common questions that always take priority in different level of many exams

1. Renal Disorders Questions and Answers With Rational
1. A client has been admitted to the hospital for urinary tract infection an
dehydration. The nurse determines that the client has received adequate volume
replacement if the BUN drops to:
1. 3 mg/dL
2. 15 mg/dL
3. 29 mg/dL
4. 35 mg/dL
Rational :The normal blood urea nitrogen level is 8 to 25 mg/dL. Values such as those in
options 3 and 4 reflect continued dehydration. Option 1 reflects a lower than normal
value, which may occur with fluid volume overload, among other conditions.
1.2. An adult client has had lab work done as part of a routine physical exam. The nurse
interprets that the client may have a mild degree of renal insufficiency if which of the
following serum creatinine levels is noted?
1. 0.2 mg/dL
2. 0.5 mg/dL
3. 1.9 mg/dL
4. 3.5 mg/dL
Rational The normal serum creatinine level for adults is 0.6 to 1.3 mg/dL. The client
with a mild degree of renal insufficiency would have a slightly elevated level. A
creatinine level of 0.2 mg/dL is low, and a level of 0.5 mg/dL is just below normal. A
creatinine level of 3.5 mg/dL may be associated with acute or chronic renal failure.

2. 1.3. The nurse instructs a client with renal failure who is receiving hemodialysis
about dietary modifications. The nurse determines that the client understands
these dietary modifications if the client selects which items from the menu?
1. Cream of wheat, blueberries, coffee
2. Sausage and eggs, banana, orange juice.
3. Bacon, cantaloupe melon, tomato juice.
4. Cured pork, grits, strawberries, orange juice.
Rational The diet for a client with renal failure who is receiving hemodialysis should
include controlled amounts of sodium, phosphorus, calcium, potassium, and fluids.
Options 2, 3, and 4 are high in sodium, phosphorus and potassium.
1.4. The client with acute renal failure has a serum potassium level of 6.0 mEq/L.
The nurse would plan which of the following as a priority action?
1. Check the sodium level.
2. Place the client on a cardiac monitor.
3. Encourage increased vegetables in the diet.
4. Allow an extra 500 mL of fluid intake to dilute the electrolyte
concentration.
Rational. The client with hyperkalemia is at risk of developing cardiac dysrhythmias and
cardiac arrest. Because of this, the client should be placed on a cardiac monitor. Fluid
intake is not increased because it contributes to fluid overload and would not affect the
serum potassium level significantly. Vegetables are a natural source of potassium in the
diet, and their use would not be increased. The nurse also may assess the sodium level
because sodium is another electrolyte commonly measured with the potassium level.
However, this is not a priority action of the nurse.

3. 1.5 The client with chronic renal failure is scheduled for hemodialysis this morning is
due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer
this medication:
1. During dialysis.
2. Just before dialysis.
3. The day after dialysis.
4. On return from dialysis.
Rational. Antihypertensive medications such as enalapril are given to the client
following hemodialysis. This prevents the client from becoming hypotensive during
dialysis and also from having the medication removed from the bloodstream by dialysis.
No rationale exists for waiting an entire day to resume the medication. This would lead to
ineffective control of the blood pressure.
1.5. The client with chronic renal failure has an indwelling abdominal catheter for
peritoneal dialysis. The client spills water on the catheter dressing while
bathing. The nurse should immediately:
1. Change the dressing.
2. Reinforce the dressing.
3. Flush the peritoneal dialysis catheter.
4. Scrub the catheter with providone-iodine.
Rational. Clients with peritoneal dialysis catheters are at high risk for infection. A wet
dressing is a conduit for bacteria to reach the catheter insertion site. The nurse ensures
that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to
prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing
the catheter with povidone-iodine is done at the time of connection or disconnection of
peritoneal dialysis.

4. 1.6. The client being hemodialyzed suddenly becomes short of breath and
complains of chest pain. The client is tachycardic, pale, and anxious. The
nurse suspects air embolism. The priority action for the nurse is to:
1. Discontinue dialysis and notify the physician.
2. Monitor vital signs every 15 minutes for the next hour.
3. Continue dialysis at a slower rate after checking the lines for air.
4. Bolus the client with 500 mL of normal saline to break up the embolus.
Rational. If the client experiences air embolus during hemodialysis, the nurse should
terminate dialysis immediately, notify the physician, and administer oxygen as needed.
Options 2, 3, and 4 are incorrect.
1.7. The nurse has completed client teaching with the hemodialysis client about
self-monitoring between hemodialysis treatments. The nurse determines that
the client best understands the information if the client states to record daily
the:
1. Amount of activity.
2. Pulse and respiratory rate.
3. Intake and output and weight.
4. Blood urea nitrogen and creatinine levels.
Rational. The client on hemodialysis should monitor fluid status between hemodialysis
treatments by recording intake and output and measuring weight daily. Ideally, the
hemodialysis client should not gain more than 0.5 kg of weight/day.

5. 1.8. The client with an external arteriovenous shunt in place for hemodialysis is at
risk for bleeding. The priority nurse action would be to:
1. Check the shunt for the presence of bruit and thrill.
2. Observe the site once as time permits during the shift.
3. Check the results of the prothrombin times as they are determined.
4. Ensure that small clamps are attached to the arteriovenous shunt
dressing.
Rational An arteriovenous shunt is a less common form of access site but carries a risk
for bleeding when it is used because two ends of an external cannula are tunneled
subcutaneously into an artery and a vein, and the ends of the cannula are joined. If
accidental disconnection occurs, the client could lose blood rapidly. For this reason, small
clamps are attached to the dressing that covers the insertion site for use if needed. The
shunt site also should be assessed at least every 4 hours.
1.9. The nurse develops a postprocedure plan of care for a client who had a renal
biopsy. The nurse avoids documenting which intervention in the plan?
1. Administering analgesics as needed.
2. Encouraging fluids to at least 3 L in the first 24 hours.
3. Testing serial urine samples with dipsticks for occult blood.
4. Ambulating the client in the room and hall for short distances.
Rational Following renal biopsy, the nurse ensures that the client remains in bed for at
least 24 hours. Vital signs and puncture site assessments are done frequently during this
time. Encouraging fluids is done to reduce possible clot formation at the biopsy site.
Serial urine samples are assayed by Hematest with urine dipsticks to evaluate bleeding.
Analgesics often are needed to manage the renal colic pain that some clients feel after
this procedure.

6. 1.10. The client with urolithiasis has a history of chronic urinary tract infections.
The nurse plans teaching the client to avoid which of the following?
1. Long-term use of antibiotics.
2. Wearing synthetic underwear and pantyhose.
3. High--phosphate foods, such as dairy products.
4. Foods that make the urine more acidic, such as cranberries.
Rational. Urolithiasis (struvite stones) can result from chronic infections. They form in
urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Teaching
should focus on prevention of infections and ingesting foods to make the urine more
acidic. The client should wear cotton (not synthetic) underclothing to prevent the
accumulation of moisture and to prevent irritation of the perineal area, which can lead to
infection.
1.1. The client who has a history of gout also is diagnosed with urolithiasis and the
stones are determined to be of uric acid type. The nurse gives the client
instructions in which foods to limit, including:
1. Milk
2. Liver
3. Apples
4. Carrots
Rational. The client with uric acid stones should avoid foods containing high amounts of
purines. This includes limiting or avoiding organ meats such as liver, brain, heart, kidney,

7. and sweetbreads. Other foods to avoid include herring, sardines, anchovies, meat extracts,
consommés, and gravies. Foods that are low in purines include all fruits, many
vegetables, milk, cheese, eggs, refined cereals, sugars and sweets, coffee, tea, chocolate,
and carbonated beverages.
1.12. The client arrives at the emergency department with complaints of low abdominal
pain and hematuria. The client is afebrile. The nurse next assesses the client to determine
a history of:
1. Pyelonephritits
2. Glomerulonephritis
3. Trauma to the bladder or abdomen
4. Renal cancer in the client's family
Rational. Bladder trauma or injury should be considered or suspected in the client with
low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be
accompanied by fever and are thus not applicable to the client in this question. Renal
cancer would not cause pain that is felt in the low abdomen; rather pain would be in the
flank area.
1.13. The client is admitted to the emergency department following a motor vehicle
accident. The client was wearing a lap seat belt when the accident occurred and now the
client has hematuria and lower abdominal pain. To assess further whether the pain is
caused by bladder trauma, the nurse asks the client if the pain is referred to which of the
following area?
1. Hip
2. Shoulder
3. Umbilicus
4. Costovertebral angle

8. Rational. Bladder trauma or injury is characterized by lower abdominal pain that may
radiate to one of the shoulders. Bladder injury pain does not radiate to the umbilicus,
costovertebral angle, or hip.
1.14. A nurse is assessing the patency of a client's left arm arteriovenous fistula prior to
initiating hemodialysis. Which finding indicates that the fistula is patent?
1. Palpation of a thrill over the fistula.
2. Presence of a radial pulse in the left wrist.
3. Absence of a bruit on auscultation of the fistula.
4. Capillary refill less than 3 seconds in the nail beds of the fingers of the left hand.
Rational. The nurse assesses the patency of the fistula by palpating for the presence of a
thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the
fistula. Although the presence of a radial pulse in the left wrist and capillary refill shorter
than 3 seconds in the nail beds of the fingers on the left hand are normal findings, they do
not assess fistula patency.
1.15.The client newly diagnosed with chronic renal failure recently has begun
hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse
assesses the client during dialysis for:
1. Hypertension, tachycardia, and fever.
2. Hypotension, bradycardia, and hypothermia.
3. Restlessness, irritability, and generalized weakness.
4. Headache, deteriorating level of consciousness, and twitching.
Rational. Disequilibrium syndrome is characterized by headache, mental confusion,
decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure
activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body
during hemodialysis. At the same time, the blood-brain barrier interferes with the
efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells

9. because of the osmotic gradient, causing brain swelling and onset of symptoms. The
syndrome most often occurs in clients who are new to dialysis and is prevented by
dialyzing for shorter times or at reduced blood flow rates.
1.16. A client with chronic renal failure has completed a hemodialysis treatment. The
nurse would use which of the following standard indicators to evaluate the client's status
after dialysis?
1. Vital signs and weight.
2. Potassium level and weight.
3. Vital signs and BUN.
4. BUN and creatinine levels.
Rational Following dialysis, the client's vital signs are monitored to determine whether
the client is remaining hemodynamically stable. Weight is measured and compared with
the client's predialysis weight to determine effectiveness of fluid extraction. Laboratory
studies are done as per protocol but are not necessarily done after the hemodialysis
treatment has ended.
1.7. The hemodialysis client with a left arm fistula is at risk for arterial steal syndrome.
The nurse assesses this client for which of the following manifestations?
1. Warmth, redness, and pain in the left hand.
2. Pallor, diminished pulse, and pain in the left hand.
3. Edema and reddish discoloration of the left arm.
4. Aching pain, pallor, and edema of the left arm.
Rational. Steal syndrome results from vascular insufficiency after creation of a fistula.
The client exhibits pallor and a diminished pulse distal to the fistula. The client also
complains of pain distal to the fistula, caused by tissue ischemia. Warmth, redness, and
pain probably would characterize a problem with infection. The manifestations described
in options 3 and 4 are incorrect.

10. 1.18. The nurse is reviewing the client's record and notes that the physician has
documented that the client has a renal disorder. On review of the lab results, the nurse
most likely would expect to note which of the following?
1. Decreased hemoglobin level.
2. Elevated BUN
3. Decreased red blood cell count.
4. Decreased white blood cell count.
Rational. Measuring the blood urea nitrogen level is a frequently used laboratory test to
determine renal function. The blood urea nitrogen level starts to rise when the glomerular
filtration rate falls below 40% to 60%. A decreased hemoglobin level and red blood cell
count may be noted if bleeding from the urinary tract occurs or if erythropoietic function
by the kidney is impaired. An increased white blood cell count is most likely to be noted
in renal disease.
1.19. Following a renal biopsy, the client complains of pain at the biopsy site that radiates
to the front of the abdomen. The nurse interprets this complaint and further assesses the
client for:
1. Bleeding.
2. Infection.
3. Renal colic.
4. Bladder perforation.
Rational. If pain originates at the biopsy site and begins to radiate to the flank area and
around the front of the abdomen, bleeding should be suspected. Hypotension, a
decreasing hematocrit level, and gross or microscopic hematuria also would indicate
bleeding. Signs of infection would not appear immediately following a biopsy. The
biopsy site would be the flank area and not the lower abdomen. No data are given to
support the presence of renal colic.

11. 1.20. A client is admitted to the hospital with a diagnosis of early-stage chronic renal
failure. Which of the following should the nurse expect to note on client assessment?
1. Anuria.
2. Polyuria.
3. Oliguria.
4. Polydypsia.
Rational. Polyuria occurs early in chronic renal failure and, if untreated, can cause severe
dehydration. Polyuria progresses to anuria, and the client loses all normal kidney
functions. Oliguria and anuria are not early signs, and polydipsia is unrelated to chronic
renal failure.
1.21. The nurse is performing an assessment on a client who has returned from the
dialysis unit following hemodialysis. The client is complaining of headache and nausea
and is extremely restless. Which of the following is the most appropriate nursing action?
1. Monitor the client.
2. Notify the physician.
3. Elevate the head of the bed.
4. Medicate the client for nausea.
Rational. Disequilibrium syndrome may be caused by the rapid decreases in the blood
urea nitrogen level during hemodialysis. These changes can cause cerebral edema that
leads to increased intracranial pressure. The client is exhibiting early signs of
disequilibrium syndrome and appropriate treatments with anticonvulsive medications and

12. barbiturates may be necessary to prevent a life-threatening situation. The physician must
be notified.
1.22. The nurse is reviewing the list of components contained in the peritoneal dialysis
solution with the client. The client asks the nurse about the purpose of the glucose
contained in the solution. The nurse bases the response on knowing that the glucose:
1. Decreases the risk of peritonitis.
2. Prevents disequilibrium syndrome.
3. Increases osmotic pressure to produce ultrafiltration.
4. Prevents excess glucose from being removed from the client.
Rational. Increasing the glucose concentration makes the solution more hypertonic. The
more hypertonic the solution, the higher the osmotic pressure for ultrafiltration and thus
the greater the amount of fluid removed from the client during an exchange. Options 1, 2,
and 4 do not identify the purpose of the glucose.
1.23. The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the
following would be included in the nursing plan of care to prevent the major
complication associated with peritoneal dialysis?
1. Maintain strict aseptic technique.
2. Add heparin to the dialysate solution.
3. Change the catheter site dressing daily.
4. Monitor the client's level of consciousness.
Rational. The major complication of peritoneal dialysis is peritonitis. Strict aseptic
technique is required in caring for the client receiving this treatment. Although option 3
may assist in preventing infection, this option relates to an external site. Options 2 and 4
are unrelated to the major complication of peritoneal dialysis.

13. 1.24. The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The
nurse tells the client that it is important to maintain the prescribed dwell time for the
dialysis because of the risk of:
1. Infection.
2. Hyperglycemia.
3. Hypophosphatemia.
4. Disequilibrium syndrome.
Rational. An extended dwell time increases the risk of hyperglycemia in the client with
diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte
changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis.
1.25. A client diagnosed with polycystic kidney disease has been taught about the
treatment plan for this disease. The nurse determines that the client needs additional
teaching if the client states that the treatment plan includes:
1. Genetic counseling.
2. Sodium restriction.
3. Increased water intake.
4. Antihypertensive medications.
Rational. Individuals with polycystic kidney disease seem to waste rather than retain
sodium. Thus, they need increased sodium and water intake. Aggressive control of
hypertension is essential. Genetic counseling is advisable because of the hereditary nature
of the disease.

14. 1.26. The nurse is caring for the client who has undergone renal angiography using the
left femoral artery for access. The nurse determines that the client is experiencing a
complication of the procedure if which of the following is observed?
1. Urine output, 50 mL/hr
2. Blood pressure, 110/74 mm Hg
3. Pallor and coolness of the left leg.
4. Absence of hematoma in the left groin.
Rational. Potential complications after renal angiography include allergic reaction to the
dye, renal damage from the dye, and vascular complications, which include hemorrhage,
thrombosis, or embolism. The nurse detects these complications by noting signs and
symptoms of allergic reaction, decreased urine output, hematoma or hemorrhage at the
insertion site, and/or signs of decreased circulation to the affected leg.
1.27. The nurse has taught the client with polycistic kidney disease about management of
the disorder and prevention and recognition of complications. The nurse determines that
the client understands the instructions if the client states that there is no reason to be
concerned about:
1. Burning on urination.
2. A temperature of 100.6F
3. New-onset shortness of breath.
4. A blood pressure of 105/68 mmHg
Rational. The client with polycystic kidney disease should report any signs and
symptoms of urinary tract infection so that treatment may begin promptly. Lowered
blood pressure is not a complication of polycystic kidney disease, and it is an expected
effect of antihypertensive therapy. The client would be concerned about increases in
blood pressure because control of hypertension is essential. The client may experience

15. heart failure as a result of hypertension, and thus any symptoms of heart failure, such as
shortness of breath, are also a concern.
1.28. The client who has suffered a crush injury to the leg has a highly positive urine
myoglobin level. The nurse assesses this particular client carefully for signs of:
1. Brain attack (stroke)
2. Acute tubular necrosis
3. Respiratory failure
4. Myocardial infarction
Rational The normal urine myoglobin level is negative. After extensive muscle
destruction or damage, myoglobin is released into the bloodstream, where it is cleared
from the body by the kidneys. When there is a large amount of myoglobin being cleared
from the body, there is a risk of the renal tubules being clogged with myoglobin,
causing acute tubular necrosis. This is one form of acute renal failure.

16. 1.29. A client has developed acute renal failure (ARF) as a complication of
glomerulonephritis. The nurse assesses the client for which of the following as an
expected manifestation of ARF?
1. Hypertension
2. Bradycardia.
3. Decreased cardiac output
4. Decreased central venous pressure
Rational. ARF caused by glomerulonephritis is classified as intrinsic or intrarenal
failure. This form of ARF is commonly manifested by hypertension, tachycardia,
oliguria, lethargy, edema, and other signs of fluid overload. ARF from prerenal causes is
characterized by decreased blood pressure, or a recent history of the same, tachycardia,
and decreased cardiac output and central venous pressure. Bradycardia is not part of the
clinical picture for any form of renal failure.
1.30. A nurse is analyzing the posthemodialysis lab test results for a client with chronic
renal failure (CRF). The nurse interprets that the dialysis is having an expected but
nontherapeutic effect if the results indicate a decreased:
1. Phosphorus.
2. Creatinine.
3. Potassium.
4. Red blood cell count
Rational Hemodialysis typically lowers the amounts of fluid, sodium, potassium, urea
nitrogen, creatinine, uric acid, magnesium, and phosphate levels in the blood.
Hemodialysis also worsens anemia, because RBCs are lost in dialysis from blood
sampling and anticoagulation during the procedure, and from residual blood that is left in
the dialyzer. Although all of these results are expected, only the lowered RBC count is
nontherapeutic and worsens the anemia already caused by the disease process.

17. 1.31.A client undergoing hemodialysis is at risk for bleeding from the heparin used
during the hemodialysis treatment. The nurse assesses for this occurrence by periodically
checking the results of which of the following lab tests?
1. Partial thromboplastin time (PTT)
2. Prothrombin time (PT)
3. Thrombin time (TT)
4. Bleeding time
Rational. Heparin is the anticoagulant used most often during hemodialysis. The
hemodialysis nurse monitors the extent of anticoagulation by checking the PTT, which is
the appropriate measure of heparin effect. The PT is used to monitor the effect of
warfarin (Coumadin) therapy. Thrombin and bleeding times are not used to measure the
effect of heparin therapy, although they are useful in the diagnosis of other clotting
abnormalities.
1.32.A client is undergoing diagnostic tests to rule out a diagnosis of renal disease. The
lab results indicate a ratio of BUN to creatinine of 15:1. The nurse determines that this
result indicates:
1. A fluid volume deficit
2. Liver failure
3. A fluid volume excess
4. A normal ratio
4. Rational The normal ratio of BUN to creatinine is approximately 10:1 to 15:1. A value
lower than 10:1 would indicate diminished urea concentration. A value greater than 15:1
would indicate inadequate renal function.

18. 1.33.A client is schedule for a excretory urogram. Which of the following would the
nurse expect to be prescribed as a component of preparation for this test?
1. NPO status after midnight.
2. Administration of a sedative before the test.
3. Administration of intravenous fluids.
4. Bowel preparation to remove fecal contents.
Rational. An excretory urogram is an invasive test that uses contrast radiopaque dye to
assess the ability of the kidneys to excrete dye in the urine. Bowel preparation is
necessary to permit adequate visualization of the kidneys, ureters, and bladder. Options 1,
2, and 3 usually are not components of preparation for this test.
1.34.A client is complaining of severe flank and abdominal pain. A flat plate of the
abdomen shows urolithiasis. Which of the following interventions is important?
1. Strain all urine
2. Limit fluid intake
3. Enforce strict bed rest
4. Encourage a high calcium diet
Rational
Urine should be strained for calculi and sent to the lab for analysis. Fluid intake of 3 to 4
L is encouraged to flush the urinary tract and prevent further calculi formation. A low-
calcium diet is recommended to help prevent the formation of calcium calculi.
Ambulation is encouraged to help pass the calculi through gravity.

19. 1.35. A client is receiving a radiation implant for the treatment of bladder cancer. Which
of the following interventions is appropriate?
1. Flush all urine down the toilet
2. Restrict the client’s fluid intake
3. Place the client in a semi-private room
4. Monitor the client for signs and symptoms of cystitis
Rational
Cystitis is the most common adverse reaction of clients undergoing radiation therapy;
symptoms include dysuria, frequency, urgency, and nocturia. Clients with radiation
implants require a private room. Urine of clients with radiation implants for bladder
cancer should be sent to the radioisotopes lab for monitoring. It is recommended that
fluid intake be increased.
1.36. A client has just received a renal transplant and has started cyclosporine therapy to
prevent graft rejection. Which of the following conditions is a major complication of this
drug therapy?
1. Depression
2. Hemorrhage
3. Infection
4. Peptic ulcer disease
Rational
Infections is the major complication to watch for in clients on cyclosporine therapy
because it’s an immunosuppressive drug. Depression may occur posttransplantation but
not because of cyclosporine. Hemorrhage is a complication associated with anticoagulant
therapy. Peptic ulcer disease is a complication of steroid therapy.

20. 1.37. A client received a kidney transplant 2 months ago. He’s admitted to the hospital
with the diagnosis of acute rejection. Which of the following assessment findings would
be expected?
1. Hypotension
2. Normal body temperature
3. Decreased WBC count
4. Elevated BUN and creatinine levels
Rational
In a client with acute renal graft rejection, evidence of deteriorating renal function is
expected. The nurse would see elevated WBC counts and fever because the body is
recognizing the graft as foreign and is attempting to fight it. The client would most likely
have acute hypertension.
1.38.The client is to undergo kidney transplantation with a living donor. Which of the
following preoperative assessments is important?
2. Urine output
3. Signs of graft rejection
4. Signs and symptoms of rejection
5. Client’s support systemand understanding of lifestyle changes
Rational : The client undergoing a renal transplantation will need vigilant follow-up
care and must adhere to the medical regimen. The client is most likely anuric or oliguric
preoperatively, but postoperatively will require close monitoring of urine output to make
sure the transplanted kidney is functioning optimally. While the client will always need to
be monitored for signs and symptoms of infection, it’s most important post-op will
require close monitoring of urine output to make sure the transplanted kidney is
functioning optimally. While the client will always need to be monitored for signs and
symptoms of infection, it’s most important postoperatively due to the immunosuppressant
therapy. Rejection can occur postoperatively.

21. 1.39. . A 79-year-old man has been admitted with benign prostatic hyperplasia. What is
most appropriate to include in the nursing plan of care?
a. Limit fluid intake to no more than 1000 mL/day.
b. Leave a light on in the bathroom during the night.
c. Ask the patient to use a urinal so that urine can be measured.
d. Pad the patient's bed to accommodate overflow incontinence.
Rational :The patient's age and diagnosis indicate a likelihood of nocturia
1.40.. The nurse completing a physical assessment for a newly admitted male patient is
unable to feel either kidney on palpation. Which action should the nurse take next?
a. Obtain a urine specimen to check for hematuria.
b. Document the information on the assessment form.
c. Ask the patient about any history of recent sore throat.
d. Ask the health care provider about scheduling a renal ultrasound.
Rational
The kidneys are protected by the abdominal organs, ribs, and muscles of the back, and
may not be palpable under normal circumstances, so no action except to document the
assessment information is needed
1.41. .How will the nurse assess for flank tenderness in a 30-year-old female patient with
suspected pyelonephritis?
a. Palpate along both sides of the lumbar vertebral column.
b. Strike a flat hand covering the costovertebral angle (CVA).
c. Push fingers upward into the two lowest intercostal spaces.
d. Percuss between the iliac crest and ribs along the midaxillary line.
Rational
Checking for flank pain is best performed by percussion of the CVA and asking about
pain

22. 42. What glomerular filtration rate (GFR) would the nurse estimate for a 30-year-old
patient with a creatinine clearance result of 60 mL/min?
a. 60 mL/min
b. 90 mL/min
c. 120 mL/min
d. 180 mL/min
Rational
The creatinine clearance approximates the GFR
43. The nurse assessing the urinary system of a 45-year-old female would use
auscultation to
a. determine kidney position.
b. identify renal artery bruits.
c. check for ureteral peristalsis.
d. assess for bladder distention.
Rational
The presence of a bruit may indicate problems such as renal artery tortuosity or
abdominal aortic aneurysm
44. The nurse is caring for a 68-year-old hospitalized patient with a decreased glomerular
filtration rate who is scheduled for an intravenous pyelogram (IVP).
Which action will be included in the plan of care?
a. Monitor the urine output after the procedure.
b. Assist with monitored anesthesia care (MAC).
c. Give oral contrast solution before the procedure.
d. Insert a large size urinary catheter before the IVP.
Rational
Patients with impaired renal function are at risk for decreased renal function after IVP
because the contrast medium used is nephrotoxic, so the nurse should monitor the
patient's urine output.

23. 45.Which nursing action is essential for a patient immediately after a renal biopsy?
a. Check blood glucose to assess for hyperglycemia or hypoglycemia.
b. Insert a urinary catheter and test urine for gross or microscopic hematuria.
c. Monitor the blood urea nitrogen (BUN) and creatinine to assess renal function.
d. Apply a pressure dressing and keep the patient on the affected side for 30 minutes.
Rational
A pressure dressing is applied and the patient is kept on the affected side for 30 to 60
minutes to put pressure on the biopsy side and decrease the risk for bleeding.
46.A male patient in the clinic provides a urine sample that is red-orange in color. Which
action should the nurse take first?
a. Notify the patient's health care provider.
b. Teach correct midstream urine collection.
c. Ask the patient about current medications.
d. Question the patient about urinary tract infection (UTI) risk factors.
Rational
A red-orange color in the urine is normal with some over-the-counter (OTC) medications
such as phenazopyridine (Pyridium).