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ATI Renal + Urinary System Practice
Questions with answers
A nurse is caring for a client who is in the oliguric-anuric stage of acute kidney injury. The client reports diarrhea, a dull headache, palpitations, and muscle tingling and weakness. Which of the following actions should the nurse take first? A. Administer an analgesic to the client B. Check the client's electrolyte values C. Measure the client's weight D. Restrict the client's protein intake - CORRECT ANSWERS ✔✔Correct Answer: B. Check the client's electrolyte values The nurse should apply the urgent versus nonurgent priority-setting framework when caring for the client. Using this framework, the nurse should consider urgent needs to be the priority because they pose a greater threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which finding is the most urgent. The nurse should check the client's most recent potassium value because these findings are manifestations of hyperkalemia, which can lead to cardiac dysrhythmias.
Incorrect Answers:A. Administering an analgesic for a dull headache is important to manage the client's pain; however, there is another action that the nurse should take first. C. Measuring the client's weight is important to monitor the client's fluid balance; however, there is another action the nurse should take first. D. Restricting the client's protein intake is important to manage the client's acute kidney injury; however, there is another action the nurse should take first. A nurse is assessing a client who has urolithiasis and reports pain in his thigh. This finding indicates the stone is in which of the following structures? A. Ureter B. Bladder C. Renal pelvis D. Renal tubules - CORRECT ANSWERS ✔✔Correct Answer: A. Ureter When stones are in the ureters, pain radiates to the genitalia and to the thighs.
needs, the ABC priority-setting framework, and/or nursing knowledge to identify which finding is the most urgent. Hyperkalemia, which can cause life-threatening cardiac dysrhythmias, is the priority for the nurse to report to the provider. Incorrect Answers: A. Hypocalcemia is an expected finding with CKD; therefore, another finding is the priority for the nurse to report to the provider. The decreased calcium level would require reporting if the client developed muscle spasms or twitching. C. Anemia is an expected finding with CKD; therefore, another finding is the priority for the nurse to report to the provider. D. Hyperphosphatemia is an expected finding with CKD; therefore, another finding is the priority for the nurse to report to the provider. A nurse is assessing a client who is receiving continuous ambulatory peritoneal dialysis. Which of the following findings should the nurse report to the provider? A. WBC 6,000/mm^ B. Potassium 3.0 mEq/L C. Clear, pale yellow drainage D. Report of abdominal fullness - CORRECT ANSWERS ✔✔Correct Answer: B. Potassium 3.0 mEq/L
A potassium level of 3.0 mEq/L is below the expected reference range and can cause dysrhythmias. Dialysis removes fluid, waste products, and electrolytes from the blood and can cause hypokalemia. Incorrect Answers:A. A WBC count of 6,000/mm^3 is within the expected reference range. C. Clear, pale yellow drainage is an expected finding after peritoneal dialysis has been established. D. Abdominal fullness is an expected finding during the dwell period, when the dialysate stays in the peritoneal cavity. A supine low-Fowler's position can reduce abdominal pressure. A nurse is assessing a client who is receiving peritoneal dialysis. Which of the following findings should the nurse report to the provider immediately? A. Difficulty draining the effluent B. Redness at the access site C. Fluid flowing from the catheter site D. Cloudy effluent - CORRECT ANSWERS ✔✔Correct Answer: D. Cloudy effluent A cloudy or opaque effluent indicates the client is at high risk for peritonitis, a bacterial infection of the peritoneum. Therefore, this is the priority finding for the nurse to report to the provider.
A decrease in urine output after TURP indicates an obstruction to urine flow by a clot or residual prostatic tissue and should be reported to the provider. Incorrect Answers:A. Pink-tinged urine and blood clots are expected findings for several days following a TURP. B. Burning with urination and urinary frequency are expected findings after a TURP and should decrease after several days. C. Stress incontinence is an expected finding following a TURP due to poor sphincter control. A nurse is providing teaching to a client who has a history of urinary tract infections (UTIs). Which of the following client statements indicates the need for additional teaching? A. "I will empty my bladder every 4 hours." B. "I will drink 2 L of fluids per day." C. "I will use a vaginal douche daily." D. "I will wear cotton underwear." - CORRECT ANSWERS ✔✔Correct Answer: C. "I will use a vaginal douche daily."
The client should avoid vaginal douches, bubble baths, and any substances that can increase the risk of UTIs. The client should use mild soap and water to wash the perineal area. Incorrect Answers:A. The client should empty her bladder every 4 hours to prevent urinary stasis, which can cause UTIs. B. The client should maintain a daily fluid intake of 2 to 3 L to flush the kidneys and prevent urinary stasis. D. The client should wear loose-fitting cotton (not nylon) underwear to prevent irritation. A nurse is providing teaching to a client who is preoperative for a renal biopsy. Which of the following statements should the nurse make? A. "You will be NPO for 8 hr following the procedure." B. "An allergy to shellfish is a contraindication to this procedure." C. "You will need to be on bed rest following the procedure." D. "A creatinine clearance is needed prior to the procedure." - CORRECT ANSWERS ✔✔Correct Answer: C. "You will need to be on bed rest following the procedure." A renal biopsy involves a tissue biopsy through needle insertion into the lower lobe of the kidney. The client should maintain bed rest in a supine position with a back roll for support for 2 to 24 hours following the
No drainage in the urinary drainage bag indicates an obstruction. The nurse should gently irrigate the indwelling urinary catheter as prescribed to clear the obstruction and allow urine and irrigating fluid to drain. Incorrect Answers:A. The nurse should instruct the client to avoid trying to urinate around the urinary catheter because this can cause bladder spasms. B. The nurse should not increase the rate of the irrigation fluid because no drainage in the urinary drainage bag indicates an obstruction of the indwelling urinary catheter. Increasing the rate of instillation can put additional pressure on the client's bladder. D. The nurse should not administer a diuretic to the client because no drainage in the urinary drainage bag indicates an obstruction of the indwelling urinary catheter. A nurse is assessing a client who has acute kidney injury (AKI). According to the RIFLE classification system, which of the following findings indicates that the client has end-stage kidney disease? A. <0.5 mL/kg of urine output for 12 hr B. No urine output for 12 hr C. No urine output without renal replacement therapy for 4 to 12 weeks D. No urine output without renal replacement therapy for more than 3 months
- CORRECT ANSWERS ✔✔Correct Answer: D. No urine output without renal replacement therapy for more than 3 months
In the RIFLE classification, R stands for Risk, I stands for Injury, F stands for Failure, L stands for Loss, and E stands for End-stage kidney disease. No urine output without renal replacement therapy for more than 3 months indicates end-stage kidney disease. Incorrect Answers:A. According to the RIFLE classification, this indicates injury. B. According to the RIFLE classification, this indicates failure. C. According to the RIFLE classification, this indicates loss. A nurse is providing teaching to a client who has gout and urolithiasis. The client asks how to prevent future uric acid stones. Which of the following suggestions should the nurse provide? (Select all that apply.) A. Take allopurinol as prescribed B. Exercise several times a week C. Limit intake of foods high in purine D. Decrease daily fluid intake E. Avoid citrus juices - CORRECT ANSWERS ✔✔Correct Answers: A. Take allopurinol as prescribed B. Exercise several times a week
Blood pressure 160/90 mmHg Due to the kidneys' role in fluid and blood pressure regulation, a client who is experiencing rejection can have hypertension. Incorrect Answers:B. Manifestations of acute kidney rejection can include an increase in serum creatinine. This finding is within the expected reference range. C. Manifestations of acute kidney rejection can include an increase in sodium. This finding is within the expected reference range. D. Manifestations of acute kidney rejection can include decreased urine output, anuria, oliguria (<30 mL/hr), and weight gain. A nurse is reviewing the laboratory findings of a client who has chronic kidney disease. The client reports significant persistent nausea and muscle weakness. Which of the following findings should the nurse expect? A. Hypernatremia B. Hypomagnesemia C. Hypercalcemia D. Hyperkalemia - CORRECT ANSWERS ✔✔Correct Answer: D. Hyperkalemia
A client who has chronic kidney disease can have hyperkalemia, which is a potassium level greater than 5.0 mEq/L. The expected reference range for potassium is 3.5 to 5.0 mEq/L. Other manifestations of hyperkalemia can include palpitations, dysrhythmias, nausea, and muscle weakness. Incorrect Answers:A. Hypernatremia is indicated by a sodium level greater than 145 mEq/L. The expected reference range for sodium is 136 to 145 mEq/L. Manifestations of hypernatremia include dry mucous membranes, agitation, thirst, hyperreflexia, and convulsions. It is not associated with chronic kidney disease. B. Hypomagnesemia is indicated by a magnesium level below 1.3 mEq/L. The expected reference range for magnesium is 1.3 to 2.1 mEq/L. Hypomagnesemia is present in clients who have hyperthyroidism or diabetes and in clients who are pregnant. It is not associated with chronic kidney disease. C. Hypercalcemia is indicated by a calcium level greater than 10.5 mg/dL. The expected reference range for calcium is 9.0 to 10.5 mg/dL. Hypercalcemia is present with some cancers, but it is not associated with chronic kidney disease. A nurse is providing teaching to a client who is preoperative prior to a transurethral resection of the prostate (TURP). Which of the following client statements indicates an understanding of the information? A. "I will not need to have a urinary catheter following this procedure." B. "I will expect my urine to be cloudy after having this procedure." C. "At least I won't have leakage of urine after having this procedure."
Calcium A client who has CKD can develop hypocalcemia due to the reduced production of active vitamin D, which is needed for calcium absorption. The client should supplement dietary calcium. Incorrect Answers:B. A client who has CKD can develop hyperphosphatemia because excretion of phosphorous by the kidneys is reduced. C. A client who has CKD can develop hyperkalemia because excretion of potassium by the kidneys is reduced. D. A client who has CKD can develop hypernatremia because excretion of sodium by the kidneys is reduced. A nurse is caring for a client who is receiving peritoneal dialysis. The nurse notes that the client's dialysate output is less than the input and that his abdomen is distended. Which of the following actions should the nurse take? A. Insert an indwelling urinary catheter B. Administer pain medication to the client C. Change the client's position D. Place the drainage bag above the client's abdomen - CORRECT ANSWERS ✔✔Correct Answer: C.
Change the client's position This client is retaining the dialysate solution after the dwell time. The nurse should ensure that the clamp is open and the tubing is not kinked and should reposition the client to facilitate the drainage of the solution from the peritoneal cavity. Incorrect Answers:A. Peritoneal dialysis is used for clients who have acute or chronic kidney disease. An indwelling urinary catheter will not relieve the client's discomfort. B. The client is retaining the dialysate solution after the dwell time. Pain medication will not correct the cause of the client's discomfort. D. The nurse should position the drainage bag lower than the client's abdomen to promote gravity drainage. A nurse is checking the laboratory values of a client who has chronic kidney disease. The nurse should expect elevations in which of the following values? A. Potassium and magnesium B. Calcium and bicarbonate C. Hemoglobin and hematocrit D. Arterial pH and PaCO2 - CORRECT ANSWERS ✔✔Correct Answer: A. Potassium and magnesium
Prerenal azotemia results from interference with renal perfusion, such as from heart failure or hypovolemic shock. Incorrect Answers: A. Clients who have prerenal azotemia typically have tachycardia, lethargy, reduced urine output, and other manifestations. C. In early stages, reversal of prerenal azotemia is possible with correction of hypovolemia and improvement in blood pressure and cardiac output. D. Infections and ingested toxins cause intrarenal AKI, not prerenal azotemia. A nurse is caring for a client who had a nephrostomy tube inserted 8 hours ago. Which of the following actions should the nurse include in the client's plan of care? A. Flush the nephrostomy tube every 4 hours with sterile water. B. Clamp the nephrostomy tube intermittently to establish continence. C. Check the skin at the nephrostomy site for irritation from urine leakage. D. Monitor for and report any blood-tinged drainage to the provider immediately. - CORRECT ANSWERS ✔✔Correct Answer: C. Check the skin at the nephrostomy site for irritation from urine leakage. The nurse should monitor the client for complications (e.g. bleeding, hematuria, fistula formation, infection), impairment of skin integrity (e.g.
inflammation, infection, bleeding, urine leakage, irritation), and tube obstruction. The nurse should use the aseptic technique for dressing changes and encourage oral intake but should never clamp or irrigate the nephrostomy tube without a specific prescription to do so. Incorrect Answers: A. Routine irrigation of a nephrostomy tube is unnecessary; however, the nurse should notify the provider if the drainage stops, becomes cloudy, or has a foul odor. B. The nephrostomy tube relieves urine outflow obstruction; therefore, the nurse should never clamp it. A nurse is providing teaching to a young adult client who has a history of calcium oxalate renal calculi. Which of the following instructions should the nurse include? A. "Drink fruit punch or juice with every meal." B. "Consume 1,000 mg of dietary calcium daily." C. "Take 1 g of a vitamin C supplement daily." D. "Increase your daily bran intake." - CORRECT ANSWERS ✔✔Correct Answer: B. "Consume 1,000 mg of dietary calcium daily."
