706. A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L).

The nurse
should plan which actions as a priority? Select all that apply.
1. Place the client on a cardiac monitor.
2. Notify the health care provider (HCP).
3. Put the client on NPO (nothing by mouth) status except for ice chips.
4. Review the client’s medications to determine if any contain or retain potassium.
- Rationale: The normal potassium level is 3.5–5.0 mEq/L (3.5–
5.0 mmol/L). A potassium level of 7.0 is elevated. The client
with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest.

707. A client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The
client is tachycardic, pale, and anxious and the nurse suspects air embolism. What are the priority
nursing actions? Select all that apply.
a) Administer oxygen to the client.
b) Continue dialysis at a slower rate after checking the lines for air.
c) Notify the health care provider (HCP) and Rapid Response Team.
d) Stop dialysis, and turn the client on the left side with head lower than feet.
e) Bolus the client with 500 mL of normal saline to break up the air embolus
Rationale: If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis
immediately, position the client so the air embolus is in the right side of the heart, notify the HCP and
Rapid Response Team, and administer oxygen as needed. Slowing the dialysis treatment or giving an
intravenous bolus will not correct the air embolism or prevent complications

708. A client arrives at the emergency department with complaints of low abdominal pain and
hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which
condition?
a) Pyelonephritis
b) Glomerulonephritis
c) Trauma to the bladder or abdomen
d) Renal cancer in the client’s family
Rationale: Bladder trauma or injury should be considered or suspected in the client with low abdominal
pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever and are
thus not applicable to the client described in this question. Renal cancer would not cause pain
that is felt in the low abdomen; rather, the pain would be in the flank area

709. The nurse discusses plans for future treatment options with a client with symptomatic polycystic
kidney disease. Which treatment should be included in this discussion? Select all the apply
a) Hemodialysis
b) Peritoneal dialysis
c) Kidney transplant
d) Bilateral nephrectomy
e) Intense immunosuppression therapy
Rationale: Polycystic kidney disease is a genetic familial disease in which the kidneys enlarge with cysts
that rupture and scar the kidney, eventually resulting in end-stage renal disease. Treatment options
include hemodialysis or kidney transplant.

710. A client is admitted to the emergency department following a fall from a horse and the health care
provider (HCP) prescribes insertion of a urinary catheter. While preparing for the procedure, the
nurse notes blood at the urinary meatus. The nurse should take which action?
a) Notify the HCP before performing the catheterization.
b) Use a small-sized catheter and an anesthetic gel as a lubricant.
c) Administer parenteral pain medication before inserting the catheter.
d) Clean the meatus with soap and water before opening the catheterization kit.
Rationale: The presence of blood at the urinary meatus may indicate urethral trauma or disruption. The
nurse notifies the HCP, knowing that the client should not be catheterized until the cause of the
bleeding is determined by diagnostic testing
711. The nurse is assessing the patency of a client’s left arm arteriovenous fistula prior to initiating
hemodialysis. Which finding indicates that the fistula is patent?
a) Palpation of a thrill over the fistula
b) Presence of a radial pulse in the left wrist
c) Visualization of enlarged blood vessels at the fistula site
d) Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand
Rationale: The nurse assesses the patency of the fistula by palpating for the presence of a thrill or
auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula

712. A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which
manifestation of the disorder?
a) Hematuria and pyuria
b) Dysuria and proteinuria
c) Hematuria and urgency
d) Dysuria and penile discharge
Rationale: Urethritis in the male client often results from chlamydial infection and is characterized by
dysuria, which is accompanied by a clear to mucopurulent discharge.

713. The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical
examination?
a) Fever, diarrhea, groin pain, and ecchymosis
b) Nausea, painful scrotal edema, and ecchymosis
c) Fever, nausea, vomiting, and painful scrotal edema
d) Diarrhea, groin pain, testicular torsion, and scrotal edema
Rationale: Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are
accompanied by fever, nausea and vomiting, and chills. Epididymitis most often is caused by infection,
although sometimes it can be caused by trauma.

714. A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess
whether the client’s problem is related to bacterial prostatitis, the nurse reviews the results of the
prostate examination for which characteristic of this disorder?
a) Soft and swollen prostate gland
b) Swollen, and boggy prostate gland
c) Tender and edematous prostate gland
d) Tender, indurated prostate gland that is warm to the touch
Rationale: The client with bacterial prostatitis has a swollen and tender prostate gland that is also warm
to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back
pain, and signs of urinary tract infection, which often accompany the disorder

715. The nurse is collecting data from a client. Which symptom described by the client is characteristic
of an early symptom of benign prostatic hyperplasia?
a) Nocturia
b) Scrotal edema
c) Occasional constipation
d) Decreased force in the stream of urine

716. The nurse monitoring a client receiving peritoneal dialysis notes that the client’s outflow is less
than the inflow. Which actions should the nurse take? Select all that apply.
a) Check the level of the drainage bag.
b) Reposition the client to his or her side.
c) Contact the health care provider (HCP).
d) Place the client in good body alignment.
e) Check the peritoneal dialysis system for kinks.
f) Increase the flow rate of the peritoneal dialysis solution.

717. A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse
should assess for which manifestations of this complication?
a) Warmth, redness, and pain in the left hand
b) Ecchymosis and audible bruit over the fistula
 c) Edema and reddish discoloration of the left arm
d) Pallor, diminished pulse, and pain in the left hand

718. The nurse is reviewing a client’s record and notes that the health care provider has documented
that the client has chronic renal disease. On review of the laboratory results, the nurse most likely would
expect to note which finding?
a) Elevated creatinine level
b) Decreased hemoglobin level
c) Decreased red blood cell count
d) Increased number of white blood cells in the urine

719. A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment.
On assessment, the nurse notes that the client’s temperature is 38.5 °C (101.2 °F). Which nursing action
is most appropriate?
a) Encourage fluid intake.
b) Notify the health care provider.
c) Continue to monitor vital signs.
d) Monitor the site of the shunt for infection

720. The nurse is performing an assessment on a client who has returned from the dialysis unit following
hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the
priority nursing action?
a) Monitor the client.
b) Elevate the head of the bed.
c) Assess the fistula site and dressing.
d) Notify the health care provider (HCP).

721. A client with severe back pain and hematuria is found to have hydronephrosis due to urolithiasis.
The nurse anticipates which treatment will be done to relieve the obstruction? Select all that apply.
a) Peritoneal dialysis
b) Analysis of the urinary stone
c) Intravenous opioid analgesics
d) Insertion of a nephrostomy tube
e) Placement of a ureteral stent with ureteroscopy

722. The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the
client that it is important to maintain the prescribed dwell time for the dialysis because of the
risk of which complication?
a) Peritonitis
b) Hyperglycemia
c) Hyperphosphatemia
d) Disequilibrium syndrome

723. A week after kidney transplantation, a client develops a temperature of 101 °F (38.3 °C), the blood
pressure is elevated, and there is tenderness over the transplanted kidney. The serum creatinine is rising
and urine output is decreased. The x-ray indicates that the transplanted kidney is enlarged. Based on
these assessment findings, the nurse anticipates which treatment?
a) Antibiotic therapy
b) Peritoneal dialysis
c) Removal of the transplanted kidney
d) Increased immunosuppression therapy

724. A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a
transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the
client’s vital signs and empties the urinary drainage bag. Which assessment finding indicates the
need to notify the health care provider (HCP)?
a) Red, bloody urine
b) Pain rated as 2 on a 0–10 pain scale
c) Urinary output of 200 mL higher than intake
 d) Blood pressure, 100/50 mm Hg; pulse, 130 beats/minute

725. The client newly diagnosed with chronic kidney disease recently has begun hemodialysis.
Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client
during dialysis for which associated manifestations?
a) Hypertension, tachycardia, and fever
b) Hypotension, bradycardia, and hypothermia
c) Restlessness, irritability, and generalized weakness
d) Headache, deteriorating level of consciousness, and twitching

726. A client who has a cold is seen in the emergency department with an inability to void. Because the
client has a history of benign prostatic hyperplasia, the nurse determines that the client should be
questioned about the use of which medication?
a) Diuretics
b) Antibiotics
c) Antilipemics
d) Decongestants

727. Nitrofurantoin is prescribed for a client with a urinary tract infection. The client contacts the nurse
and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation
about the client’s complaints?
a) The client may have contracted the flu.
b) The client is experiencing anaphylaxis.
c) The client is experiencing expected effects of the medication.
d) The client is experiencing a pulmonary reaction requiring cessation of the medication.

728. The nurse is providing discharge instructions to a client receiving trimethoprim-sulfamethoxazole.

Which instruction should be included in the list?
a) Advise that sunscreen is not needed.
b) Drink 8 to 10 glasses of water per day.
c) If the urine turns dark brown, call the health care provider (HCP) immediately.
d) Decrease the dosage when symptoms are improving to prevent an allergic response.

729. Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse should instruct the client to
report which symptom if it develops during the course of this medication therapy?
a) Nausea
b) Diarrhea
c) Headache
d) Sore throat

730. Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that
the medication is effective based on which observation?
a) Urine is clear amber.
b) Urination is not painful.
c) Urge incontinence is not present.
d) A reddish-orange discoloration of the urine is present.

731. Bethanechol chloride is prescribed for a client with urinary retention. Which disorder would be a
contraindication to the administration of this medication?
a) Gastric atony
b) Urinary strictures
c) Neurogenic atony
d) Gastroesophageal reflux

732. The nurse, who is administering bethanechol chloride, is monitoring for cholinergic overdose
associated with the medication. The nurse should check the client for which sign of overdose?
a) Dry skin
b) Dry mouth
c) Bradycardia
 d) Signs of dehydration

733. Oxybutynin chloride is prescribed for a client with urge incontinence. Which sign would indicate a
possible toxic effect related to this medication?
a) Pallor
b) Drowsiness
c) Bradycardia
d) Restlessness

734. Following kidney transplantation, cyclosporine is prescribed for a client. Which laboratory result
would indicate an adverse effect from the use of this medication?
a) Hemoglobin level of 14.0 g/dL (140 mmol/L)
b) Creatinine level of 0.6 mg/dL (53 mcmol/L)
c) Blood urea nitrogen level of 25 mg/dL (8.8 mmol/L)
d) Fasting blood glucose level of 99 mg/dL (5.5 mmol/L)

735. The nurse is providing dietary instructions to a client who has been prescribed cyclosporine. Which
food item should the nurse instruct the client to exclude from the diet?
a) Red meats
b) Orange juice
c) Grapefruit juice
d) Green, leafy vegetables

736. Tacrolimus is prescribed for a client who underwent a kidney transplant. Which instruction
should the nurse include when teaching the client about this medication?
a) Eat at frequent intervals to avoid hypoglycemia.
b) Take the medication with a full glass of grapefruit juice.
c) Change positions carefully due to risk of orthostatic hypotension.
d) Take the oral medication every 12 hours at the same times every day.

737. The nurse is reviewing the laboratory results for a client receiving tacrolimus. Which laboratory
result would indicate to the nurse that the client is experiencing an adverse effect of the medication?
a) Potassium level of 3.8 mEq/L (3.8 mmol/L)
b) Platelet count of 300,000 mm3 (300 Â 109/L)
c) Fasting blood glucose of 200 mg/dL (11.1 mmol/L)
d) White blood cell count of 6000 mm3 (5 to 10 Â 109/L)

738. The nurse receives a call from a client concerned about eliminating brown-colored urine after
taking nitrofurantoin for a urinary tract infection. The nurse should make which appropriate response?
a) “Continue taking the medication; the brown urine occurs and is not harmful.”
b) “Take magnesium hydroxide with your medication to lighten the urine color.”
c) “Discontinue taking the medication and make an appointment for a urine culture.”
d) “Decrease your medication to half the dose, because your urine is too concentrated.”

739. A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would
indicate a therapeutic effect of the medication?
a) Hematocrit of 33% (0.33)
b) Platelet count of 400,000 mm3 (400 Â 109/L)
c) White blood cell count of 6000 mm3 (6.0 Â 109/L)
d) Blood urea nitrogen level of 15 mg/dL (5.25 mmol/L)

740. A client with a urinary tract infection is receiving ciprofloxacin by the intravenous (IV) route. The
nurse appropriately administers the medication by performing which action?
a) Infusing slowly over 60 minutes
b) Infusing in a light-protective bag
c) Infusing only through a central line
d) Infusing rapidly as a direct IV push medication