RUEL M.

BERSABES OUR LADY OF PERPETUAL HELP REVIEW CENTER

Classified Examination: Care of Clients with Genito-urinary disorders Prepared by: Carlo Paul C. Sana, RN, MANc
Name:_____________________________________ DIRECTION: Choose the letter of the BEST answer by writing the corresponding letter of your choice on the answer sheet provided. STRICTLY NO ERASURES ALLOWED. You may detach the answer sheet (last page of this test material). 1. Which among the following is a sign of bladder irritability following radiation therapy for prostate cancer? A. Dysuria B. Polyuria C. Dribbling D. Hematuria Answer: A. Dysuria, nocturia and urgency are all signs of an irritable bladder after radiation therapy. B. This is not an indication of bladder irritability C. Same as Letter B D. Same as Letter B 2. A client is diagnosed to have bladder cancer. The nurse prior to assessment will be expecting which clinical finding associated with this pathology? A. Suprapubic pain B. Dysuria C. Painless hematuria D. Urinary retention Answer: C. The most common manifestation of bladder cancer is painless hematuria. 3. A client who was subjected for cystoscopy is being assessed by the nurse. Which among the following options indicate development of cystoscopic complication? A. Headache and dizziness B. Chills C. Pink-tinged urine D. Bladder spasms Answer: B. Chills could indicate the onset of acute infection that can progress to septic shock. Dizziness would not be an anticipated symptom after a cystoscopy. Pink-tinged urine and bladder spasms are common after cystoscopy. 4. An ileal conduit: A. Is a non-permanent procedure that can be reversed after some time B. Diverts urine into the colon, where it is expelled through the rectum C. Communicates urine from the ureters to a stoma opening on the abdomen D. Creates an opening in the bladder that allows urine to drain into an external pouch Answer: C. In ileal conduit, the ureters are anastamosed to the ileal segment, and urine is expelled via a stoma opening on the abdomen. The client requires urinary appliance/pouch. 5. This is known to be useful in helping control odor in the urine collecting bag after it has been cleansed. A. Saline solution B. Vinegar C. Ammonia D. Bleach Answer: B. Weak vinegar solution is most effective in controlling odor in the urine collecting bag. 6. A client with ileal conduit verbalized while shedding a tear, This thing in my abdomen is really embarrassing. The appropriate nursing diagnosis for the client will be: A. Anxiety related to urinary diversion B. Knowledge deficit: Urinary diversion care related to insufficient teachings C. Low self-esteem related to feelings of worthlessness D. Disturbed body image related to urinary diversion creation Answer: D. The clients statement indicates disturbance in body image related to the presence of the contraption like urinary pouch. 7. Virgie experiences severe flank pain came in to the hospital for further evaluation, and was diagnosed with renal calculi. Her temperature is 38.4C, rated the pain as 9 out of 10, and is complaining of nausea. Which of the following would be a priority outcome for Virgie? A. Prevention of urinary tract complications B. Alleviation of nausea C. Alleviation of pain D. Maintenance of fluid and electrolyte balance Answer:C. The priority problem of the client with renal calculi is pain. The pain is sever and colicky in nature. 8. Tin-tin has passed out hematuria. The nurse should observe for: A. Loose bowel movement B. Urine ketones C. Symptoms of peritonitis D. Gross blood in the urine Answer: D. Changes in the amount of blood in the urine may indicate progressive increases in kidney damage. A. This is unrelated to hematuria B. This is unrelated to hematuria; it is associated with breakdown of adipose tissue C. Same as letter A 9. A nurse is caring for a client undergoing peritoneal dialysis. Which of the following is least likely expected during the procedure? A. The fluid that drains during the first exchange is pink-tinged B. The dialysate solution is warmed at body temperature C. Urine and blood glucose level monitoring D. Blood transfusion Answer: Blood transfusion is least likely expected in peritoneal dialysis. Blood transfusion is done in hemodialysis to prevent hypovolemia. A, B, and C are expected in peritoneal dialysis 10. A client with ESRD (End-stage-renal-disease) has been scheduled for hemodialysis. She has an AV fistula creation over her left forearm. Which among the following interventions is not correct in caring for this client? A. Promote comfort during hemodialysis B. Do not administer antihypertensives during hemodialysis C. BP taking over the left arm must be avoided D. Monitor urine and blood glucose levels Answer: D. Monitoring of urine and blood glucose levels is not included in the nursing care plan of the client undergoing hemodialysis. This intervention is necessary when the client is having peritoneal dialysis. The peritoneal dialysate contains glucose and may cause hyperglycemia and glycosuria. 11. Marina is scheduled to have kidney ureter bladder radiograph in the morning. What preparation(s) should the nurse expect to carry out before the procedure? A. NPO after midnight

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RUEL M. BERSABES OUR LADY OF PERPETUAL HELP REVIEW CENTER

Classified Examination: Care of Clients with Genito-urinary disorders Prepared by: Carlo Paul C. Sana, RN, MANc
B. Administer diazepam as prescribed C. Laxative and enema as prescribed D. No special preparation Answer: C. KUB requires cleansing of the colon for better visualization of the kidneys, ureters and bladder. An enema is given before the procedure. SITUATION for 12, 13 & 14: A client is experiencing flank pain, and was subjected to have intravenous pyelogram to determine the location of renal calculi. 12. Which of the following preparations should the nurse do before the procedure? A. Increased oral fluid intake must be given B. Instruct the client that she may experience bladder spasms during the procedure C. Assess allergy with sea foods D. Ask when was the clients last bowel movement Answer: C. IVP involves the use of hypaque, an iodinated radiopaque dye. There is a need to check for history allergy to sea foods and iodine to prevent anaphylactic shock. *Prepare EPINEPHRINE at bedside since anaphylactic shock is a potential complication. *Bowel prep *NPO 6 to 8 hours *Written consent *After the procedure: -Increase oral fluid intake to excrete the dye. -Burning sensation on voiding -Observe for signs of delayed allergic reaction (rash, pruritus, Dyspnea) 13. What should the nurse anticipate to include in her plan of care after the procedure? A. Maintain on bed rest B. Increased oral fluid intake must be given C. Assess for hematuria D. Administering a laxative Answer: B. Adequate fluid intake after IVP facilitates excretion of the contrast medium used, from the body. 14. Which among the following drugs is expected to be at bedside during the procedure? A. Epinephrine B. Diazepam C. Narcan D. Paracetamol Answer: A. Epinephrine is expected to be at bedside since anaphylactic shock is a potential complication. Epinephrine relaxes the smooth muscle by stimulating beta2 receptors and alpha and beta receptors in the sympathetic nervous system. 15. The nurse tried asking her client whether he has collected urine specimen since the time urinalysis was ordered. The client responded: I have placed my urine specimen in the vial you gave me, and Ive collected it two hours ago. The nurses appropriate action would be: A. Discard the previously collected specimen, and obtain a new one. B. Quickly send the urine to the laboratory C. Add fresh urine to the previously collected specimen and immediately send it to the laboratory D. Refrigerate the specimen until transport to the laboratory is available Answer: A. Urine specimen should be sent immediately to the laboratory to prevent contamination of the specimen and the environment. Therefore, a urine specimen which has been standing for 2 hours should be discarded. A new specimen should be obtained and sent to the laboratory immediately to have accurate result. 16. Immediately after the renal surgery, the PACU nurse assesses the client. Which among the following finding(s) will prompt the nurse to report immediately to the physician? A. Temperature = 37.5C B. Urine output = 15 ml/hour C. Absence of bowel sounds D. A 2X2 inch area of serousanguinous drainage on the clients flank dressing Answer: B. Urine output of 15 ml per hour indicates oliguria. Oliguria is a manifestation of impaired renal function or internal hemorrhage after renal surgery. This requires emergent management. The physician should be notified immediately. 17. A client with renal stone was noted to be composed of uric acid. The physician ordered a lowpurine, alkaline-ash diet. Which among the following food lists support this type of diet? A. Corn, milk, apples, tomatoes B. Grapes, corn, cereals, liver C. Spinach, eggs, dried peas, gravy D. Salmon, chicken, caviar, asparagus Answer: A. Because high-purine diet contributes to the formation of uric acid crystals, stones are more likely to develop in acidic urine. Foods allowed on an alkaline ash diet include milk, fruits (except plums, cranberries and prunes), and vegetables, especially legumes and green vegetables. Gravy, chicken and, liver are high in purine, and should not be included in the clients diet. 18. A client returns for OPD follow-up check up after 7 days from admission. One home medication given to her was Allopurinol (Zyloprim). Before the followup check up, she was asked to have her blood tested to know whether this drug reached its therapeutic effect. Which of the following supports this data? A. Decreased urinary alkaline phosphatase level B. Decreased serum calcium level C. Increased serum calcium level D. Decreased serum uric acid level Answer: D. Allopurinol inhibits the enzyme (xanthine oxidase) responsible for uric acid formation. This medication is indicated to decrease BUA levels 19. This is the most common initial manifestation of acute renal failure: A. Dysuria B. Anuria C. Hematuria D. Oliguria Answer: D. Oliguria is a common initial manifestation of impaired renal function like in renal failure. 20. A client with acute renal failure is experiencing an continuous elevation of serum potassium. The nurse anticipates this emergency situation to occur: A. Cardiac arrest B. Pulmonary edema C. Circulatory collapse D. Cerebrovascular accident Answer: A. Hyperkalemia may lead to dysrhythmias and cardiac arrest. 21. A client diagnosed with acute renal failure is experiencing oliguria. The nurse will be expecting which among the following complications? A. Pulmonary edema B. Metabolic alkalosis C. Hypotension

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RUEL M. BERSABES OUR LADY OF PERPETUAL HELP REVIEW CENTER

Classified Examination: Care of Clients with Genito-urinary disorders Prepared by: Carlo Paul C. Sana, RN, MANc
D. Hypokalemia Answer: A. In the oliguric phase of acute renal failure, there is excessive water retention in the body. The client develops edema, including pulmonary edema. 22. Manuel had his first hemodialysis therapy, and developed nausea, headache, and confusion. The nurse knows that Manuel may have developed which complication? A. Infection B. Disequilibrium syndrome C. Air embolism D. Sepsis Answer: B. Disequilibrium syndrome is common during initial hemodialysis. This results from more rapid removal of waste products from the blood rather than from the brain, due to the presence of blood-brain barrier. Higher concentration of waste products in the brain attracts more fluids. Cerebral edema occurs, causing increased ICP. To prevent disequilibrium syndrome, initial hemodialysis should only be done for 30 minutes only, then the duration of the procedure will be gradually increased. 23. Which of the following serum levels wont be improved by dialysis therapy? A. Elevated serum creatinine B. Hyperkalemia C. Decreased hemoglobin D. Hypernatremia Answer: C. Dialysis could not improve hemoglobin levels. The procedure is effective in removing metabolites like urea and creatinine, edema, fluids and excess electrolytes from the blood. 24. Dora came in to the hospital and is in moderate distress. Probable diagnosis was acute cystitis. Which of the following is an initial response to this disease, and is an expected finding of the nurse? A. High grade fever B. Frequency and burning sensation on urination C. Flank pain and nausea D. Hematuria Answer: B. Cystitis, which is inflammation and infection of the bladder, is characterized by burning on urination. 25. A client with acute cystitis was prescribed with an antibiotic. She is on her fourth day of therapy, and she no longer feels the signs and symptoms she had prior to consultation. She told the nurse, I dont need the antibiotics anymore, I feel good now. The nurses best response would be: A. It is alright to discontinue your antibiotics, now that youre feeling good. B. You should continue your antibiotic therapy until the 7th day to prevent bacterial resistance C. I will tell your doctor about your concern. D. Its about time, that Im going to tell you, that today is your last day of antibiotic therapy. Answer: B. Antibiotics therapy should not be disrupted for a week to prevent bacterial resistance. 26. A client with cystitis is prescribed with phenazopyridine hydrochloride (Pyridium). This drugs action is: A. It releases formaldehyde and provides bacteriostatic action B. It potentiates the action of the antibiotic therapy C. Provides an analgesic effect on the bladder mucosa D. Prevents crystallization that may occur with sulfa drugs Answer: C. Pyridium is a urinary tract analgesic. It normally causes red-orange discoloration of the urine 27. After conducting a health teaching to a client who improved from UTI, the nurse assesses for information retention. Which among the following statements indicate that the client needs further instructions before discharge? A. I may hold my urine for 8 to 10 hours B. I should empty my bladder every after exual intercourse C. I should wipe from front to back every after urinating D. I should increase my fluid intake Answer: A. One should empty the bladder every 2 to 3 hours. Urinary stasis in the bladder enhances proliferation of microorganisms 28. A client with chronic kidney disease experiences Dyspnea. The nurse assessed his lung fields and crackles were auscultated on both lung bases. His BP increased from 120/80 mmHg to 170/100 mmHg. His gained in weight with 2 lbs. Which is the most appropriate nursing diagnosis for this clinical situation? A. Excess fluid volume related to the kidneys inability to maintain fluid balance B. Increased cardiac output related to fluid overload C. Ineffective tissue perfusion related to interrupted arterial blood flow D. Ineffective therapeutic regimen management related to lack of knowledge about therapy Answer: A. The assessment findings indicate fluid overload due to inability of the kidneys to excrete fluids through formation of urine. 29. A client with chronic kidney disease is experiencing nausea. The nurse knows that this may be caused by: A. Metabolic acidosis caused by drug therapy B. Buildup of waste product in the blood C. Chronic anemia and fatigue D. Excess fluid overload Answer: The accumulation of waste products in the blood affects the brain, specifically the vomiting center is triggered. 30. The nurse knows that the dialysis solution is warmed before it is used in peritoneal dialysis primarily because: A. It promotes the elimination of serum urea B. Forces potassium back into the cells C. Prevents hypothermia D. Promotes abdominal muscle relaxation Answer: A. Warm temperature of the solution increases capillary permeability, thereby enhancing removal of waste products from the blood like urea, and creatinine. 31. During peritoneal dialysis, the nurse noticed that the flow of dialysate has stopped even if it hasnt drained out yet. What is the initial action of the nurse? A. Turn the client from side to side B. Reposition the peritoneal catheter C. Immediately notify the physician D. Document the incident Answer: B. If the drainage stops, turn the client to sides. The lumen of the catheter may be occluded by a loop of colon. 32. The nurse knows that the most potential and dangerous complication of peritoneal dialysis is:

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RUEL M. BERSABES OUR LADY OF PERPETUAL HELP REVIEW CENTER

Classified Examination: Care of Clients with Genito-urinary disorders Prepared by: Carlo Paul C. Sana, RN, MANc
A. Abdominal pain B. Gastrointestinal bleeding C. Peritonitis D. Muscle cramps Answer: C. Peritonitis is the most potentially dangerous complication of peritoneal dialysis. This may be due to administration of contaminated dialysate solution or break in aseptic technique when performing the procedure. 33. A nurse is assessing for a client with kidney failure. Which among the following is an expected finding? A. Noticeable breaks of blood vessels in the face B. Peri-orbital edema C. Rashes on cheek and neck D. Facial twitching Answer: Periorbital edema is a sign of fluid retention. Because the patient with renal impairment has generalized edema, this facial feature is extremely significant in assessing edema 34. The physician has ordered a urinalysis and a serum osmolality (concentration) determination. The nurse assesses that the kidneys are functioning appropriately if: A. High serum osmolality and low urine osmolality B. Low serum osmolality and high serum osmolality C. High serum osmolality and high urine osmolality, vice versa. D. Findings are incidental and unremarkable Answer: C. If the blood osmolality is high, the kidneys need to dilute the blood and excrete more concentrated urine, and the reverse is true. This helps determine the test takers understanding of the function of the kidneys. 35. A nurse who does frequent catheterization to her client is aware that this is a potential for: A. Introducing microbes to the urinary system B. Frequent genital exposure of the client C. Indwelling catheter D. Causing urethral erosion Answer: A. The frequency of introducing a catheter into the bladder offers a very real risk of infection. Because there is no indwelling catheter, there is no erosion of the urethra. Excessive genital exposure of the patient is inappropriate. 36. The patient who has cystitis has been told to drink at least 30 mL for each kilogram of body weight. Her weight is 154 pounds. The nurse instructs the patient to drink: A. 2000 ml B. 2100 ml C. 2700 ml D. 3500 ml Answer: B. 154 pounds divided by 2.2 pounds/kg = 70 kg. 70 kg 30 mL = 2100 Ml 37. The nurse cautions a client taking Phenazopyridine (Pyridium) that it may cause: A. Dizziness B. Nausea C. Cloth staining D. Skin rashes in C. Recovery D. End-stage Answer: D. End-stage is under chronic renal failure. Acute renal failure: -Oliguric phase: decreased urine output, increased BUN, increased creatinine, edema, hypertension, hyperkalemia, hypermagnesemia, hyperphosphatemia, hyponatremia, and metabolic acidosis. This stage lasts for 1 to 3 weeks -Diuretic phase: This signifies that kidneys are starting to regain their functions. There is increased urine output (3 to 5 Liters per day), with excessive loss of potassium (hypokalemia). This stage lasts for 1 week. -Recovery phase: It takes 3-12 months for the kidneys to recover. During this time, the client should avoid nephrotoxic drugs. 39. The nurse includes in the discharge teaching of a patient who has had a lithotripsy that the patient should: A. Monitor for presence of edema B. Check for the presence of stone debris in the urine in 1 to 4 weeks C. Decrease fluid intake to 800 ml / day D. Be on complete bed rest for 5 days to 1 week Answer: B. The stones that have shattered with the sound waves will show up as debris in 1 to 4 weeks. Fluid intake is encouraged and activity is resumed the next day. Edema is not a concern. 40. The patient on dialysis asks why he is receiving aluminum hydroxide gel (Amphojel) for his renal disorder. The nurse explains that Amphojel will: A. Calm the frequent upset stomach experienced by dialysis patients B. Bind with phosphorus to increase the serum calcium level C. Increases the appetite D. Corrects the pH of the bowel Answer: B. Amphojel binds phosphorus, which increases the serum calcium level. This is used to relieve hyperphosphatemia. 41. The nurse becomes alarmed when the dialysis patient who is taking gentamicin (Garamycin) says: A. My head is pounding! B. Hey, make your voice louder. I cant hear you! C. I feel weak because of this continuous LBM Im into. D. Give me a glass of water. Im very thirsty. Answer: B. Gentamicin is an aminoglycoside which inhibits protein synthesis by binding directly to the 30S ribosomal subunit; bactericidal. This is ototoxic. 42. Erythropoietin is a hormone produced by the kidney. When the patient is in chronic renal failure, loss of this hormone will result in: A. Immunosuppression B. Atherosclerosis C. Anemia D. Hypertension Answer: C. The test taker needs to correlate knowledge of the physiology of the kidney to the care of someone in chronic kidney failure. 43. Anton has an acute kidney failure. During your shift, he developed confusion and irritability. You know that this may be caused by: A. Hyperkalemia B. Hypernatremia C. Elevated BUN D. Limited fluid intake

Answer: C. Pyridium causes the urine to be a bright orange color, which can stain clothing 38. Stages of acute following, except: A. Oliguria B. Diuresis renal failure include the

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RUEL M. BERSABES OUR LADY OF PERPETUAL HELP REVIEW CENTER

Classified Examination: Care of Clients with Genito-urinary disorders Prepared by: Carlo Paul C. Sana, RN, MANc
Answer: C. An elevated blood urea nitrogen, indicating uremia, is toxic to the central nervous system and causes mental cloudiness, confusion, and loss of consciousness. A. Hyperkalemia is associated with muscle weakness, irritability, nausea, and diarrhea B. Hypernatremia is associated woth firm tissue turgor, oliguria, and agitation D. Dehydration can cause fatigue, dry skin, and mucous membranes, along with rapid pulse and respiratory distress. 44. The nurse knows that the purpose of peritoneal dialysis is to: A. Reestablish normal kidney functioning B. Clean the peritoneum C. Provide fluid for intracellular spaces D. Eliminate toxins and metabolic wastes Answer: D. Peritoneal dialysis uses the peritoneum as a selectively permeable membrane for diffusion of toxins and wastes from the blood into the dialysate A. Peritoneal dialysis acts as a substitute for kidney function; it does not reestablish kidney function B. The dialysate does not clean the peritoneal membrane; the semipermeable membrane allows toxins and wastes to pass into the dialysate within the abdominal cavity C. Fluid in the abdominal cavity does not enter the intracellular compartment 45. A client is with urinary calculus which is composed of uric acid after reviewing the pathology result. The nurse must instruct the client to avoid: A. Milk B. Cheese C. Red meats D. Organ meats Answer: D. Uric acid stones are controlled by a lowpurine diet. Foods high in purine, such as organ meats and extracts should be avoided. A. Milk should be avoided with calcium stones, not uric acid stones. B. Chees should be avoided with cystine stones, not uric acid stones C. Only organ meats must be avoided 46. A client suspected with urolithiasis must be instructed to: A. Decrease fluid intake B. Strain urine C. Supplement diet with calcium D. Urinate every 6 to 8 hours Answer: B. Patient with urolithiasis (urinary stones) should be encouraged to strain all urine. To observe if a stone had been passed. The stone passed needs to be submitted to the laboratory for analysis. Management of urolithiasis depends on the type of stone. 47. A client who just had kidney transplantation is expected to receive: A. Imuran (Azathioprine) B. Garamycin (Gentamycin SO4) C. Tagamet (Cimetidine) D. Vasotec (Enalapril) Answer: A. After kidney transplantation, the client will receive immunosuppressant to prevent Graftversus-host disease (GVHD or rejection reaction). The different commonly used immunosuppressants are as follows: Imuran (Azathiopine), Sandimmune (Cyclosporin), ProGraf (Tacrolimus) and Prednisone 48. Which of the following indicates peritoneal infection? A. Cloudy dialysate fluid B. Edema C. Poor drainage of dialysate D. Redness at the catheter insertion site Answer: A. Cloudy dialysate fluid indicates peritonitis. Notify the physician. Prepare to collect specimen for culture. 49. In caring for a client with cystoclysis or continuous bladder irrigation, the nurse should: A. Monitor specific gravity of urine B. Record urinary output hourly C. Subtract irrigant from output to determine urine volume D. Include irrigating solution in any 24 hour urine tests ordered Answer: C. The total amount of irrigation solution instilled into the bladder is eliminated with urineand therefore must be subtracted from the total output to determine the volume of urine excreted. A. An accurate specific gravity cannot be obtained when irrigating solutions are being instilled into the bladder. B. Hourly outputs are indicated only if there is concern about renal failure or oliguria. D. 24-hour urine tests would not be accurate if the client were receiving continuous irrigations. 50. A client with kidney failure experiences tingling of the fingers and toes. Muscular twitching is also noted. The nurse knows that this is caused by: A. Acidosis B. Calcium depletion C. Potassium retention D. Sodium chloride depletion Answer: B. In kidney failure, as the glomerular filtration rate decreases, phosphorus is retained. As hyperphosphatemia occurs, calcium is excreted. Calcium depletion causes tetany. A. The symptoms describes are not characteristics of this condition C. Same as letter A D. Same as letter A 51. As a nurse, you understand that in the absence of any respiratory abnormalities, the clients respiratory center is stimulated by: A. Oxygen B. Lactic acid C. Calcium ions D. Carbon dioxide Answer: D. The respiratory center in the medulla responds primarily to increased carbon dioxide concentration in the blood. A. Oxygen is not the primary stimulus to breathing; it functions as a primary stimulus in individuals who have chronic hypercapnia. 52. This refers to the movement of gases in and out of the lungs A. Ventilation B. Diffusion C. Perfusion D. Respiration Answer: A. This involves inhalation and exhalation. B. Diffusion is the exchange of gases from an area of higher pressure to an area of lower pressure. C. Perfusion is the availability of movement of blood for transport of gases, nutrients, and metabolic waste products. D. Respiration is the process of gaseous exchange between the individual and the environment. 53.

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RUEL M. BERSABES OUR LADY OF PERPETUAL HELP REVIEW CENTER

Classified Examination: Care of Clients with Genito-urinary disorders Prepared by: Carlo Paul C. Sana, RN, MANc

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