7.

While providing client teaching, the nurse recognizes

that the client on peritoneal dialysis has an
GENITO URINARY SYSTEM understanding of peritonitis when states:
A. I’ll call you immediately if I notice that my
Name_____________________________________ dialysate outflow is cloudy.
B. It’s normal for my dialysate to be bloody.
1. The physician orders hourly urine measurement for C. Abdominal pain will occur when I perform my
postoperative client. The nurse records the following daily dialysis fluid exchanges
amounts for 2 consecutive hours: 8 1m., 50 ml; 9am., 60 D. I have no control over catheter connection site
ml. Based on these amounts, which action should the contamination during a dialysis fluid exchange.
nurse take?
A. Continue to monitor and record the clients 8. The client with acute renal failure has a serum
hourly urine output. potassium level of 6.0 mEq/L. The nurses would plan
B. Notify the physician which of the following as a priority action?
C. Irrigate the indwelling urinary catheter. A. Check the sodium level
D. Increase the I.V. fluid infusion rate B. Place the client on a cardiac monitor
2. The nurse is recording a client’s complaint of painful C. Encourage increased vegetables in the client
urination. When documenting this symptoms, the nurse D. Allow an extra 500ml of fluid intake to dilute
should use which of the following terms? the electrolyte concentration.
A. Oliguria
B. Anuria 9. The client with Chronic renal failure who is scheduled
C. Pyuria for hemodialysis this morning is due to receive a daily
D. Dysuria dose of enalapril (Vasotec). The nurse should plan to
3. A client with chronic renal failure is admitted to the adminester this medication:
hospital. The physician orders arterial blood gases to be A. During dialysis
drawn. Which of the following should the nurse expect? B. Just before dialysis
A. Metabolic Alkalosis C. The day after dialysis
B. Metabolic acidosis D. On the return from dialysis
C. Respiratory alkalosis
D. Respiratory acidosis 10. The client with chronic renal failure has an
4. After the nurse has completed the preoperative indwelling abdominal catheter for peritoneal dialysis.
teaching for client who’s having surgery for an ileal The client spills water on the catheter dressing while
conduit, the client asks the nurse when the ileal conduit bathing. The nurse should immediately:
can be reversed. The nurse would base an answer on the A. Change the dressing
knowledge that: B. Reinforce the dressing
A. 3months after the bowel has had time to heal, it C. Flush the peritoneal dialysis catheter
may be re anastomosed. D. Scrub the catheter with providone iodine
B. The reversal can be done 3 weeks after 11. The nurse has completed client teaching wit the
antibiotics take effect. hemodialysis client about self monitoring between
C. This procedure is permanent. hemodialysis treatments. The nurse determines that the
D. Most surgical procedure's are reversible client best understands the information if the client states
to record daily the:
5. The nurse is assigned to care for a new pediatric A. Amount of activity
admission, a 5 year old child with nephrotic syndrome. B. Pulse and respiratory rate
Which of the following nursing diagnoses should be C. Intake and output and weight
added to the child's care plan? D. Blood urea nitrogen and creatinine levels
A. Imbalanced nutrition: More than body
requirements related to weight gain. 12. The client with an external arteriovenous shunt in
B. Activity intolerance related to increased use of place for hemodialysis is at risk for bleeding. The
sedatives priority nursing action would be to
C. Disturbed body image related to loss of hair A. Check the shunt for the presence of bruit and
D. Excess fluid volume related to glomerular thrill
damage B. Observe the site once as time permits during the
shift
6. A client in acute renal failure is admitted to the C. Check the results of the prothrombin time as
nephrology unit. The period of oliguria in clients with they are determined.
this condition usually lasts about 10 days. Which of the D. Ensure that small clamps are attached to the
following assessments of kidney function would the arteriovenous shunt dressing
nurse make during the oliguric phase
A. No urine output because the kidneys would be in 13. The nurse is inserting a Foley catheter into the
a state of suppression bladder of a female adult client. The nurse slips the
B. Urine output of 30 to 60 ml/hr catheter into an opening for four-5 inches and no urine is
C. Urine output of less than 400 to 600 ml in obtained. The most probable reason for this is that
24hours A) there is no urine present in the bladder
D. Urine output that would be directly related to the B) the catheter is in the vagina
amount of I.V. fluids infused C) the catheter is not inserted in far enough
D) the bladder is over distended
14. A client is placed on sulfamethoxazole-trimethoprim A. Hold the urine to increase bladder capacity
(Bactrim) for a recurrent urinary tract infection. Which B. Avoid eating foods high in sodium
of the following is appropriate reinforcement of C. Restrict fluid to prevent elimination accidents
information by the nurse? D. Avoid taking antihistamines

A) "Drink at least 8 glasses of water a day." 22. A client has been on antibiotics for 72 hours for
B) "Be sure to take the medication with food." cystitis. Which report from the client requires priority
C) "It is safe to take with oral contraceptives." attention by the nurse?
D) "Stop the medication after 5 days." A. Foul smelling urine
B. Burning on urination
15. During a fluid exchange for the client who is 48 C. Elevated temperature
hours post insertion of the abdominal Tenckhoff catheter D. Nausea and anorexia
for peritoneal dialysis, the nurse knows that the
appearance of which of the following needs to be 23. The nurse is caring for a client with a vascular access
reported to the health care provider immediately? for hemodialysis. Which of these findings necessitates
immediate action by the nurse?
A) Slight pink - tinged drainage A. Pruritic rash
B) Abdominal discomfort B. Dry, hacking cough
C) Muscle weakness C. Chronic fatigue
D) Cloudy drainage D. Elevated temperature

16. A client is waiting to have an intravenous pyelogram 24. Following a diagnosis of acute glomerulonephritis
(IVP). The most important factor to be obtained by the (AGN) in their 6 year-old child, the parents remark: “We
nurse prior to the procedure is just don’t know how he caught the disease!” The nurse's
response is based on an understanding that
A) time to the client's last meal A) AGN is a streptococcal infection that involves the
B) the client's allergy history kidney tubules
C) assessment of the peripheral pulses B) The disease is easily transmissible in schools and
D) results of the blood coagulation studies camps
C) The illness is usually associated with chronic
17. The nurse develops a post procedure plan of care for respiratory infections
a client who had a renal biopsy. The nurse avoids D) It is not "caught" but is a response to a previous B-
documenting which intervention in the plan? hemolytic strep infection
A. Administering analgesics are needed
B. Encourage fluids to at least 3 L in the first 24 25. The client newly diagnosed with CRF recently has
hours begun hemodialysis. Knowing that the client is at risk
C. Testing serial urine samples with dipsticks for for disequilibrium syndrome, the nurse assesses the
occult blood client during dialysis for:
D. Ambulating the client in the room and hall for A. Hypertension, tachycardia, & fever
short distances B. Hypotension, bradycardia, & hypothermia
18. The client with Urolithiasis has a history of Chronic C. Restlessness, irritability, & generalized
urinary tract infections. The nurse plans teaching the weakness
client to avoid which of the following? D. Headache, deteriorating level of consciousness,
A. Long term use of antibiotics & twitching
B. Wearing synthetic underwater and pantyhose 26. A client with CRF has completed a hemodialysis
C. High- phosphate foods, such as dairy products. treatment. The nurse would use which of the following
D. Foods that make the urine acidic, such as standard indicators to evaluate the clients status after
cranberries dialysis?
19. The client who has a history of gout also is A. Vital sign and weight
diagnosed with Urolithiasis and stones are determined to B. Potassium level and weight
be of uric acid type. The nurse gives the client C. Vital signs and blood urea nitrogen level
instructions in which foods to limit, including: D. Blood Urea Nitrogen and creatinine levels
A. Milk
B. Liver 27. The nurse is reviewing the clients records and notes
C. Apples that the physician has documented that the client has
D. Carrots a renal disorder. On review of the laboratory results,
the nurse most likely would expect to note which of
20. The client arrives at the ER with complaints of low the following?
abdominal pain and hematuria. The client is afebrile. A. Decreased hemoglobin level
The nurse next assesses the client to determine a B. Elevated blood urea nitrogen level
history of: C. Decreased renal blood cell count
A. Pyelonephritis D. Decreased white blood cell count
B. Glomerulonephritis
C. Trauma to the bladder or abdomen
D. Renal cancer in the client’s family 28. Following a renal biopsy, the client complains of
pain at the biopsy site that radiates to the front of the
21. When caring for a client with urinary incontinence, abdomen. The nurse interprets this complaint and further
which content should be reinforced by the nurse? assesses the client for:
 A. Bleeding 35. The nurse is performing assessment on a client who
B. Infection has returned from dialysis unit following hemodialysis.
C. Renal colic The client is complaining of headache and nausea and is
D. Bladder perforation extremely restless. Which of the following is the most
29. A client is admitted to the hospital with a diagnosis appropriate nursing action?
of early state CRF. Which of the following should the A. Monitor the client
nurse expect to note on client assessment? B. Notify the physician
A. Anuria C. Elevate the head of the bed
B. Polyuria D. Medicate the client for nausea
C. Oliguria
D. Polydypsia 36. The nurse is preparing to care for a client receiving
30. A client is admitted for hemodialysis. Which peritoneal dialysis. Which of the following would be
abnormal lab value would the nurse anticipate not being included in the nursing plan of care to prevent the major
improved by hemodialysis? complication associated wit peritoneal dialysis?
A. Low hemoglobin A. Maintain strict aseptic technique
B. Hypernatremia B. Add heparin to the dialysate solution
C. High serum creatinine C. Change the catheter site dressing daily
D. Hyperkalemia D. Monitor the clients level of consciousness
• BPH 37. A Client newly diagnosed with renal failure has just
been started on peritoneal dialysis. During the infusion
of the dialysate, the nurse complains of abdominal pain.
31. The nurse is caring for a client with benign prostatic Which action by the nurse is appropriate?
hypertrophy. Which of the following assessments would A. Stop the dialysis
the nurse anticipate finding? B. Slow the infusion
A. Large volume of urinary output with each C. Decrease the amount to be infused
voiding D. Explain that the pain will subside after the first
B. Involuntary voiding with coughing and sneezing few exchanges.
C. Frequent urination 38. The nurse is monitoring an 88 year old woman at
D. Urine is dark and concentrated risk for developing a urinary tract infection. Which of
the following, if noted, would alert the nurse to the
31. A client with CRF returns to the nursing unit possibility of the presence of urinary tract infection for
following a hemodialysis treatment. On assessment, the this client?
nurse notes that the clients tem is 100.2 F. Which of the A. Fever
following is the appropriate nursing action? B. Urgency
A. Encourage fluids C. Frequency
B. Notify the physician D. Confusion
C. Continue to monitor vital signs E.
D. Monitor the site of the shunt for infection 39. The client returns to the nursing unit following a
pyelolithotomy for removal of kidney stone. A penrose
32. A 6 year-old female is diagnosed with recurrent drain is in place. Which of the following actions would
urinary tract infections (UTI). Which one of the the nurse includes in the clients postoperative plan of
following instructions would be best for the nurse to tell care?
the caregiver? A. Positioning the client on the affected side
A. Increase bladder tone by delaying voiding B. Irrigate the Penrose drain using sterile procedure
B. When laundering clothing, rinse several times C. Changing dressing frequency around the
C. Use plain water for the bath, shampooing hair Penrose drain
last D. Weighing dressing and adding the amount to the
D. Have the child use antibacterial soaps while output
bathing 40. The nurse is caring for a client following kidney
transplantation. The client develops oliguria. Which of
33. A client is admitted with a distended bladder due to the following would the nurse anticipate to be prescribed
the inability to void. The nurse obtains an order to as the treatment of the oliguria?
catheterize the client knowing that gradual emptying is A. Resting fluids
preferred over complete emptying because it: B. Encourage fluid intake
A. Reduces the potential for renal collapse C. Administering of diuretics
B. Reduces the potential for shock D. Irrigation of the Foley catheter
C. Reduces the intensity of bladder spasms
D. Prevents bladder atrophy 41. The nurse is caring for a client with chronic renal
failure on hemodialysis 3 times a week. The client
34. For a 6 year-old child hospitalized with moderate becomes confused and irritable 6 hours before his next
edema and mild hypertension associated with acute treatment. Which of these items might explain the reason
glomerulonephritis (AGN), which one of the following for the client’s behavior?
nursing interventions would be appropriate? A. Elevated blood urea nitrogen (BUN)
A. Institute seizure precautions B. Potassium loss
B. Weigh the child twice per shift C. Calcium depletion
C. Encourage the child to eat protein-rich foods D. Metabolic alkalosis
D. Relieve boredom through physical activity
 following assessment findings would indicate the need
42. The nurse admits a 50 year-old client with a 3 day to notify the physician?
history of fever, flank pain, and elevated blood pressure. A. Red bloody urine
Which of the following data obtained in the admission B. Pain RT bladder spasm
interview alerts the nurse that this may be acute C. Urinary output of 200ml higher than intake
glomerulonephritis? D. BP 100/50mmhg; P 130 beats/min
A. Travel to a foreign country
B. Sore throat 3 weeks ago 49. A client dx with polycystic kidney disease has been
C. Type 1 diabetes since age 15 taught about the tx plan for this disease. The nurse
D. History of mild hypertension determines that the client needs additional teaching if the
client states that the treatment plan includes:
43. While performing a dialysate exchange for a client A. Genetic counseling
on peritoneal dialysis, which finding would alert the B. Sodium restriction
nurse that the client has developed an acute C. Increased water intake
complication? D. Antihypertensive medications
A. Pulse 86 and blood pressure 112/74
B. Respiration rate of 30 with rales (use bibasilar 50. The nurse is documenting the assessment and care of
C. Client sleeps throughout fluid exchange hospitalized client following an uncomplicated
D. Catheter dressing saturated with clear fluid cystoscopy. Which one of the following would be an
unlikely notation post procedure for this client?
44. The RN is doing initial discharge teaching to a 65 A. Voiding pink tinged urine
year-old female client with renal calculi. Which of the B. Assisted to tub room for sitz bath
following should be included as dietary C. Traction applied to Foley catheter
recommendations to prevent recurrence? D. Increasing fluid intake without nausea
A. Consume foods high in vitamin E
B. Reduce dietary calcium
C. Increase sources of vitamin C
D. Increase protein levels

45. An 18 month-old child is on peritoneal dialysis in

preparation for a renal transplant in the near future.
When the nurse obtains the child's health history, the
mother indicates that the child has not had the first
measles, mumps, rubella (MMR) immunization. The
nurse understands that which of the following is true in
regards to giving immunizations to this child?
A. Live vaccines are withheld in children with renal
chronic illness
B. The MMR vaccine should be given now, prior to
the transplant
C. An inactivated form of the vaccine can be given
at any time
D. The risk of vaccine side effects precludes giving
the vaccine

46. During a situation of pain management in patient

with kidney disorder, which statement is a priority to
consider for the ethical guidelines of the nurse?
A. The client's self-report is the most important
consideration
B. Cultural sensitivity is fundamental to pain
management
C. Clients have the right to have their pain relieved
D. Nurses should not prejudge a client's pain using
their own values

47. A week after transplantation, the client develops a

temp of 101 F, the blood pressure is elevated, the kidney
is tender. The x-ray indicates is enlarged. Based on the
assessment findings, the nurse would suspect which of
the following complications?
A. Acute rejection
B. Kidney infection
C. Chronic rejection
D. Kidney obstruction
48. After four hours of transurethral resection surgery of
the prostate because of BPH. The nurse takes the clients
V/S and empties the urinary drainage bag. Which of the