Renal -
l. The cli(:nt with u renal culculus bus just returned from an cxtracorporeal shock
wave lithotripsy procedure and the nurse finds an ecchymotic area on the
pafomts' right lower back. What is the nurse's FIRST best action?
A. not i l'y the physician
B. apply ice to the site
C. pince the client in prone position
D. document the observation as the only action
Answer: 13
Rationale- the shock waves can cause bleeding into the tissues through which the
waves pass. Application of ice can reduce the extent and discomfort of the bruising.
2. A client undergoes a nephrcctomy for trauma to the kidney. Which assessment
v,,ould requi re priority in(crvcnlto n by the nurse?
A . blood pressure is 108/58
B. mine output is 20 ml/hr for 2 hours
C. incisional pain level is 8/ 10
D. crackles are beard at both lung bases
Answer: B
Rationale- because the mine output should be at least 0.5 ml/kg/hr, a 40 ml output or
2 hours indicates that the patient may have decreased renal perfusion because of
bleeding, inadequate fluid intake, or obstruction at the suture site. The blood pressure
requires ongoing monitoring but does not indicate perfusion at this time. The patient
should cough and deep breathe, but the crackles do not indicate a need for an
immediate change in therapy. The incisional pain should be addressed, but this is not
potentially life-threatening as decreased renal perfusion. In addition, the nurse can
medicate the patient for pain.
3. The nurse reviewing Jab reports on kidney function identifies a result that
suggests decreased renal function, which is:
A. BUN 25 mg/dL
B. Creatinine 0.6mg/dL
C. BUN 15 mg/dL
D. Creatinine 2.0 mg/dL
Answer: D
Rationale- the normal for BUN is 10 to 20 mg/dL. The normal for creatinine is 0.6 to
1.2 mg/dL. The creatinine is elevated.
, 7
4. a client begins hemodialysis after having had conservative management of
chronic kidney disease. The nurse explains that one dietary regulation that will
be changed when hemodialysis is started is that:
A. dietary sodium and potassium are unrestricted because these levels are nonnalized
by dialysis
B. tmlimited fluids are allowed since retained fluid is removed during dialysis
C. more protein will be allowed because of the removal of urea and creatinine by
dialysis
D. increased calories are needed because glucose is lost during hemodialysis
Answer: C
Rationale- once the patient is started on dialysis and nitrogenous wastes are removed,
more protein in the diet is allowed. Fluids are still restricted to avoid excessive weight
gain and complications such as shortness of breath. Glucose is not lost dming
hemodialysis. Sodium and potassium intake continues to be restricted to avoid the
complications associated with high levels of these electrolytes.
5. a client diagnosed with CKD (chronic kidney disease), is being treated with
conservative management of CKD, the nurse determines teaching has been
effective when the patient states,
A. "I need to take the Epogen to boost my immune system"
B. "l will try to increase my intake of bananas and broccoli
C. "I need to try to decrease my intake of dairy products"
D. "I will increase my fluid intake to flush my kidneys"
Answer: C
Rationale- the patient with CKD who is not receiving dialysis is generally taught to
restrict fluids. The patient would need to measure uri ne output and then add 600 ml
for insensible losses to ca lculate an appropriate oral intake. Erythropoietin is given to
increase red blood cell count and will not offer any benefit for immune function.
Dairy products are restricted because of the high phosphate level. They are also
higher in K. many fruits and vegetables (bananas and broccoli) are high in potassium
and should be restricted in the patient with CKD).
6. A client has a history of urinary URGE incontinence. Which nursing action will
be included in the plan of care?
A. use a bladder scanner to check urine residual after the patient voids
B. increase intake of' caffcinatcd beverages
C. demonstrate the use of the Crede maneuver to the patient
D. behavioral interventions which include bladder training and exercise
Answer: D
, Rationale - checking for residual urine and performing the Crede Maneuver are
intervcntions for overflow incontinence. Caffeinated beverages stimulate and act as
diuretics .
7. Mr. N has undergon e a cystectomy and a Koch pouch procedure for bladder
cancer. During the rehabilitation phase following surgery, the nurse should
include which of the following in her teaching plan?
A . technique for inigating ureteral catheter
B. technique for applying an external pouch
C. care of a suprapubic catheter
D. self catheterization technique
Answer: D
Rationale- postop care for the client with Kock or Indiana pouch is similar to that of
any client with a trinary diversion , except there is no external pouch. The client
performs catheterization using the same principles as for clean, intermittent urinary
self-catheterization.
8. A client is admitted with severe nausea, vomiting, and diarrhea. He is
hypotensive, and is noted to have severe oligmia with a BUN level of 30 and
creatinine level of 1. The nurse should be prepared to:
A. Give furosemide (Lasix) 20mg IV
B. Bolus with 500 cc N S followed by N S at 100 cc/hr
C. Increase oral fluids, at least a liter per shift
D. Start hemodialysis after a temporary access is obtained
Answer- B
Rationale- the client is prerenal secondary to hypovolemia. Iv fluids should be given
to rehydrate the client, urine output should increase, and the BUN and creatinine
levels will normalize . The client wouldn't be able to tolerate oral fluids because of
nausea, vomiting and diarrhea. The client isn't fluid overloaded, and her urine output
wont increase with Lasix. The client wont need dialysis because the oliguria and
increased BUN are due to dehydration
9. a client has been admitted to the hospital for urinary tract infection and
dehydration. The nurse determines that the client has received adequate volume
replacement if the BUN level drops to
A. 3mg/dL
B. 15mg/dl
C. 29mg/dl
D. 35mg/dl
answer- B
l. The cli(:nt with u renal culculus bus just returned from an cxtracorporeal shock
wave lithotripsy procedure and the nurse finds an ecchymotic area on the
pafomts' right lower back. What is the nurse's FIRST best action?
A. not i l'y the physician
B. apply ice to the site
C. pince the client in prone position
D. document the observation as the only action
Answer: 13
Rationale- the shock waves can cause bleeding into the tissues through which the
waves pass. Application of ice can reduce the extent and discomfort of the bruising.
2. A client undergoes a nephrcctomy for trauma to the kidney. Which assessment
v,,ould requi re priority in(crvcnlto n by the nurse?
A . blood pressure is 108/58
B. mine output is 20 ml/hr for 2 hours
C. incisional pain level is 8/ 10
D. crackles are beard at both lung bases
Answer: B
Rationale- because the mine output should be at least 0.5 ml/kg/hr, a 40 ml output or
2 hours indicates that the patient may have decreased renal perfusion because of
bleeding, inadequate fluid intake, or obstruction at the suture site. The blood pressure
requires ongoing monitoring but does not indicate perfusion at this time. The patient
should cough and deep breathe, but the crackles do not indicate a need for an
immediate change in therapy. The incisional pain should be addressed, but this is not
potentially life-threatening as decreased renal perfusion. In addition, the nurse can
medicate the patient for pain.
3. The nurse reviewing Jab reports on kidney function identifies a result that
suggests decreased renal function, which is:
A. BUN 25 mg/dL
B. Creatinine 0.6mg/dL
C. BUN 15 mg/dL
D. Creatinine 2.0 mg/dL
Answer: D
Rationale- the normal for BUN is 10 to 20 mg/dL. The normal for creatinine is 0.6 to
1.2 mg/dL. The creatinine is elevated.
, 7
4. a client begins hemodialysis after having had conservative management of
chronic kidney disease. The nurse explains that one dietary regulation that will
be changed when hemodialysis is started is that:
A. dietary sodium and potassium are unrestricted because these levels are nonnalized
by dialysis
B. tmlimited fluids are allowed since retained fluid is removed during dialysis
C. more protein will be allowed because of the removal of urea and creatinine by
dialysis
D. increased calories are needed because glucose is lost during hemodialysis
Answer: C
Rationale- once the patient is started on dialysis and nitrogenous wastes are removed,
more protein in the diet is allowed. Fluids are still restricted to avoid excessive weight
gain and complications such as shortness of breath. Glucose is not lost dming
hemodialysis. Sodium and potassium intake continues to be restricted to avoid the
complications associated with high levels of these electrolytes.
5. a client diagnosed with CKD (chronic kidney disease), is being treated with
conservative management of CKD, the nurse determines teaching has been
effective when the patient states,
A. "I need to take the Epogen to boost my immune system"
B. "l will try to increase my intake of bananas and broccoli
C. "I need to try to decrease my intake of dairy products"
D. "I will increase my fluid intake to flush my kidneys"
Answer: C
Rationale- the patient with CKD who is not receiving dialysis is generally taught to
restrict fluids. The patient would need to measure uri ne output and then add 600 ml
for insensible losses to ca lculate an appropriate oral intake. Erythropoietin is given to
increase red blood cell count and will not offer any benefit for immune function.
Dairy products are restricted because of the high phosphate level. They are also
higher in K. many fruits and vegetables (bananas and broccoli) are high in potassium
and should be restricted in the patient with CKD).
6. A client has a history of urinary URGE incontinence. Which nursing action will
be included in the plan of care?
A. use a bladder scanner to check urine residual after the patient voids
B. increase intake of' caffcinatcd beverages
C. demonstrate the use of the Crede maneuver to the patient
D. behavioral interventions which include bladder training and exercise
Answer: D
, Rationale - checking for residual urine and performing the Crede Maneuver are
intervcntions for overflow incontinence. Caffeinated beverages stimulate and act as
diuretics .
7. Mr. N has undergon e a cystectomy and a Koch pouch procedure for bladder
cancer. During the rehabilitation phase following surgery, the nurse should
include which of the following in her teaching plan?
A . technique for inigating ureteral catheter
B. technique for applying an external pouch
C. care of a suprapubic catheter
D. self catheterization technique
Answer: D
Rationale- postop care for the client with Kock or Indiana pouch is similar to that of
any client with a trinary diversion , except there is no external pouch. The client
performs catheterization using the same principles as for clean, intermittent urinary
self-catheterization.
8. A client is admitted with severe nausea, vomiting, and diarrhea. He is
hypotensive, and is noted to have severe oligmia with a BUN level of 30 and
creatinine level of 1. The nurse should be prepared to:
A. Give furosemide (Lasix) 20mg IV
B. Bolus with 500 cc N S followed by N S at 100 cc/hr
C. Increase oral fluids, at least a liter per shift
D. Start hemodialysis after a temporary access is obtained
Answer- B
Rationale- the client is prerenal secondary to hypovolemia. Iv fluids should be given
to rehydrate the client, urine output should increase, and the BUN and creatinine
levels will normalize . The client wouldn't be able to tolerate oral fluids because of
nausea, vomiting and diarrhea. The client isn't fluid overloaded, and her urine output
wont increase with Lasix. The client wont need dialysis because the oliguria and
increased BUN are due to dehydration
9. a client has been admitted to the hospital for urinary tract infection and
dehydration. The nurse determines that the client has received adequate volume
replacement if the BUN level drops to
A. 3mg/dL
B. 15mg/dl
C. 29mg/dl
D. 35mg/dl
answer- B
