Assessment of renal and urinary function
Urinary Disorders
Renal Disorders
End Stage Renal Disease
Miscellaneous
100

The nurse is performing an assessment on a client who has returned from dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. What is the priority nursing action?

A. Monitor the client.

B. Elevate the head of bed.

C. Assess the fistula site and dressing.

D. Notify the Primary Health Care Provider. 

What is D? Notify the PHCP. 

Rationale: Disequilibrium syndrome may be caused by rapid removal of solutes from the body during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs and symptoms of disequilibrium syndrome, and appropriate treatments with anticonvulsant and barbiturates may be necessary to prevent a life threatening situations. The PHCP must be notified first. Monitoring the client, elevating HOB, and assessing the fistula site are correct action, but the priority action is notify the PHCP.

100
The nurse is caring for a patient with dementia in a long-term care facility when the patient develops increased confusion and experiences a fall. What should the nurse suspect this patient may be experiencing? A. Stroke B. Fecal impaction C. Myocaridal infarction D. Urinary tract infection
What is D (urinary tract infection)?
100
A patient with chronic kidney disease experiences decreased erythropoietin levels. What complication, related to this finding, does the nurse anticipate when caring for this patient? A. Anemia B. Acidosis C. Hyperkalemia D. Hypocalcemia
What is A (anemia)?
100
Which assessment findings indicate that a patient's arteriovenous fistula is patent? A. Positive bruit, negative thrill B. Negative bruit, positive thrill C. Positive bruit, positive thrill D. Negative bruit, negative thrill
What is C (positive bruit, positive thrill)?
100
The nurse is caring for a patient with hypovolemic shock related to multitrauma. This patient is at risk for prerenal acute kidney injury related to which factor? A. Decreased perfusion to the kidneys B. Direct trauma to the kidneys C. Obstruction to urine flow D. Vasodilation of renal arterioles
What is A (Decreased perfusion to the kidneys)?
200
Which statement from a patient undergoing an intravenous pyelogram (excretory urogram) is most concerning? A. "I'm afraid of needles." B. "I've haven't had anything to eat or drink since yesterday." C. "I take medicine to help me sleep at night." D. "I"m allergic to crabs and shrimp."
What is D (I'm allergic to crabs and shrimp)?
200
The nurse is assessing the laboratory findings of a patient with a urinary tract infection. Which finding is most concerning? A. Left shift in the white blood cell (WBC) differential B. Serum white blood cell count of 15,000/mm3 C. Presence of red blood cells in the urine D. Presence of white blood cells in the urine
What is A (Left shift in the white blood cell (WBC) differential)?
200
The nurse is educating a patient on a potassium-restricted diet. What food should the patient avoid due to having high levels of potassium? A. Butter B. Citrus fruit C. Cooked white rice D. Corn
What is B (citrus fruit)?
200
A patient with end stage renal disease has completed a hemodialysis treatment. The nurse measures which parameters at the completion of the procedure to assess hemodynamic stability and determine effectiveness of fluid removal? A. Vital signs and blood urea nitrogen (BUN) B. Serum sodium and potassium levels C. Vital signs and weight D. BUN and serum creatinine levels
What is C (Vital signs and weight)?
200

The older client with BPH and hypertension is being treated with doxazosin (Cardura) while staying in the hospital. Which should the nurse monitor for following the first dose? A. Increased heart rate and shortness of breath B. Orthostatic hypotension and syncope C. Prolonged erection and loss of appetite D. Drowsiness and temporary memory loss

What is B (orthostatic hypotension and syncope)?

300
Which amount of urine output over an 24-hour period is associated with oliguria (select all that apply)? A. 200 mL B. 350 mL C. 750 mL D. 1000 mL
What is A and B (200 mL and 350 mL)?
300
The nurse is caring for a 73-year-old man patient with a history of benign prostatic hyperplasia and symptoms of a possible urinary tract infection. Which diagnostic finding would support this diagnosis? A. White blood cell count is 7500 cells/µL. B. Prostate specific antigen level of 5.0 ng/mL. C. Glucose, protein, and ketones are present in the urine D. Nitrites and leukocyte esterase are present in the urine.
What is D (Nitrites and leukocyte esterase are present in the urine)?
300
Which intervention can be used to decrease the risk of contrast-induced nephropathy in a patient with chronic kidney disease undergoing a computed tomography scan with intravenous contrast? A. Administer sodium bicarbonate after the procedure B. Hydrate with intravenous 0.9% sodium chloride before the procedure C. Administer oral N-acetylcysteine after the procedure D. Perform renal replacement therapy before the procedure.
What is B (hydrate with intravenous 0.9% sodium chloride before the procedure)?
300
Which statement by the nurse regarding continuous ambulatory peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to this procedure? A. "It is essential that you maintain aseptic technique to prevent peritonitis." B "You will be allowed a more liberal protein diet once you complete CAPD." C. "It is important for you to maintain a daily written record of blood pressure and weight." D. "You will need to continue regular medical and nursing follow-up visits while performing CAPD."
What is A ("It is essential that you maintain aseptic technique to prevent peritonitis.")?
300
Which is the nurse's highest priority for meeting the needs of a patient who presents with a 3-day history of vomiting and diarrhea, blood pressure of 85/60 mm Hg, and heart rate of 105 beats/min? A. Finding the source of infection B. Preventing nutritional deficit C. Replacement of fluid loss D. Relief of nausea
What is C (Replacement of fluid loss)?
400
A 24-hour urine collection is scheduled to begin at 0600. Which instruction should the nurse provide to the patient? A. "Save all of your urine starting at 0600." B. "Void at 0600 and discard that urine, then begin the collection." C. "Void at 0600, save that urine and begin the collection." D. "A urinary catheter will be inserted to make the collection more accurate."
What is B ("Void at 0600 and discard that urine, then begin the collection.")?
400
Which prevention strategy will the nurse teach the patient with a risk for renal calculi? A. “Start taking antibiotics at the first sign of a stone.” B. “Avoid dairy products and other sources of calcium." C. “Avoid aspirin and aspirin-containing products.” D. “Drink at least 3 to 4 L of fluid every day.”
What is D (“Drink at least 3 to 4 L of fluid every day.”)?
400
A patient is admitted to the medical unit with acute kidney injury caused by prostatic hyperplasia and urethral obstruction. Which of these provider orders should the nurse implement first? A. Place patient on a protein-restricted diet. B. Insert a 16-Fr Foley retention catheter. C. Collect a 24-hour urine specimen for creatinine clearance. D. Give furosemide (Lasix) 80 mg IV.
What is B (Insert a 16-Fr Foley retention catheter)?
400
A patient is receiving hemodialysis for the first time. The patient reports a headache with nausea and begins to vomit. A short time later, the nurse notices a decreased level of consciousness. What is the most likely cause of these changes? A. The dialysis was performed too rapidly B. The patient experienced an allergic reaction to the dialysate C. The patient experienced a cerebral fluid shift D. Too much fluid was pulled off during the treatment
What is C (The patient experienced a cerebral fluid shift)?
400
Which statement by the patient with diabetic nephropathy indicates a need for further education about their disease? A. ''Diabetes is the leading cause of renal failure.'' B. "I need less insulin, so I am getting better.'' C. "I may need to reduce my insulin.'' D. ''I must call my provider if the urine dipstick shows protein.''
What is B ("I need less insulin, so I am getting better.")?
500
Which laboratory value indicates renal impairment? A. Serum creatinine of 0.8 mg/dL B. Blood urea nitrogen of 14 mg/dL C. Creatinine clearance (GFR) of 40 mL/min D. Uric acid level of 6 mg/dL
What is C (Creatinine clearance (GFR) of 40 mL/min)?
500
A patient undergoing continuous bladder irrigation at a rate of 1000 mL/hr has a urinary output of 200 mL/hr. Which will the nurse do first? A. Notify the physician. B. Stop the irrigation flow. C. Document the finding as the only action. D. Irrigate the catheter with a large-piston syringe.
What is B (Stop the irrigation flow)?
500
Long-term, chronic use of which medication class can lead to chronic kidney disease? A. Beta-blockers B. Insulin C. Non-steroidal anti-inflammatory drugs (NSAIDs) D. Loop diuretics
What is C (NSAIDs)?
500
The nurse in the dialysis clinic is reviewing the home medications of a patient with end stage renal disease. Which medication reported by the patient indicates that patient teaching is required? A. Ferrous sulfate B. Acetaminophen (Tylenol) C. Magnesium hydroxide D. Sevelamer (Renagel)
What is C (Magnesium hydroxide)?
500
The RN has just received change-of-shift report. Which of the assigned patients will be assessed first? A. A patient with chronic renal failure who was just admitted with shortness of breath B. A patient with renal insufficiency who is scheduled to have an AV fistula inserted C. A patient with acute kidney injury whose blood urea nitrogen and creatinine are increasing D. A patient receiving peritoneal dialysis who is due for an exchange
What is A (A patient with chronic renal failure who was just admitted with shortness of breath)?
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