Urinary and Renal System 1. A client has been on gentamycin sulfate (Garamycin) for about 10 days.

With regard to this medication, what nursing observation would necessitate holding the medication and notifying the physician? a. There is a decrease in the amount of urine with increased concentration b. The client keeps asking the nurse to repeat information c. A decrease in blood pressure with bradycardia d. Increased lethargy and difficulty with coordination 2. An adult male with a history of renal calculi presents to the emergency department with complaints of severe flank pain radiating to his groin area; e is also experiencing nausea and vomiting. His temperature is 99 degrees F. What would the nurse anticipate administering at this time? a. Morphine sulfate 10mg subQ now b. Ibuprofen Advil) 600mg now and q6h c. Aspirin 625mg po now and q4h d. Trimethobenzamide (Tigan) 250mg po now 3. An older adult woman is treated with oxybutynin (Ditropan) for urinary frequency and urgency. The nurse would explain to the client that she will probably experience: a. Increased sensitivity to sunlight b. Dizziness when she stands up c. A dry mouth and increased thirst d. Increased bruising 4. A client with dysuria is taking phenazopyridine (Pyridium). The nurse should teach the client to expect the urine to be: a. Greater in volume b. Orange in color c. Pungent in odor d. Concentrated in consistency

5. A client is receiving nitrifurantin (Furadantin) for treatment of a urinary tract infection. What would be important for the nurse to tell the client? a. Restrict fluid intake due to dysuria b. Increase intake of fluids; urine may turn orange c. Increase intake of fruit juices, especially grapefruit d. Avoid tub baths; take showers instead 6. The nurse would anticipate which medication being prescribed to a client to treat UTI? a. Furosemide (Lasix) b. Metoprolol (Lopressor) c. Nitrofurantoin (Macrodantin) d. Lovastatin (Mevacor) 7. Kidney transplant clients are frequently placed on immunosuppressant drugs. What nursing measure would not be appropriate in caring for these clients?

a. b. c. d.

Keep all irrigation fluids sterile Maintain aseptic technique Give all medications by injection Screen all visitors for infections

8. Which of the following clients would be at the highest risk for developing acute renal failure? a. Client with a history of chronic glomerulonephritis b. Client with post hemorrhage for abruption placentae c. Client post uncomplicated open heart surgery d. Client who has been on aminoglycoside therapy

9. Which of the following explanations of a clean-catch urine for culture and sensitivity for a male client would be most accurate? a. Catch the first 30 ml of your stream in a sterile container for a sample. b. Clean the urinary meatus with an iodine solution and be sure not to touch the sterile container with the penis. c. Clean the shaft of the penis along with the meatus with soap and water and catch the first part of the urinary stream in the sterile container. d. Clean the meatus with an antiseptic, do not touch any part of the penis to the sterile container, void a small amount, and then collect the urine. 10. The nurse must obtain a urine specimen from an infant. What is the best method for the nurse to obtain a clean-catch specimen? a. Give the infant plenty of fluids and watch for the voiding b. Place the infant on a pediatric bedpan c. Perform a straight catherization d. Apply a pediatric urine collector to dry skin 11. The nurse understands that a female child is more susceptible to UTIs than male because she has: a. Less resistance b. A shorter urethra c. A smaller bladder d. Smaller kidneys 12. A school-age child is diagnosed with acute glomerulonephritis. Which nursing action takes priority when caring for this child? a. Checking urine specific gravity every 8 hours b. Monitoring blood pressure every 4 hours c. Offering the child fluids every hour d. Providing the child with a regular diet and snacks 13. A toddler has just returned from surgery for removal of a kidney because of Wilms tumor. A priority nursing action would be to: a. Offer a toddler ice chips when awake b. Administer pain medication when the toddler cries c. Provide games at the toddlers developmental level

d. Take toddlers vital signs 14. A client with fever and urinary urgency has an order for collection of a urine specimen for culture and sensitivity. The nurse should instruct the client to collect the specimen from the: a. First stream of urine b. Middle stream of urine c. Final stream of urine d. The full volume of urine 15. An older adult woman voices concern about the fact that she dribbles urine whenever she coughs or sneezes. The nurse would explain that this is most likely: a. Stress incontinence caused by weakened perineal muscles b. Urge incontinence caused by progressive nervous system damage c. Overflow incontinence caused by a full bladder d. Mixed incontinence, which is a combination of stress and overflow incontinence 16. An older client is admitted to the hospital with dehydration and electrolyte imbalance is confused and incontinent of urine. What would be the best nursing intervention for the incontinence? a. Insert an indwelling catheter b. Place absorbent incontinence pads under the client c. Assist the client to the bathroom every 2 hours d. Restrict fluids after the evening meal 17. The nurse is obtaining an admission history from the parents of a child with acute glomerulonephritis. What would be important for the nurse to determine? a. If the child has had long-term analgesic use b. If the child has had a recent history of hypertension c. If the child has had a history of hypertension d. If the child has had repeated urinary tract infections

18. The nurse is caring for a client post hemodialysis. Which of the following signs are r/t disequilibrium syndrome? a. Lethargy and cramping b. Bradycardia and hyperkalemia c. Headache and nausea d. Leg cramps and hypertension 19. The nurse understands that the most common microorganism causing an uncomplicated urinary tract infection (UTI) in females is : a. Escherichia coli b. Candida albicans c. Proteus vulgaris d. Staphylococcus saprophyticus 20. The nurse would identify which of the following as an early sign of possible cystitis?

a. b. c. d.

Hematuria and dysuria Chills and fever Flank pain and malaise Urgency and dysuria

21. A child with facial and peripheral edema is diagnosed with nephritic syndrome. What would be important for the nurse to include in the plan of care? a. Assessment of weight every other day b. Encourage fluids to balance the bodys need for fluid c. Encourage exercise daily to mobilize the edema d. Maintain skin care to prevent breakdown 22. A child is diagnosed with glomerulonephritis and is admitted to the hospital. What would the nurse expect to find the admitting assessment of the child? a. Temperature above 102 degrees F and bilateral flank pain b. Periorbital edema and an increase in blood pressure c. Dependent pitting edema with weight gain d. Oliguria with strong, concentrated urine 23. The nurse is caring for a client who is going to have a renal angiogram. What is the most important information to obtain from the client before the test? a. Adequacy of voiding b. History of allergies c. Results of hematological and clotting studies d. Current medications 24. A real biopsy is performed on a client. The nurse is assessing the client 4 hours after the biopsy. What assessment data would indicate to the nurse that a complication is occurring? a. Urinary incontinence b. Decreased pulse rate in left foot c. Increased flank pain d. Headache and tachycardia 25. A client undergoing hemodialysis has an arteriovenous gft (AVG) in the left arm. What is the most important to be included in the clients care plan? a. Irrigate with heparin solution to maintain patency b. Take blood pressure readings form the right arm c. Assess the pulse rate distal to the graft site d. Draw all blood for diagnostics from the graft site 26. The nurse is cycling fluids during peritoneal dialysis. The fluid has infused into the abdominal cavity, but it is not effectively draining during the outflow. How can the nurse facilitate the fluid return? a. Turning the client to a prone position b. Manipulating the indwelling catheter c. Elevating the HOB, thereby increasing intraabdominal pressure d. Elevating the foot of the bed to increase abdominal pressure and gravity flow

27. A client with renal failure begins to exhibit some muscle twitching. What additional information is important for the nurse to determine? a. Presence of other neurological changes b. The stats of fluid intake and output c. The presence of circulatory changes d. A significant decrease in hemoglobin level 28. A client has had a kidney stone removed by nephrolithotomy. A nephrostomy tube has been placed in the right kidney. What would be important nursing care for this client? a. Clamp the nephrostomy tube and drain every 2 hours b. Irrigate the nephrostomy tube with 30cc normal saline to maintain patency c. Remove the tube at approximately 1 inch every hour d. Maintain the drainage collection dependent to the clients position 29. A female client is being catheterized. The nurse advances the catheter into an opening 5-6 inches with no urine return. What is the best interpretation of this situation? a. The catheter is too small for urine to flow without pressure b. There must be a defect in the catheter c. The client was catheterized after she had voided d. The catheter is not in the urinary meatus and is probably in the vagina 30. The nurse is assessing a client in acute renal failure. What is an indication the client is progressing into olguric stage? a. Hematuria of 600mL/24hrs b. Increasing urine specific gravity c. Serum K level of 3.5 meq/L d. Urine output of 400ml/24hrs 31. The nurse is caring for a client in acute renal failure. What nursing observations would indicate the development of a complication associated with the problem of fluid volume excess in this client? a. Decreased sensation and tingling in the extremities b. Increased incidence of bleeding gums and epistaxis c. Increasing peripheral edema and moist breath sounds d. Serum K above 4 mEq/L

32. What would the nurse anticipate finding when performing a skin assessment on a chronic renal failure client? a. Warm, moist, pink-colored skin b. Cool, clammy, dusky-colored skin c. Warm-edematous, copper-colored skin d. Bruised, dry, yellow/gray tone to skin 33. A cystoscopy is going to be performed on a client. What is important for the nurse to tell the client? a. A local anesthetic and a sedative will be given; if he is awake during the procedure, he should not experience severe pain b. A sedative will be given, but it is important for him to remain fully awake in order to cooperate with the physician during the procedure

c. A long black tube will be inserted through the wall of the bladder for 15 min to view the bladder and interior d. A three-way foley catheter will be inserted and dye will be injected into the urinary tract through the cystoscope 34. What is the best description of the pain that a client experiences when beginning to pass a renal calculus? a. Intermittent sharp pain that radiates down the left leg b. Intermittent dull but hot pain in the upper thighs c. Dull flank pain that only occurs with voiding d. Sharp pain in the shoulder and chest that radiates 35. Why is it important to monitor red blood cell count in a chronic renal failure client? a. Granulocytopenia could occur, which can cause infection b. Production of erythropoietin will be affected due to renal failure c. Blood cell production could increase due to increased production of rennin d. An increase in waste products could cause thrombocytopenia 36. Which client would be at the highest risk for development of acute renal failure? a. Client with placenta previa with hemorrhage controlled b. Client with cardiac disease and frequent problems of tachycardia c. Hypertensive client who forgets to take his medication d. Older adult client with a 20-year old history of type 2 diabetes 37. The nurse is caring for a client in renal failure. What observations would indicate the renal failure is progressing? a. Lethargy, hypertension, proteinuria b. Hypotension, tachycardia, increased irritability c. Increased urinary concentration, weight loss d. Diarrhea, hypovolemia 38. An infant born with hypospadias. The mother asks the nurse when circumcision should be done. What is the best nursing response? a. There is no problem with circumcision it can be done whenever the parents desire it b. Circumcision will probably be delayed until there can be further diagnostic studies of the problem c. Circumcision is usually delayed until the congenital condition is repaired d. Voiding studies will have to be completed before circumcision can be done 39. A client has an arteriovenous graft (AVG) in his left arm for dialysis. How will the nurse check the patency of the AVG? a. Palpate above the forearm for a rushing sound b. Check the pulse site distal to the graft site c. Palpate the graft site for presence of a thrill d. Check the graft site for warmth and color 40. The nurse is caring for a group of clients in a long-term care facility. What nursing measure will promote incontinence?

a. b. c. d.

Plan schedule to facilitate assisting everyone to the bathroom every 2-3 hours Decrease the amount of PO fluids to increase bladder control Record all clients intake and output to evaluate adequacy of intake Assess for bladder distention in clients who are increasingly restless.

41. At 10am the nurse begins a 24-hr urine collection. What are the guidelines for collection of this specimen? a. Collect a specimen now, add it to the container, and collect all urine until 10am the next day. b. Ask client to void now and discard the specimen, then collect all urine for 24hrs, ask client to void at 10am the next day, and add it to the specimen container c. Collect specimen now and discard it, collect urine for 24hrs, ask client to avoid at 10am the following morning, and discard the specimen d. Ask client to void now and retain the specimen, and collect all urine 24hrs at 2-hr intervals. 42. What finding would be noted on assessment of a client who has an acute lower urinary tract infection (UTI?) a. Gross painless hematuria b. Low back pain c. Polyuria d. Dysuria 43. A female client is diagnosed with recurrent cystitis and is asking for information about self-care. What practice would the nurse discourage? a. Drink as much fluid as possible throughout the day b. Take a shower rather than bathing in a tub c. Refrain from voiding to reduce the concentration of the urine d. Immediately void and wash after intercourse 44. The nurse is caring for a client who has just returned to the room from having hemodialysis. The nurse is advised to evaluate the client for diequilibrium syndrome. What will the nurse assess for in this client in order to identify this complication? a. Increased blood pressure b. Bradycardia with irregular pulse c. Weight gain with decreased serum Na levels d. Confusion and decreased blood pressure 45. What is significant about the development of proteinuria in a client with type 1 diabetes mellitus? a. Renal failure will most likely develop in approximately 10 years b. It indicates that the clients diabetes is uncontrolled c. Serum creatinine levels will diminish as the microalbuminuria increases d. Insulin requirements should be lowered

46. A child is hospitalized with acute clomerulonephritis. He has experienced weight gain, increased blood pressure, and proteinuria. Which of the following are appropriate nursing actions for this child? a. Initiating contact isolation precautions b. Encouraging increased fluid intake c. Encouraging ambulation as tolerated

d. Providing a high-calorie, low-protein diet 47. Which nursing observations indicate that a male client with a kidney stone is experiencing renal colic? a. Severe flank pain and hematuria b. Stress incontinence with a full bladder c. Increased blood pressure with severe burning on urination d. Enuresis with epididymitis 48. What will the nurse identify as the goal of treatment for a client with acute renal failure? a. Increase urine output by increasing liver and renal perfusion b. Prevent loss of electrolytes across the basement membrane c. Increase the concentration of electryolytes in the urine d. Maintain renal function and decrease renal workload 49. A client with chronic renal failure has an arteriovenous fistula (AVF) for hemodialysis on her left forearm. What action will the nurse take to protect this access? a. Irrigate with heparin and normal saline solution every 8 hrs b. Apply warm, moist packs to the area after hemodialysis c. Do not use left arm to take blood pressure readings d. Keep the arm elevated above the level of the heart 50. A client in renal failure is to have a serum blood urea nitrogen (BUN) level determined. What will this diagnostic test measure? a. Concentration of the urine osmolarity and electrolytes b. Serum level of the end products of protein metabolism c. Ability of the kidneys to concentrate urine d. Levels of C-reactive protein to determine inflammation

51. The nurse is performing a urinary catheterization on a male client. How will the nurse hold the penis for insertion of the catheter? a. The penis should be held perpendicular to the clients body b. The nurse should hold the penis parallel with the clients body c. The penis should be held to the side of the clients body d. The nurse should hold the penis flush against the clients abdomen 52. The nurse is performing a urinary catheterization on a female client. What technique will the nurse use to cleanse the labia folds and the area around the urethra? a. With a pair of forceps, cleanse each side of the labia folds with a cotton ball; dispose of it; obtain a second cotton ball and repeat the process b. Using fingers to hold the cotton ball, cleanse each side of the perineal area or labia, moving from the top of the urethra to the anal area. c. Using a pair of forceps, cleanse one side of the labia folds, moving from the anal area toward the urethra d. Using a pair of forceps, cleanse down one side of the labia folds, discard cotton ball, and cleanse down the other side with another sterile cotton ball.

53. The nurse is performing a urinary catheterization on a female client. On the first attempt to insert the catheter, the nurse does not find the urethral opening. What is the best nursing action? a. Have someone bring another sterile catheter and pair of sterile gloves b. Cleanse the end of the catheter with the cleansing solution in the catheter tray c. Take down the entire setup and obtain another catheterization tray d. Remove the catheter and attempt to reinsert it into the urinary orifice. 54. The nurse assesses the postoperative client and determined the clients bladder is distended. A urinary retention catheter is in place. What would be the best nursing action? a. Check for kinking of the catheter b. Remove the catheter c. Irrigate the catheter with a warm solution d. Evaluate the intake and output for the past 8 hours 55. A chronic renal failure client is on hemodialysis. The client has an arteriovenous graft (AVG) in his left forearm. What are the nursing actions to maintain patency of the graft? a. Daily irrigations with a 25-gauge needle and sterile normal saline b. Note on the care plan and on the bed regarding no blood pressure or needle sticks on the left arm c. Frequent assessment of the left arm and compare to the size of the right arm d. Assist client with active exercises to increase muscle tone in the left arm 56. What is the correct method for obtaining a urine specimen for a culture and sensitivity from a clients closed drainage system? a. Discontinue the catheter and allow it to drain into the sterile urine container b. Drain approximately 50ml of urine from the urine collection bag into the sterile container c. Empty the urine collection bag, allow it to fill again, and collect the sample in the sterile container d. Withdraw a sample of urine with a sterile syringe from the entry port of the catheter 57. A client has developed acute renal failure. During the oliguric phase, the plan of care would include which nursing intervention? a. Observe for signs of secondary infection b. Provide a high-protein, low carbohydrate diet c. Encourage progressive ambulation d. Encourage fluids to 2000ml in 24hrs 58. What is an important nursing intervention in the care of a client with a kidney stone? a. Force fluids to 3000ml in 24hrs b. Maintain complete bed rest c. Collect a 24-hr urine specimen d. Insert a urinary retention catheter 59. The nurse instruct the client in measures to prevent kidney stone formation in the future. What response by the client would indicate he understood the teaching plan? a. I will begin a daily 45-min jogging program. b. I will increase my fluid intake.

c. I will call the doctor when nocturia occurs. d. I will increase my supplemental vitamins C and D daily. 60. A client returns to his room after renal surgery, and he has a right nephrostomy tube. What is a priority nursing action? a. Irrigate the tube with 30ml of normal saline four times a day b. Clamp the tube if excess drainage is excessive c. Advance the tube 1 inch every 8 hours d. Ensure that the tube is draining freely 61. The nurse is assigned to care for a client with a kidney stone. Which nursing observations would indicate the client is experiencing renal colic? a. Severe flank pain, radiating toward the testicles b. Stress incontinence with a full bladder c. Hematuria, severe burning on urination d. Enuresis with hyperalbuminuria 62. A client returns from surgery with a urinary retention catheter in place. What nursing care will assist to prevent the development of a urinary tract infection secondary to the catheter? a. Thoroughly cleanse the perineal area with an iodine soap every 4 hours b. Keep the urine collection container at or above the level of the bed. c. Disconnect the catheter and drain it every 4 hours to prevent occlusion d. Maintain a closed drainage system without any obstruction to urine flow. 63. What would be the best nursing action if a sterile urinary catheter has been placed in the vaginal opening in error? a. Use an alcohol wipe and clean the catheter thoroughly before reinserting b. Remove the catheter and obtain a new catheter for insertion c. Place the catheter into a disinfectant solution and use it later d. Discard the catheter kit and try later during the shift to catheterize the client. 64. When providing instructions to geriatric clients about the prevention of UTI, what would the nurse include in the teaching plan? Select all that apply: a. Take all medication ordered, regardless of symptoms b. Increase intake of fluids to 3L daily c. Cleanse the perineal area from back to front d. Increase intake of orange and apple juices e. Empty the bladder regularly (every 2-4 hours) and completely f. Seek early treatment when burning on urination or urgency occur 65. The nurse has removed a urinary retention catheter. Which of the following signs and symptoms would the nurse identify as the development of a possible complication? Select all that apply: a. Increased bladder capacity b. Voiding every hour c. Difficulty urinating d. Feeling of urgency to void e. Increased thirst