon dioxide (CO2)
b) Oxygen
c) Sodium bicarbonate
d) Nitrous oxide
A) Carbon dioxide (CO2)
When ventilation is impaired, the body retains CO2
because the carbonic acid level increases in the blood.
Sodium bicarbonate is used to treat acidosis. Nitrous
oxide, which has analgesic and anesthetic properties,
commonly is administered before minor surgical
procedures. When ventilation is impaired, the body
doesn't retain oxygen. Instead, the tissues use oxygen
and CO2 results.

A group of students are reviewing information about


disorders of the bladder and urethra. The students
demonstrate understanding of the material when they
identify which of the following as a voiding
dysfunction?

a) Urinary retention
b) Cystitis
c) Bladder stones
d) Urethral stricture
A) Urinary retention
Urinary retention and urinary incontinence are voiding
dysfunctions, temporary or permanent alterations in the
ability to urinate normally. Cystitis is an infectious
disorder. Bladder stones and urethral stricture are
obstructive disorders.

The nurse expects which of the following assessment


findings in the client in the diuretic phase of acute
renal failure?
a) Dehydration
b) Crackles
c) Hypertension
d) Hyperkalemia
A) Dehydration
The diuretic phase of acute renal failure is characterized
by increased urine output, hypotension, and
dehydration.

A male client has doubts about performing peritoneal


dialysis at home. He informs the nurse about his
existing upper respiratory infection. Which of the
following suggestions can the nurse offer to the client
while performing an at-home peritoneal dialysis?
a) Perform deep-breathing exercises vigorously.
b) Avoid carrying heavy items.
c) Auscultate the lungs frequently.
d) Wear a mask when performing exchanges.
D) Wear a mask when performing exchanges
The nurse should advise the client to wear a mask while
performing exchanges. This prevents contamination of
the dialysis catheter and tubing, and is usually advised
to clients with upper respiratory infection. Auscultation
of the lungs will not prevent contamination of the
catheter or tubing. The client may also be advised to
perform deep-breathing exercises to promote optimal
lung expansion, but this will not prevent contamination.
Clients with a fistula or graft in the arm should be
advised against carrying heavy items.

Which nursing assessment finding indicates that the


client who has undergone renal transplant has not met
expected outcomes?
a) Weight loss
b) Fever

c) Absence of pain
d) Diuresis
b) Fever
Fever is an indicator of infection or transplant rejection.

A 32-year-old flight attendant is undergoing


diagnostics due to a significant drop in renal output.
The physician has scheduled an angiography and you
are in the midst of completing client education about
the procedure. The client asks what the angiography
will reveal. What is your response, as her nurse?
a) Renal circulation
b) Urine production
c) Kidney function
d) Kidney structure
A) Renal circulation
A renal angiogram (renal arteriogram) provides details
of the arterial supply to the kidneys, specifically the
location and number of renal arteries (multiple vessels
to the kidney are not unusual) and the patency of each
renal artery.

The nurse observes the color of the client's urine


which appears pale blue-green. The nurse obtains a
drug history from the client based on the
understanding that drugs used by the client may affect
which of the following?
a) Size of the urinary bladder
b) Urinary tract tests
c) Urine specific gravity
d) Amount of urine produced
B) Urinary tract tests
It is important to inquire about drugs because some
drugs may affect the outcome of urinary tract tests as
well as the color and odor of the urine. Dietary intake
may affect urine characteristics as well as urinary tract
disorders and their management. Drugs do not directly
affect the size of the urinary bladder or the amount of
urine produced.

A nurse, when caring for a client, notes that the


specific gravity of the client's urine is low. What could
have lead to the low specific gravity of urine?
a) Repeated diarrhea
b) Excess fluid intake
c) Frequent vomiting
d) Urine retention
B) Excessive fluid intake
Excess fluid intake results in low specific gravity of
urine. Excessive fluid intake will result in formation of

dilute urine. When the urine is diluted, it results in low


specific gravity of urine. Frequent vomiting, repeated
diarrhea, and urine retention will result in high specific
gravity of urine.

Following a unilateral adrenalectomy, a nurse should


assess for hyperkalemia as indicated by:
a) diaphoresis.
b) tremors.
c) muscle weakness.
d) constipation.
C) Muscle weakness
Muscle weakness, bradycardia, nausea, diarrhea, and
paresthesia of the hands, feet, tongue, and face are
findings associated with hyperkalemia, which is
transient and results from transient hypoaldosteronism
when the adenoma is removed. Tremors, diaphoresis,
and constipation aren't seen in hyperkalemia.

Susan Young, a 57-year-old financial officer, has been


exhibiting signs and symptoms which lead her
urologist to suspect the adequacy of her urinary
function. Beginning with the least invasive tests, which
of the following would you expect the physician to
prescribe to assess kidney function? Choose all correct
options.
a) Blood urea nitrogen (BUN) level
b) Creatinine clearance
c) Angiography
d) All options are correct
C) Angiography
Angiography provides the details of the arterial supply
to the kidneys, specifically the number and location of
renal arteries. Radiography shows the size and position
of the kidneys, ureters, and bladder. A CT scan is useful
in identifying calculi, congenital abnormalities,
obstruction, infections, and polycystic diseases.
Cystoscopy is used for providing a visual examination of
the internal bladder.

The nurse is preparing an education program on risk


factors for kidney disorders. Which of the following risk
factors would be inappropriate for the nurse to include
in the teaching program?
a) Pregnancy
b) Diabetes mellitus
c) Neuromuscular disorders
d) Hypotension

D) Hypotension
Hypertension, not hypotension, is a risk factor for kidney
disease.

Which of the following terms is used to refer to


inflammation of the renal pelvis?
a) Pyelonephritis
b) Interstitial nephritis
c) Urethritis
d) Cystitis
A) Pyleonephritis
Pyelonephritis is an upper urinary tract inflammation,
which may be acute or chronic. Cystitis is inflammation
of the urinary bladder. Urethritis is inflammation of the
urethra. Interstitial nephritis is inflammation of the
kidney.

A client with a genitourinary problem is being


examined in the emergency department. When
palpating the client's kidneys, the nurse should keep in
mind which anatomic fact?
a) The kidneys are situated just above the adrenal
glands.
b) The left kidney usually is slightly higher than the
right one.
c) The kidneys lie between the 10th and 12th thoracic
vertebrae.
d) The average kidney is approximately 5 cm (2?) long
and 2 to 3 cm (? to 1??) wide.
B) The left kidney usually is slightly higher than the right
one
The left kidney usually is slightly higher than the right
one. An adrenal gland lies atop each kidney. The
average kidney measures approximately 11 cm (4??)
long, 5 to 5.8 cm (2? to 2?) wide, and 2.5 cm (1?)
thick. The kidneys are located retroperitoneally, in the
posterior aspect of the abdomen, on either side of the
vertebral column. They lie between the 12th thoracic
and 3rd lumbar vertebrae.

True or False?
GFR is primarily dependent on adequate blood flow
and adequate hydrostatic pressure.
True

True or False?
The primary function of the kidney is to excrete
nitogeneous waste products.

False
Primary function of kidney is to regulate the volume and
composition of extracellular fluids

True or False?
Water is the primary substance reabsorbed in the
collecting duct?
True

True or False?
Atrial Natriuretic Factor (ANF) is secreted by the right
atruim when atrial blood pressure is low, and it inhibits
the action of aldosterone.
False
Atrial Natriuretic Factor (ANF) is secreted by the right
atruim when atrial blood pressure is low, and it inhibits
the action of high antidiuretic hormone (ADH) or renin or
angiotensin II

True or False?
Increased permeability in the glomerulus causes loss
of proteins into the urine.
True

True or False?
Prostaglandin synthesis by the kidneys causes
vasodilation and increased renal blood flow.
True

A patient with an obstruction of the renal artery


causing renal ischemia exhibits HTN. One factor that
may contribute to HTN:
a) increase renin release
b) increased ADH secretion
c) decreased aldosterone secretion
d) increased synthesis and release of prostaglandins
A) Increase Renin Release
Renin is released in resonse to decreased B/P, renal
ischemia, eosinophil chemotactic factor (ECF) depletion,
and other factors affecting blood suppy to the kidney. It
is they catalyst of the renin-angiotensin-aldosterone
system, which raises B/P when stimulated. ADH is
secreted by the posterior pituitary in response to serum
hyperosmolality and low blood volume. Aldosterone is
secreted within the renin-angiotensin II, and kidney
prostaglandins lower B/P by causing vasodilation.

A clinical situation in which the increased release of


erythropoietin would be expected is:
a) hypoexmia
b) hypotension
c) hyperkalemia
d) fluid overload
a) Hypoexmia
Erythropoietin is released when the oxygen tension of
the renal blood supply is low and stimulates production
of red blood cells in the bone marrow. Hypotension
causes activation of the renin-angiotensin-aldosterone
system, as well as release of ADH. Hyperkalemis
stimulates release of aldosterone from the adrenal
cortex, and fluid overload does not directly stimulate
factors affecting the kidney.

The sites where urinary stones are most likely to


obstruct the urinary system are at the __________ and
the ____________.
Ureteropelvic junction and Ureterovesical junction

The volume of urine in the bladder that usually causes


the urge to urinate is ____ mL.
200-250 mL

Total bladder capacity ranges from _________ mL to


_________ mL.
600-1000mL

Absorption or leakage of urine wastes out of the


urinary system is prevented by the cellular
characteristics of the _______.
urothelium

An age related change in the kidney that leads to


nocturia in an older adult is
a) decreased renal mass
b) decreased detrusor muscle tone
c) decreased ability to conserve sodium
d) decreased ability to concentrate urine
D) decreased ability to concentrate urine
The decreased ability to concentrate urine results in an
increased volume of dilute urine, which does not
maintain the usual diurnal elimination pattern. A
decrease in bladder capacity also contributes to
nocturia, but decreased bladder muscle tone results in
urinary retention. Decreased renal mass decreases renal
reserve, but function is generally adequate under
normal circumstances.

During physical assessment of the urinary system, the


nurse
a) auscultates the lower abdominal quadrants for fluid
sounds
b) palpates an empty bladder at the level of the
symphysis pubis
c) percusses the kidney with a firm blow at the
posterior costovertebral angle
d) positions the patient prone to palpate the kidneys
with a posterior approach
c) percusses the kidney with a firm blow at the posterior
costovertebral angle
To assess for kidney tenderness, the nurse strikes the
fist of one hand over the dorsum of the other hand at
the posterior costovertebral angle. The upper abdominal
quadrants and costovertebral angles are auscultated for
vascular bruits in the renal vessels and aorta, and an
empty bladder is not palpable. The kidneys are palpated
through the abdomen, with the patient supine.

A urinalysis of a urine specimen that is not processed


within 1 hour may result in erroneous measurement of
a) glucose
b) bacteria
c) specific gravity
d) white blood cells
B) bacteria
bacteria in warm urine specimens multiply rapidly, and
false or unreliable bacterial counts may occur with old
urine. Glucose, specific gravity, and WBCs do not
change in urine specimens, but pH becomes more
alkaline, RBCs are hemolyzed, and casts may
disintegrate.

Which of the following urine specific gravity values


would indicate to the nurse that the patient is
receiving excessive IV fluid therapy?
a) 1.002
b) 1.010
c) 1.025
d) 1.030
a) 1.002
A urine specific gravity of 1.002 is low, indicating dluite
urine and the excretion of excess fluid. Fluid overload,
diuretics, or lack of ADH can cause dilute urine. Normal
urine specific gravity indicates concentrated urine that
would be seen in dehydration.

While caring for a 77-year old woman who has a


urinary catheter, the nurse monitors the patient for the
development of a UTI. The clinical manifestations the
patient is most likely to experience include:
a) cloudy urine and fever
b) urethral burning and blood urine
c) vague abdominal pain and disorientation
d) suprapubic pain and slight decline in body
temperature
c) vague abdominal pain and disorientation
The usual classic symptoms of UTI are often absent in
older adults, who tend to experience nonlocalized
abdominal pain rather than dysuria and suprapubic pain.
They may also experience cognitive impairment
characterized by confusion or decreased level of
consciousness.

A woman with no hx of UTIs who is experiencing


urgency, frequency, and dysuria comes to the clinic,
where a dipstick and microscopic urinalysis indicate
bacteriuria. The nurse anticipates that the patient will
a) need to have a blood specimen drawn for a CBC and
kidney function test
b) not be treated with medications unless she
develops a fever, chills, or flank pain
c) be requested to obtain a clean-catch midstream
urine specimen for culture and sensitivity
d) be treated empirically with TMP-SMX Bactrim for 3
days.
d) be treated empirically with TMP-SMX Bactrium for 3
days
Unless a patient has a hx of recurrent UTIs, TMP-SMX or
nitrofurantoin is usually used to empirically treat an
initial UTI without a culture and sensitivity test.
Asymptomatic bacteriuria does not justify tc, but
symptomatic UTIs should always be treated.

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