ATI Renal and Urinary System Practice
Questions
1. A nurse is caring for a client who is in the oliguric-anuric stage of acute kidney
injury. The client reports diarrhea, a dull headache, palpitations, and muscle
tingling and weakness. Which of the following actions should the nurse take
first?
A. Administer an analgesic to the client
B. Check the client's electrolyte values
C. Measure the client's weight
D. Restrict the client's protein intake
Correct Answer: B. Check the client's electrolyte values
Rational: The nurse should apply the urgent versus nonurgent priority-setting
framework when caring for the client. Using this framework, the nurse should
consider urgent needs to be the priority because they pose a greater threat to the
client. The nurse might also need to use Maslow's hierarchy of needs, the ABC
priority-setting framework, and/or nursing knowledge to identify which finding is
the most urgent. The nurse should check the client's most recent potassium value
because these findings are manifestations of hyperkalemia, which can lead to
cardiac dysrhythmias.
Incorrect Answers: A. Administering an analgesic for a dull headache is important
to manage the client's pain; however, there is another action that the nurse
should take first.
C. Measuring the client's weight is important to monitor the client's fluid balance;
however, there is another action the nurse should take first.
D. Restricting the client's protein intake is important to manage the client's acute
kidney injury; however, there is another action the nurse should take first.
2. A nurse is assessing a client who has urolithiasis and reports pain in his
thigh. This finding indicates the stone is in which of the following structures?
A. Ureter
B. Bladder
C. Renal pelvis
D. Renal tubules
Correct Answer: A. Ureter
,Rational: When stones are in the ureters, pain radiates to the genitalia and to the
thighs.
Incorrect Answers: B. Stones in the bladder produce manifestations of irritation
that resemble a urinary tract infection. They can also cause pain in the vulva and
scrotal areas.
C. The renal pelvis is part of the kidney. Stones in the kidneys cause pain in the
costovertebral region.
D. The renal tubules are within the nephron, which is part of the kidney. Stones in
the kidneys cause flank pain.
3. A nurse is reviewing the laboratory report of a client who has chronic kidney
disease (CKD). The nurse finds the following laboratory test results: potassium
6.8 mEq/L, calcium 7.4 mg/dL, hemoglobin 10.2 g/dL, and phosphate 4.8
mg/dL. Which finding is the priority for the nurse to report to the provider?
A. Hypocalcemia
B. Hyperkalemia
C. Anemia
D. Hypoalbuminemia
Correct Answer: B. Hyperkalemia
Rational: The nurse should apply the urgent versus nonurgent priority-setting
framework when caring for this client. Using this framework, the nurse should
consider urgent needs the priority need because they pose more of a threat to the
client. The nurse may also need to use Maslow's hierarchy of needs, the ABC
priority-setting framework, and/or nursing knowledge to identify which finding is
the most urgent. Hyperkalemia, which can cause life-threatening cardiac
dysrhythmia, is the priority for the nurse to report to the provider.
Incorrect Answers: A. Hypocalcemia is an expected finding with CKD; therefore,
another finding is the priority for the nurse to report to the provider. The
decreased calcium level would require reporting if the client developed muscle
spasms or twitching.
C. Anemia is an expected finding with CKD; therefore, another finding is the
priority for the nurse to report to the provider.
D. Hyperphosphatemia is an expected finding with CKD; therefore, another finding
is the priority for the nurse to report to the provider.
4. A nurse is assessing a client who is receiving continuous ambulatory
peritoneal dialysis. Which of the following findings should the nurse report
, to the provider?
A. WBC 6,000/mm^3
B. Potassium 3.0 mEq/L
C. Clear, pale yellow drainage
D. Report of abdominal fullness
Correct Answer: B. Potassium 3.0 mEq/L
Rational: A potassium level of 3.0 mEq/L is below the expected reference range
and can cause dysrhythmias. Dialysis removes fluid, waste products, and
electrolytes from the blood and can cause hypokalemia.
Incorrect Answers: A. A WBC count of 6,000/mm^3 is within the expected
reference range.
C. Clear, pale yellow drainage is an expected finding after peritoneal dialysis has
been established.
D. Abdominal fullness is an expected finding during the dwell period, when the
dialysate stays in the peritoneal cavity. A supine low-Fowler's position can reduce
abdominal pressure.
5. A nurse is assessing a client who is receiving peritoneal dialysis. Which of
the following findings should the nurse report to the provider immediately?
A. Difficulty draining the effluent
B. Redness at the access site
C. Fluid flowing from the catheter site
D. Cloudy effluent: Correct Answer: D. Cloudy effluent
Rational: A cloudy or opaque effluent indicates the client is at high risk for
peritonitis, a bacterial infection of the peritoneum. Therefore, this is the priority
finding for the nurse to report to the provider.
Incorrect Answers: A. Difficulty draining the effluent indicates the client is
experiencing clamped tubing, a fibrin clot, or a kinked catheter that is impeding
outflow, which requires further assessment by the nurse. However, another
finding is the priority for the nurse to report.
B. Redness at the access site indicates the client is at risk for local infection, which
can lead to catheter failure and peritonitis. However, another finding is the
priority for the nurse to report.
C. Fluid flowing from the catheter site indicates the client is at risk for dialysate
leakage, which can create a need for hemodialysis support. However, another
finding is the priority for the nurse to report.
Questions
1. A nurse is caring for a client who is in the oliguric-anuric stage of acute kidney
injury. The client reports diarrhea, a dull headache, palpitations, and muscle
tingling and weakness. Which of the following actions should the nurse take
first?
A. Administer an analgesic to the client
B. Check the client's electrolyte values
C. Measure the client's weight
D. Restrict the client's protein intake
Correct Answer: B. Check the client's electrolyte values
Rational: The nurse should apply the urgent versus nonurgent priority-setting
framework when caring for the client. Using this framework, the nurse should
consider urgent needs to be the priority because they pose a greater threat to the
client. The nurse might also need to use Maslow's hierarchy of needs, the ABC
priority-setting framework, and/or nursing knowledge to identify which finding is
the most urgent. The nurse should check the client's most recent potassium value
because these findings are manifestations of hyperkalemia, which can lead to
cardiac dysrhythmias.
Incorrect Answers: A. Administering an analgesic for a dull headache is important
to manage the client's pain; however, there is another action that the nurse
should take first.
C. Measuring the client's weight is important to monitor the client's fluid balance;
however, there is another action the nurse should take first.
D. Restricting the client's protein intake is important to manage the client's acute
kidney injury; however, there is another action the nurse should take first.
2. A nurse is assessing a client who has urolithiasis and reports pain in his
thigh. This finding indicates the stone is in which of the following structures?
A. Ureter
B. Bladder
C. Renal pelvis
D. Renal tubules
Correct Answer: A. Ureter
,Rational: When stones are in the ureters, pain radiates to the genitalia and to the
thighs.
Incorrect Answers: B. Stones in the bladder produce manifestations of irritation
that resemble a urinary tract infection. They can also cause pain in the vulva and
scrotal areas.
C. The renal pelvis is part of the kidney. Stones in the kidneys cause pain in the
costovertebral region.
D. The renal tubules are within the nephron, which is part of the kidney. Stones in
the kidneys cause flank pain.
3. A nurse is reviewing the laboratory report of a client who has chronic kidney
disease (CKD). The nurse finds the following laboratory test results: potassium
6.8 mEq/L, calcium 7.4 mg/dL, hemoglobin 10.2 g/dL, and phosphate 4.8
mg/dL. Which finding is the priority for the nurse to report to the provider?
A. Hypocalcemia
B. Hyperkalemia
C. Anemia
D. Hypoalbuminemia
Correct Answer: B. Hyperkalemia
Rational: The nurse should apply the urgent versus nonurgent priority-setting
framework when caring for this client. Using this framework, the nurse should
consider urgent needs the priority need because they pose more of a threat to the
client. The nurse may also need to use Maslow's hierarchy of needs, the ABC
priority-setting framework, and/or nursing knowledge to identify which finding is
the most urgent. Hyperkalemia, which can cause life-threatening cardiac
dysrhythmia, is the priority for the nurse to report to the provider.
Incorrect Answers: A. Hypocalcemia is an expected finding with CKD; therefore,
another finding is the priority for the nurse to report to the provider. The
decreased calcium level would require reporting if the client developed muscle
spasms or twitching.
C. Anemia is an expected finding with CKD; therefore, another finding is the
priority for the nurse to report to the provider.
D. Hyperphosphatemia is an expected finding with CKD; therefore, another finding
is the priority for the nurse to report to the provider.
4. A nurse is assessing a client who is receiving continuous ambulatory
peritoneal dialysis. Which of the following findings should the nurse report
, to the provider?
A. WBC 6,000/mm^3
B. Potassium 3.0 mEq/L
C. Clear, pale yellow drainage
D. Report of abdominal fullness
Correct Answer: B. Potassium 3.0 mEq/L
Rational: A potassium level of 3.0 mEq/L is below the expected reference range
and can cause dysrhythmias. Dialysis removes fluid, waste products, and
electrolytes from the blood and can cause hypokalemia.
Incorrect Answers: A. A WBC count of 6,000/mm^3 is within the expected
reference range.
C. Clear, pale yellow drainage is an expected finding after peritoneal dialysis has
been established.
D. Abdominal fullness is an expected finding during the dwell period, when the
dialysate stays in the peritoneal cavity. A supine low-Fowler's position can reduce
abdominal pressure.
5. A nurse is assessing a client who is receiving peritoneal dialysis. Which of
the following findings should the nurse report to the provider immediately?
A. Difficulty draining the effluent
B. Redness at the access site
C. Fluid flowing from the catheter site
D. Cloudy effluent: Correct Answer: D. Cloudy effluent
Rational: A cloudy or opaque effluent indicates the client is at high risk for
peritonitis, a bacterial infection of the peritoneum. Therefore, this is the priority
finding for the nurse to report to the provider.
Incorrect Answers: A. Difficulty draining the effluent indicates the client is
experiencing clamped tubing, a fibrin clot, or a kinked catheter that is impeding
outflow, which requires further assessment by the nurse. However, another
finding is the priority for the nurse to report.
B. Redness at the access site indicates the client is at risk for local infection, which
can lead to catheter failure and peritonitis. However, another finding is the
priority for the nurse to report.
C. Fluid flowing from the catheter site indicates the client is at risk for dialysate
leakage, which can create a need for hemodialysis support. However, another
finding is the priority for the nurse to report.
