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NURS 321 Quiz
A 45-year-old male patient has undergone surgery for invasive bladder cancer. Which nursing intervention is most appropriate to clear blood clots from the bladder postsurgery? a. Perform intravesical immunotherapy. b. Perform continuous bladder irrigation. c. Record accurate bladder intake and output. d. Administer intravesical chemotherapy medications. - ansb. Perform continuous bladder irrigation. A 58-year-old female with a history of diabetes presents for a routine physical examination. A urinalysis is obtained and evaluated. The results indicate the presence of glucose in the urine. The nurse recognizes that this indicates which of the following? A. Serum glucose of 150 mg/dl B. Serum glucose of 250 mg/dl C. Serum BUN of 12 mg/dl D. Serum BUN of 35 mg/dl - ansB. Serum glucose of 250 mg/dl A client is diagnosed with a 3-mm right kidney stone. The nurse should plan to include which teaching with the client? Select all that apply. a. Use of kidney stone strainers b. Side effects of analgesics c. Restricting amount of oral fluid intake d. Changing positions slowly when taking alpha blockers e. Increasing the number of dairy products in diet - ansa, b, and d A client is diagnosed with hydronephrosis due to obstructive kidney stones. The nurse should assess for which electrolyte imbalance that might lead to cardiac dysrhythmia? a. Potassium b. Calcium c. Magnesium d. Sodium - ansa. Potassium A male client diagnosed with kidney stones is unable to void. What procedure should the nurse anticipate next? a. Nephrostomy tube placement b. Percutaneous nephrolithotomy
c. Foley catheter insertion d. Renal ultrasound imaging - ansc. Foley catheter insertion A nurse is assessing the vital signs of a patient diagnosed with stones in his or her ureters. Which vital sign change is most likely to be observed? a. Decreased heart rate b. Decreased temperature c. Decreased blood pressure d. Decreased respiratory rate - ansc. Decreased blood pressure A patient experiences severe blood loss and hypovolemia following a motor vehicle crash. The nurse should assess for signs and symptoms of which condition most likely to affect the patient? a. Chronic kidney disease b. Intrarenal acute kidney injury c. Prerenal acute kidney injury d. Postrenal kidney acute injury - ansc. Prerenal acute kidney injury A patient is diagnosed with poststreptococcal glomerulonephritis. Which intervention may be employed to treat edema? a. Diuretics b. Antihypertensives c. Dietary protein restriction d. Sodium and fluid restriction - ansd. Sodium and fluid restriction A patient is diagnosed with urolithiasis. Which treatment strategies are most likely to aid in the removal or prevention of small stones passing during urination? Select all that apply. a. Ureteroscopy b. Alpha-adrenergic blockers c. Narcotics and antiemetics d. Percutaneous nephrolithotomy e. Extracorporeal shock wave lithotripsy - ansb and e A patient is undergoing treatment for chronic kidney disease (CKD) with dialysis. During a follow-up visit, the nurse observes from the laboratory tests that the patient has developed nephrotoxicity from a prescribed medication. Which medication is responsible for the patient's condition? a. Meperidine b. Morphine c. Penicillin
An 80-year-old male presents for a physical exami- nation and reports changes in his urinary pattern including urinary frequency, hesitancy, and aslow stream of urine. As the nurse, you recognize these findings are likely attributed to which of the following? A. Decreased bladder capacity related to age B. Renal failure C. Enlargement of the prostate gland D. Decrease in size of the kidneys - ansC. Enlargement of the prostate gland An older adult male patient is diagnosed with a urinary tract infection (UTI). Which is the most likely reason for this infection? a. Sexual activity b. Long urethra c. Prostatic enlargement d. Stretching of the bladder - ansc. Prostatic enlargement An older male adult with a history of kidney stones presents to the emergency department with a family member. Which finding in the assessment would most likely alert the nurse to the possibility of a urinary tract infection while waiting on urinalysis results? a. Family member states client is confused b. History of benign prostatic hypertrophy c. Takes alpha-adrenergic blocker daily d. Voids 100 mL straw-colored urine - ansa. Family member states client is confused Glomerulonephritis is characterized by glomerular damage. Which of the following statements describes the cause of this damage? a. Accumulation of immune complexes in the glomeruli b. Growth of microorganisms in the glomeruli c. Hemolysis of red blood cells circulating in the glomeruli d. Release of bacteria which is toxic to the glomeruli - ansa. Accumulation of immune complexes in the glomeruli In which of the following disorders would a patient benefit from being taught how to perform self catheterization? a. Nephrosclerosis b. Polycystic Kidney Disease c. Renal Trauma d. Urethral stricture - ansd. Urethral stricture
Since erythropoietin levels are decreased in CKD, what changes would the nurse expect to see in a patient's CBC? a. Decreased platelets b. Decreased red blood cells c. Increased platelets d. Increased red blood cells - ansb. Decreased red blood cells The laboratory reports of a patient with kidney disease indicate an increase in the blood urea nitrogen (BUN) levels. Which could be the reason behind this condition? a. Decreased erythropoietin production b. Decreased gastrointestinal absorption c. Increased protein intake and breakdown d. Increased production of nonvolatile acids - ansc. Increased protein intake and breakdown The nurse caring for a patient on a urology unit recognizes that which of the following laboratory values indicates the highest priority need for further assessment and intervention? A. Serum uric acid 12.5 mg/dl B. Serum calcium 8.8 mg/dl C. Serum potassium 4.8 mEq/l D. Serum BUN 20 mg/dl - ansA. Serum uric acid 12.5 mg/dl The nurse expects to observe which of the following altered laboratory values in a patient diagnosed with renal failure? A. Decreased calcium B. Increased calcium C. Decreased phosphorus D. Increased hematocrit - ansA. Decreased calcium The nurse includes which dietary information in the teaching plan about the management of chronic kidney disease? a. Decrease fluid intake and protein intake, decrease carbohydrate intake b. Increase fluid intake, decrease carbohydrate intake and protein intake c. Decrease fluid intake and protein intake, increase carbohydrate intake d. Increase fluid intake, increase carbohydrate intake and protein intake - ansc. Decrease fluid intake and protein intake, increase carbohydrate intake The nurse is assessing a patient for a routine physical examination. Which of the following are normal findings when assessing the renal and urinary systems? (Select all that apply.)
A. To assess for allergies to contrast, iodine, and seafood prior to the study B. To educate the patient to increase fluid intake following the study C. To obtain an order for NPO status following the study D. To ensure that IV contrast is administered only through a central line E. To assess the patient's baseline creatinine value prior to the study - ansA, B, and E The nurse is caring for a patient who presents to the emergency department with symptoms associated with urolithiasis. Which of the symptoms supports a diagnosis of urolithiasis? Select all that apply. a. Polyuria b. Diarrhea c. Flank pain d. Nausea and vomiting e. Abdominal distention - ansc and d The nurse is caring for a patient who underwent a radical nephrectomy for renal cancer. Which postoperative assessment made by the nurse is most beneficial to the patient? Select all that apply. a. Monitoring the color of the incision b. Monitoring for swelling at the incision site c. Maintaining proper hydration in the patient d. Maintaining the draining tubes parallel to the bed level e. Monitoring for excessive drainage from the incisions - ansa, b, and c The nurse is caring for a patient with an injury to the renal system. Which should be included in the initial treatment of the patient? a. Promoting urinary drainage b. Encouraging the patient to rest c. Administering IV fluids d. Determining the extent of damage - ansa. Promoting urinary drainage The nurse is instructing a patient with polycystic kidney disease regarding safety precautions. Which statement made by the patient indicates a need for further teaching? a. "I should increase my fluid intake." b. "I should eat a low-protein diet." c. "I should immediately report if my temperature is high." d. "I should immediately report changes in my urinary pattern." - ansa. "I should increase my fluid intake." RationaleL Fluids should be restricted since these patients have HTN
The nurse is preparing a client for extracorporeal shock wave lithotripsy. Which assessment finding should be reported to the healthcare provider immediately? a. Negative urine human chorionic gonadotropin test b. Client reports taking blood thinner medication daily c. History of previous stones d. Creatinine level 0.9 mg/dL - ansb. Client reports taking blood thinner medication daily The nurse is providing dietary instructions to a patient treated for kidney stones to reduce the risk of stone formation. Which statement made by the patient indicates effective learning? a. "I should avoid citrus fruits." b. "I should reduce water intake." c. "I should increase salt intake in my food." d. "I should avoid tea, coffee, and chocolates." - ansd. "I should avoid tea, coffee, and chocolates." The nurse is providing discharge education to a patient with urolithiasis. Which clinical manifestations might necessitate the need for surgical intervention? Select all that apply. a. The development of renal colic b. Pain and burning during urination c. Pain controlled by narcotics d. A stone that does not pass in 2 to 3 weeks e. The decreased incidence of nausea and vomiting - ansa and b The nurse is providing instructions to a patient regarding diet management. The patient is in the oliguric phase of an acute kidney injury. Which statement indicates effective learning? a. "I should reduce salt in my diet." b. "I should consume more proteins." c. "I should increase intake of water." d. "I should increase fish products in my diet." - ansa. "I should reduce salt in my diet." The nurse is reviewing the patient's reports to determine his or her condition. Which observations would lead to the suspicion of a urinary tract infection? Select all that apply. a. Cloudy urine b. Hydronephrosis c. 2-mm stones in ureters d. Nitrites in urine cultures
Rationale: Blood in the urine (hematuria) is the best indicator of blunt kidney injury. The nurse recognizes that genetic counseling is appropriate for which patient? a. A child with frequent urinary tract infections b. An adult with frequent urinary tract infection c. An adult with autosomal dominant polycystic kidney disease d. An adult with metastatic renal cancer - ansc. An adult with autosomal dominant polycystic kidney disease The nurse recognizes which of the following patients is at the highest risk of developing bladder cancer? a. A 75-year-old male with a history of diabetes b. A 40-year-old female with a 20-year smoking history c. A 30-year-old female who works as a hairdresser d. A 52-year-old female with a history of frequent UTIs - ansb. A 40-year-old female with a 20-year smoking history The nurse recognizes which patient has the highest risk of renal cancer? A. A 76-year-old African American female B. A 50-year-old Caucasian male C. A 24-year-old Caucasian male D. A 50-year-old African American male - ansD. A 50-year-old African American male The nurse recognizes which patient is at greatest risk for a UTI? A. A 35-year-old sexually active male B. A 23-year-old sexually active female C. A 50-year-old sexually active female D. An 18-year-old sexually active male - ansB. A 23-year-old sexually active female The nurse should include which information in the discharge teaching plan for a patient who underwent peritoneal dialysis catheter placement? Select all that apply. a. Notify the provider if fluid appears cloudy. b. Review numerous dietary restrictions. c. Purulent drainage is expected at insertion site. d. Notify provider if any redness is noted. e. Pain at the insertion site may indicate infection. - ansa, d, and e The nurse should include which risk factors when teaching about kidney stone prevention? Select all that apply.
a. Living in a warm climate b. Family history c. Low salt intake d. Low protein intake e. Previous stones - ansa, b, and e The nurse should inform the physician if, when assessing the patient with an AV fistula, they note which of the following? A. A loud, turbulent bruit B. A quiet swooshing bruit C. A low-pitched thrill D. A continuous thrill - ansA. A loud, turbulent bruit Rationale: A normal functioning graft will have a low-pitched bruit. A turbulent bruit is indicative of an increased force, mostly due to stenosis. The nurse should intervene immediately if the patient post-renal transplantation is noted to have which of the following symptoms? a. Weight loss, hypotension, reduced urine output b. Fever, reduced urine output, elevated blood pressure c. Weight gain, hypotension, increased urine output d. Increased urine output, hypertension, fever - ansb. Fever, reduced urine output, elevated blood pressure Rationale: The priority is the combination of fever, reduced urine output, and elevated BP which may be indicative of the presence of AKI related to trans- plant rejection. The nurse should recognize that which assessment findings are consistent with chronic kidney disease? Select all that apply. a. Slow manifestation of symptoms b. Decreased creatinine clearance c. Increased serum creatinine levels d. Trace of protein in the urine e. History of hypertension - ansa, b, c, and e The nurse should recognize which of the following as risk factors for acute kidney injury? Select all that apply. a. Dehydration b. Trauma c. Edema d. Hypovolemia e. Hypervolemia - ansa, b, and d
C. Black males living in New York D. White females living in Oregon - ansB. White males living in Georgia The patient is diagnosed with a urolithiasis smaller than 5 mm in diameter. She is in minimal pain and urinalysis does not indicate infection. What is the first line of treatment? a. Extracorporeal shock wave lithotripsy b. Percutaneous nephrolithotomy c. Trial passage d. Ureteroscopy - ansc. Trial passage Rationale: Fifty percent of stones that are less than 5 mm in size will pass spontaneously. For patients with minimal pain and no hydronephrosis or infection, the first line of treatment is an opportunity to pass the stone without intervention. Surgery is the treatment of choice for a patient who presents with a stone larger than 10 mm. Surgical choices are varied and dependent on stone size, location, and urgency of treatment. Ureteroscopy, percutaneous nephrolithotomy, and extracorporeal shock wave lithotripsy are common surgical procedures for the management of stones. The patient with clinical manifestations of oliguria and elevated creatinine clearance would be most consistent with: A. Tubular necrosis B. Tubular secretion C. Glomerular filtration D. Capillary permeability - ansA. Tubular necrosis The risk factor or factors most often associated with CKD include which of the following? (Select all that apply.) A. Hypertension B. Diabetes mellitus C. Malnutrition D. Peripheral vascular disease E. Smoking - ansA and B What are some complications of acute pyelonephritis? List 2 complications and explain why they could occur. - ansrenal damage & urosepsis? What is the duration of the oliguric phase in acute kidney injury? a. Hours to days b. 15 to 35 days c. 1 to 3 weeks d. Several months to 1 year - ansb. 15 to 35 days
What is the etiological process in glomerulonephritis? A. Tubular necrosis caused by bacteria and antibody reactions B. Deposition of immunological complexes and complement along the GBM C. Deposition of bacteria and immunological components within the loop of Henle D. Destruction of proteolytic enzymes contained in the GBM - ansB. Deposition of immunological complexes and complement along the GBM What is the first sign a nurse would see in a patient with AKI? a. oliguria b. dysuria c. polyuria d. hematuria - ansa. oliguria What is the priority teaching point when the nurse is discussing narcotic analgesic side effects with a client diagnosed with kidney stones? a. Lightheadedness b. Nausea and vomiting c. Respiratory depression d. Constipation - ansc. Respiratory depression What is the priority teaching point when the nurse is discussing the treatment regimen with a patient who has received a kidney transplant for end stage renal disease? a. To take medications daily at the same time b. To keep all follow-up appointments as scheduled c. The need for meticulous immediate and lifelong care d. To inform patient of scarring at the incision site - ansc. The need for meticulous immediate and lifelong care What specific symptoms would the nurse expect if a CKD patient is retaining urea or nitrogenous wastes? - anshigh bun? When obtaining a nursing history on a patient with cancer of the urinary system, what does the nurse recognize as a risk factor for both bladder cancer and kidney cancer? a. Chronic use of opioids b. Family history of cancer c. Kidney stones d. Smoking - ansd. Smoking When planning care for a patient with urolithiasis, which nursing diagnoses should the nurse include? Select all that apply.
d. Increasing glomerular filtration rate e. Urine output less than 400 mL/day - ansb, c, and e Which assessments should be performed to prevent intrarenal damage from postrenal causes in patients with acute kidney injuries? a. Examination of prostate b. Measurement of blood volume c. Measurement of cardiac output d. Identification of nephrotoxins - ansa. Examination of prostate Rationale: BPH can cause mechanical obstruction Which clinical manifestation is observed in a patient with upper ureteral stones? a. Flank pain b. Genital pain c. Urinary urgency d. Urinary frequency - ansa. Flank pain Which description of pain most likely causes the nurse to suspect a client is suffering from kidney stones? a. Moderate lower back tightness on one side b. Mild cramping in lower abdominal area c. Colicky pain with nausea and vomiting d. Constant dull pain in bilateral flank areas - ansc. Colicky pain with nausea and vomiting Which detection method is used to make a definitive diagnosis of bladder cancer? a. Cystoscopy b. Urine cultures c. Urine cytology d. Computed tomography - ansa. Cystoscopy Which diagnostic procedure is used to differentiate among solid masses, tumors, and cysts in the kidney? a. Renal ultrasound b. Urine cytology c. Radionuclide isotope d. Intravenous pyelogram - ansa. Renal ultrasound Which intervention for the treatment of anemia in patients with chronic kidney disease requires the addition of stool softeners?
a. Blood transfusions b. Erythropoietin therapy c. Oral iron supplementation d. Folic acid supplementation - ansc. Oral iron supplementation Which is a prerenal cause of AKI? a. Acute glomerulonephritis and neoplasms b. Septic shock and nephrotoxic injury from medications c. Pyelonephritis and calculi formation d. Hypovolemia and myocardial infarction - ansd. Hypovolemia and myocardial infarction Which is true regarding urinary tract infections (UTIs)? a. They are more common in men than in women. b. The common age group for UTIs in women is 18 to 50 years. c. Conditions such as pelvic organ prolapse increase the risk of a UTI. d. Enterobacter is a common intestinal bacterium responsible for 80% of uncomplicated UTIs. - ansc. Conditions such as pelvic organ prolapse increase the risk of a UTI. Which laboratory abnormality may lead to a disturbed thought process in a patient with end-stage renal disorder? a. Anemia b. Uremic toxins c. Fluid retention d. Electrolyte imbalances - ansb. Uremic toxins Which laboratory test helps to evaluate the kidney function? a. Blood tests b. Ultrasound test c. Urodynamic studies d. Voiding cystourethrogram (VCUG) - ansa. Blood tests Which medication is used to decrease discomfort in a patient with a urinary tract infection (UTI)? a. Doxazosin b. Ciprofloxacin c. Phenazopyridium d. Trimethoprim-sulfamethoxazole - ansc. Phenazopyridium Which of the following are considered causes of CKD? Select all that apply
Which of the following statements most likely explains why the serum BUN could be increased? a. The patient may have nonrenal tissue disease. b. The patient has decreased protein in the urine. c. The patient has impaired renal function. d. The patient has not eaten enough protein. - ansc. The patient has impaired renal function. Which of the following urinary diversions is a continent diversion which is created by forming a ileal pouch with a stoma for catheterization? a. Ileal conduit b. Indiana pouch c. Orthotopic neobladder d. Urostomy - ansb. Indiana pouch Which patient is at risk of renal trauma? a. A patient with hypertension b. A patient who smokes tobacco c. A patient who has been stabbed d. A patient with end-stage renal disease - ansc. A patient who has been stabbed Which patient is at the highest risk of developing a urinary tract infection (UTI)? a. 65-year-old male patient b. 25-year-old pregnant patient c. 20-year-old sexually inactive patient d. 15-year-old male patient with poor hygiene - ansb. 25-year-old pregnant patient Which phase of an acute kidney injury involves an increase in the creatinine levels? a. Oliguric phase b. Diuretic phase c. Initiating phase d. Recovery phase - ansa. Oliguric phase Which statements are true regarding UTIs? (Select all that apply.) a. Urinary tract infections are more common in women because of the close proximity of the urethra, vagina, and rectum. b. Sexual intercourse does not increase the risk for UTIs. c. It is more common for males to develop a UTI because of the length of the urethra. d. Sexual intercourse increases the risk for a UTI. e. Flank pain is a symptom of lower UTIs. - ansa and d
Which symptom is common in urinary cancer? a. Dysuria b. Hematuria c. Incontinence d. Renal colic - ansb. Hematuria Which test is most specific for renal function? a. Blood urea nitrogen (BUN) b. Creatinine clearance c. Renal scan d. Serum creatinine - ansb. Creatinine clearance Rationale: The rate at which the creatinine is cleared from the blood and eliminated in urine approximates the GFR. This is what creatinne clearance is; it is the most specific test of renal function. Which topics should the nurse include in the teaching session to decrease the risk for developing urolithiasis in the future? Select all that apply. a. Increasing fluid intake b. Decreasing citrate intake c. Increasing sodium intake d. Decreasing oxalate intake e. Increasing fatty acid intake. - ansa and d Which topics should you include during the patient teaching session to decrease the risk for developing urolithiasis in the future? Select all that apply. a. Decreasing citrate intake b. Decreasing oxylate intake c. Increasing fatty acid intake d. Increasing fluid intake e. Increasing sodium intake - ansb and d Why is the glomerular filtration rate (GFR) decreased in patients experiencing AKI or CKD? - ansb/c decreased functioning, not able to clear or filter well? You are a nurse in the emergency department (ED) who is caring for a 30-year-old female patient who presents with symptoms associated with urolithiasis. Which observation from the initial assessment supports a diagnosis of urolithiasis? Select all that apply. a. Abdominal distention
