661 EXAM 3 REVIEW QUESTIONS AND
ANSWERS WITH SOLUTIONS 2024
The patient with chronic renal failure who is scheduled for hemodialysis this morning is scheduled to
receive a daily dose of enalapril. The nurse plans to administer this medication:
A. During dialysis
B. Just before dialysis
C. The day after dialysis
D. Upon return from dialysis - ANSWER D. Upon return from dialysis
Antihypertensive medications, such as enalapril, are administered to the patient following hemodialysis.
This prevents the patient from becoming hypotensive during dialysis and also having the medication
removed from the bloodstream by dialysis. There is no rationale for waiting a full day to resume this
medication, and could lead to ineffective control of the blood pressure.
A patient with a history of heart failure who is undergoing peritoneal dialysis has developed crackles in
the lower lung fields. The nurse interprets this finding is most likely related to:
A. Natural progression of renal failure
B. Compliance with dietary sodium restriction
C. Intake greater than output on the dialysis record
D. Adherence to digoxin therapy schedule - ANSWER C. Intake greater than output on the dialysis record
,Crackles in the lung fields of the peritoneal dialysis patient result from overhydration or from insufficient
fluid removal during dialysis. An intake that is greater than the output of peritoneal dialysis would
overhydrate the patient, resulting in lung crackles. Adherence to medication and diet therapy should
control this sign, not exacerbate it. If dialysis is effective, there is no connection between the progression
of renal failure.
Which assessment data reported by a 28-year-old client (assigned female at birth) is consistent with a
lower urinary tract infection (UTI)?
A. Poor urine output
B. Bilateral flank pain
C. Nausea and vomiting
D. Burning on urination - ANSWER D. Burning on urination
Pain with urination is a common symptom of a lower UTI. Urine output does not decrease, but frequency
may be experienced. Flank pain and nausea are associated with an upper UTI.
Nursing staff on a hospital unit are reviewing rates of hospital-acquired infections (HAI) of the urinary
tract. Which nursing action will be most helpful in decreasing the risk for HAI in clients admitted to the
hospital?
A. Encouraging adequate oral fluid intake
B. Testing urine with a dipstick daily for nitrites
C. Avoiding unnecessary urinary catheterizations
D. Providing frequent perineal hygiene to patients - ANSWER C. Avoiding unnecessary urinary
catheterizations
,Because catheterization bypasses many of the protective mechanisms that prevent urinary tract
infection (UTI), avoidance of catheterization is the most effective means of reducing HAI. The other
actions will also be helpful, but are not as useful as decreasing urinary catheter use.
The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform
the physician that the client may be exhibiting signs of acute kidney injury (AKI)?
A. The client's average urine output has been 10 mL/hr for several hours.
B. The client reports an inability to initiate voiding.
C. The client's urine is cloudy with a foul odor.
D. The client reports abdominal/flank pain. - ANSWER A. The client's average urine output has been 10
mL/hr for several hours.
Oliguria is the most common clinical situation seen in AKI. Flank pain and inability to initiate voiding are
not characteristic of AKI. Cloudy, foul-smelling urine is suggestive of a urinary tract infection.
A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should
the nurse include in the client's post procedure care?
A. Strain the client's urine following the procedure.
B. Administer a bolus of 500 mL normal saline following the procedure.
C. Monitor the client for fluid overload following the procedure.
D. Insert a urinary catheter for 24 to 48 hours after the procedure. - ANSWER A. Strain the client's urine
following the procedure.
, Which finding by the nurse will be most helpful in determining whether a 67-year-old client with benign
prostatic hyperplasia (BPH) has an upper urinary tract infection (UTI)?
A. Bladder distention
B. Foul-smelling urine
C. Suprapubic discomfort
D. Costovertebral tenderness - ANSWER D. Costovertebral tenderness
Costovertebral tenderness is characteristic of pyelonephritis. Bladder distention, foul-smelling urine, and
suprapubic discomfort are characteristic of lower UTI and are likely to be present if the patient also has
an upper UTI.
A patient with acute renal failure is ordered to be on a fluid restriction of 1500 mL per day. The nurse
best plans to assist the patient with maintaining the restriction by:
A. Removing the water pitcher from the bedside
B. Using mouthwash with alcohol for mouth care
C. Prohibiting beverages with sugar to minimize thirst
D. Asking the client to calculate the IV fluids into the total daily allotment - ANSWER A. Removing the
water pitcher from the bedside
The nurse can help the patient to maintain fluid restriction through a variety of means. One way is to
provide frequent mouth care; however, alcohol-based products should be avoided because they are
drying to mucous membranes. The use of ice chips and lip ointments is another intervention that may be
helpful. Beverages that the patient enjoys are provided and not restricted based on sugar content. The
ANSWERS WITH SOLUTIONS 2024
The patient with chronic renal failure who is scheduled for hemodialysis this morning is scheduled to
receive a daily dose of enalapril. The nurse plans to administer this medication:
A. During dialysis
B. Just before dialysis
C. The day after dialysis
D. Upon return from dialysis - ANSWER D. Upon return from dialysis
Antihypertensive medications, such as enalapril, are administered to the patient following hemodialysis.
This prevents the patient from becoming hypotensive during dialysis and also having the medication
removed from the bloodstream by dialysis. There is no rationale for waiting a full day to resume this
medication, and could lead to ineffective control of the blood pressure.
A patient with a history of heart failure who is undergoing peritoneal dialysis has developed crackles in
the lower lung fields. The nurse interprets this finding is most likely related to:
A. Natural progression of renal failure
B. Compliance with dietary sodium restriction
C. Intake greater than output on the dialysis record
D. Adherence to digoxin therapy schedule - ANSWER C. Intake greater than output on the dialysis record
,Crackles in the lung fields of the peritoneal dialysis patient result from overhydration or from insufficient
fluid removal during dialysis. An intake that is greater than the output of peritoneal dialysis would
overhydrate the patient, resulting in lung crackles. Adherence to medication and diet therapy should
control this sign, not exacerbate it. If dialysis is effective, there is no connection between the progression
of renal failure.
Which assessment data reported by a 28-year-old client (assigned female at birth) is consistent with a
lower urinary tract infection (UTI)?
A. Poor urine output
B. Bilateral flank pain
C. Nausea and vomiting
D. Burning on urination - ANSWER D. Burning on urination
Pain with urination is a common symptom of a lower UTI. Urine output does not decrease, but frequency
may be experienced. Flank pain and nausea are associated with an upper UTI.
Nursing staff on a hospital unit are reviewing rates of hospital-acquired infections (HAI) of the urinary
tract. Which nursing action will be most helpful in decreasing the risk for HAI in clients admitted to the
hospital?
A. Encouraging adequate oral fluid intake
B. Testing urine with a dipstick daily for nitrites
C. Avoiding unnecessary urinary catheterizations
D. Providing frequent perineal hygiene to patients - ANSWER C. Avoiding unnecessary urinary
catheterizations
,Because catheterization bypasses many of the protective mechanisms that prevent urinary tract
infection (UTI), avoidance of catheterization is the most effective means of reducing HAI. The other
actions will also be helpful, but are not as useful as decreasing urinary catheter use.
The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform
the physician that the client may be exhibiting signs of acute kidney injury (AKI)?
A. The client's average urine output has been 10 mL/hr for several hours.
B. The client reports an inability to initiate voiding.
C. The client's urine is cloudy with a foul odor.
D. The client reports abdominal/flank pain. - ANSWER A. The client's average urine output has been 10
mL/hr for several hours.
Oliguria is the most common clinical situation seen in AKI. Flank pain and inability to initiate voiding are
not characteristic of AKI. Cloudy, foul-smelling urine is suggestive of a urinary tract infection.
A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should
the nurse include in the client's post procedure care?
A. Strain the client's urine following the procedure.
B. Administer a bolus of 500 mL normal saline following the procedure.
C. Monitor the client for fluid overload following the procedure.
D. Insert a urinary catheter for 24 to 48 hours after the procedure. - ANSWER A. Strain the client's urine
following the procedure.
, Which finding by the nurse will be most helpful in determining whether a 67-year-old client with benign
prostatic hyperplasia (BPH) has an upper urinary tract infection (UTI)?
A. Bladder distention
B. Foul-smelling urine
C. Suprapubic discomfort
D. Costovertebral tenderness - ANSWER D. Costovertebral tenderness
Costovertebral tenderness is characteristic of pyelonephritis. Bladder distention, foul-smelling urine, and
suprapubic discomfort are characteristic of lower UTI and are likely to be present if the patient also has
an upper UTI.
A patient with acute renal failure is ordered to be on a fluid restriction of 1500 mL per day. The nurse
best plans to assist the patient with maintaining the restriction by:
A. Removing the water pitcher from the bedside
B. Using mouthwash with alcohol for mouth care
C. Prohibiting beverages with sugar to minimize thirst
D. Asking the client to calculate the IV fluids into the total daily allotment - ANSWER A. Removing the
water pitcher from the bedside
The nurse can help the patient to maintain fluid restriction through a variety of means. One way is to
provide frequent mouth care; however, alcohol-based products should be avoided because they are
drying to mucous membranes. The use of ice chips and lip ointments is another intervention that may be
helpful. Beverages that the patient enjoys are provided and not restricted based on sugar content. The
