GENITO URINARY SYSTEM Name_____________________________________ 1. The physician orders hourly urine measurement for postoperative client.

The nurse records the following amounts for 2 consecutive hours: 8 1m., 50 ml; 9am., 60 ml. Based on these amounts, which action should the nurse take? A. Continue to monitor and record the clients hourly urine output. B. Notify the physician C. Irrigate the indwelling urinary catheter. D. Increase the I.V. fluid infusion rate 2. The nurse is recording a client’s complaint of painful urination. When documenting this symptoms, the nurse should use which of the following terms? A. Oliguria B. Anuria C. Pyuria D. Dysuria 3. A client with chronic renal failure is admitted to the hospital. The physician orders arterial blood gases to be drawn. Which of the following should the nurse expect? A. Metabolic Alkalosis B. Metabolic acidosis C. Respiratory alkalosis D. Respiratory acidosis 4. After the nurse has completed the preoperative teaching for client who’s having surgery for an ileal conduit, the client asks the nurse when the ileal conduit can be reversed. The nurse would base an answer on the knowledge that: A. 3months after the bowel has had time to heal, it may be re anastomosed. B. The reversal can be done 3 weeks after antibiotics take effect. C. This procedure is permanent. D. Most surgical procedure's are reversible 5. The nurse is assigned to care for a new pediatric admission, a 5 year old child with nephrotic syndrome. Which of the following nursing diagnoses should be added to the child's care plan? A. Imbalanced nutrition: More than body requirements related to weight gain. B. Activity intolerance related to increased use of sedatives C. Disturbed body image related to loss of hair D. Excess fluid volume related to glomerular damage 6. A client in acute renal failure is admitted to the nephrology unit. The period of oliguria in clients with this condition usually lasts about 10 days. Which of the following assessments of kidney function would the nurse make during the oliguric phase A. No urine output because the kidneys would be in a state of suppression B. Urine output of 30 to 60 ml/hr C. Urine output of less than 400 to 600 ml in 24hours D. Urine output that would be directly related to the amount of I.V. fluids infused

7. While providing client teaching, the nurse recognizes that the client on peritoneal dialysis has an understanding of peritonitis when states: A. I’ll call you immediately if I notice that my dialysate outflow is cloudy. B. It’s normal for my dialysate to be bloody. C. Abdominal pain will occur when I perform my daily dialysis fluid exchanges D. I have no control over catheter connection site contamination during a dialysis fluid exchange. 8. The client with acute renal failure has a serum potassium level of 6.0 mEq/L. The nurses would plan which of the following as a priority action? A. Check the sodium level B. Place the client on a cardiac monitor C. Encourage increased vegetables in the client D. Allow an extra 500ml of fluid intake to dilute the electrolyte concentration. 9. The client with Chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to adminester this medication: A. During dialysis B. Just before dialysis C. The day after dialysis D. On the return from dialysis 10. The client with chronic renal failure has an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter dressing while bathing. The nurse should immediately: A. Change the dressing B. Reinforce the dressing C. Flush the peritoneal dialysis catheter D. Scrub the catheter with providone iodine 11. The nurse has completed client teaching wit the hemodialysis client about self monitoring between hemodialysis treatments. The nurse determines that the client best understands the information if the client states to record daily the: A. Amount of activity B. Pulse and respiratory rate C. Intake and output and weight D. Blood urea nitrogen and creatinine levels 12. The client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. The priority nursing action would be to A. Check the shunt for the presence of bruit and thrill B. Observe the site once as time permits during the shift C. Check the results of the prothrombin time as they are determined. D. Ensure that small clamps are attached to the arteriovenous shunt dressing 13. The nurse is inserting a Foley catheter into the bladder of a female adult client. The nurse slips the catheter into an opening for four-5 inches and no urine is obtained. The most probable reason for this is that A) there is no urine present in the bladder B) the catheter is in the vagina C) the catheter is not inserted in far enough D) the bladder is over distended

14. A client is placed on sulfamethoxazole-trimethoprim (Bactrim) for a recurrent urinary tract infection. Which of the following is appropriate reinforcement of information by the nurse? A) B) C) D) "Drink at least 8 glasses of water a day." "Be sure to take the medication with food." "It is safe to take with oral contraceptives." "Stop the medication after 5 days."

A. Hold the urine to increase bladder capacity B. Avoid eating foods high in sodium C. Restrict fluid to prevent elimination accidents D. Avoid taking antihistamines 22. A client has been on antibiotics for 72 hours for cystitis. Which report from the client requires priority attention by the nurse? A. Foul smelling urine B. Burning on urination C. Elevated temperature D. Nausea and anorexia 23. The nurse is caring for a client with a vascular access for hemodialysis. Which of these findings necessitates immediate action by the nurse? A. Pruritic rash B. Dry, hacking cough C. Chronic fatigue D. Elevated temperature 24. Following a diagnosis of acute glomerulonephritis (AGN) in their 6 year-old child, the parents remark: “We just don’t know how he caught the disease!” The nurse's response is based on an understanding that A) AGN is a streptococcal infection that involves the kidney tubules B) The disease is easily transmissible in schools and camps C) The illness is usually associated with chronic respiratory infections D) It is not "caught" but is a response to a previous Bhemolytic strep infection 25. The client newly diagnosed with CRF recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for: A. Hypertension, tachycardia, & fever B. Hypotension, bradycardia, & hypothermia C. Restlessness, irritability, & generalized weakness D. Headache, deteriorating level of consciousness, & twitching 26. A client with CRF has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the clients status after dialysis? A. Vital sign and weight B. Potassium level and weight C. Vital signs and blood urea nitrogen level D. Blood Urea Nitrogen and creatinine levels 27. The nurse is reviewing the clients records and notes that the physician has documented that the client has a renal disorder. On review of the laboratory results, the nurse most likely would expect to note which of the following? A. Decreased hemoglobin level B. Elevated blood urea nitrogen level C. Decreased renal blood cell count D. Decreased white blood cell count

15. During a fluid exchange for the client who is 48 hours post insertion of the abdominal Tenckhoff catheter for peritoneal dialysis, the nurse knows that the appearance of which of the following needs to be reported to the health care provider immediately? A) B) C) D) Slight pink - tinged drainage Abdominal discomfort Muscle weakness Cloudy drainage

16. A client is waiting to have an intravenous pyelogram (IVP). The most important factor to be obtained by the nurse prior to the procedure is A) B) C) D) time to the client's last meal the client's allergy history assessment of the peripheral pulses results of the blood coagulation studies

17. The nurse develops a post procedure plan of care for a client who had a renal biopsy. The nurse avoids documenting which intervention in the plan? A. Administering analgesics are needed B. Encourage fluids to at least 3 L in the first 24 hours C. Testing serial urine samples with dipsticks for occult blood D. Ambulating the client in the room and hall for short distances 18. The client with Urolithiasis has a history of Chronic urinary tract infections. The nurse plans teaching the client to avoid which of the following? A. Long term use of antibiotics B. Wearing synthetic underwater and pantyhose C. High- phosphate foods, such as dairy products. D. Foods that make the urine acidic, such as cranberries 19. The client who has a history of gout also is diagnosed with Urolithiasis and stones are determined to be of uric acid type. The nurse gives the client instructions in which foods to limit, including: A. Milk B. Liver C. Apples D. Carrots 20. The client arrives at the ER with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of: A. Pyelonephritis B. Glomerulonephritis C. Trauma to the bladder or abdomen D. Renal cancer in the client’s family 21. When caring for a client with urinary incontinence, which content should be reinforced by the nurse?

28. Following a renal biopsy, the client complains of pain at the biopsy site that radiates to the front of the abdomen. The nurse interprets this complaint and further assesses the client for:

A. Bleeding B. Infection C. Renal colic D. Bladder perforation 29. A client is admitted to the hospital with a diagnosis of early state CRF. Which of the following should the nurse expect to note on client assessment? A. Anuria B. Polyuria C. Oliguria D. Polydypsia 30. A client is admitted for hemodialysis. Which abnormal lab value would the nurse anticipate not being improved by hemodialysis? A. Low hemoglobin B. Hypernatremia C. High serum creatinine D. Hyperkalemia • BPH

35. The nurse is performing assessment on a client who has returned from dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which of the following is the most appropriate nursing action? A. Monitor the client B. Notify the physician C. Elevate the head of the bed D. Medicate the client for nausea 36. The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated wit peritoneal dialysis? A. Maintain strict aseptic technique B. Add heparin to the dialysate solution C. Change the catheter site dressing daily D. Monitor the clients level of consciousness 37. A Client newly diagnosed with renal failure has just been started on peritoneal dialysis. During the infusion of the dialysate, the nurse complains of abdominal pain. Which action by the nurse is appropriate? A. Stop the dialysis B. Slow the infusion C. Decrease the amount to be infused D. Explain that the pain will subside after the first few exchanges. 38. The nurse is monitoring an 88 year old woman at risk for developing a urinary tract infection. Which of the following, if noted, would alert the nurse to the possibility of the presence of urinary tract infection for this client? A. Fever B. Urgency C. Frequency D. Confusion E. 39. The client returns to the nursing unit following a pyelolithotomy for removal of kidney stone. A penrose drain is in place. Which of the following actions would the nurse includes in the clients postoperative plan of care? A. Positioning the client on the affected side B. Irrigate the Penrose drain using sterile procedure C. Changing dressing frequency around the Penrose drain D. Weighing dressing and adding the amount to the output 40. The nurse is caring for a client following kidney transplantation. The client develops oliguria. Which of the following would the nurse anticipate to be prescribed as the treatment of the oliguria? A. Resting fluids B. Encourage fluid intake C. Administering of diuretics D. Irrigation of the Foley catheter 41. The nurse is caring for a client with chronic renal failure on hemodialysis 3 times a week. The client becomes confused and irritable 6 hours before his next treatment. Which of these items might explain the reason for the client’s behavior? A. Elevated blood urea nitrogen (BUN) B. Potassium loss C. Calcium depletion D. Metabolic alkalosis

31. The nurse is caring for a client with benign prostatic hypertrophy. Which of the following assessments would the nurse anticipate finding? A. Large volume of urinary output with each voiding B. Involuntary voiding with coughing and sneezing C. Frequent urination D. Urine is dark and concentrated 31. A client with CRF returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the clients tem is 100.2 F. Which of the following is the appropriate nursing action? A. Encourage fluids B. Notify the physician C. Continue to monitor vital signs D. Monitor the site of the shunt for infection 32. A 6 year-old female is diagnosed with recurrent urinary tract infections (UTI). Which one of the following instructions would be best for the nurse to tell the caregiver? A. Increase bladder tone by delaying voiding B. When laundering clothing, rinse several times C. Use plain water for the bath, shampooing hair last D. Have the child use antibacterial soaps while bathing 33. A client is admitted with a distended bladder due to the inability to void. The nurse obtains an order to catheterize the client knowing that gradual emptying is preferred over complete emptying because it: A. Reduces the potential for renal collapse B. Reduces the potential for shock C. Reduces the intensity of bladder spasms D. Prevents bladder atrophy 34. For a 6 year-old child hospitalized with moderate edema and mild hypertension associated with acute glomerulonephritis (AGN), which one of the following nursing interventions would be appropriate? A. Institute seizure precautions B. Weigh the child twice per shift C. Encourage the child to eat protein-rich foods D. Relieve boredom through physical activity

42. The nurse admits a 50 year-old client with a 3 day history of fever, flank pain, and elevated blood pressure. Which of the following data obtained in the admission interview alerts the nurse that this may be acute glomerulonephritis? A. Travel to a foreign country B. Sore throat 3 weeks ago C. Type 1 diabetes since age 15 D. History of mild hypertension 43. While performing a dialysate exchange for a client on peritoneal dialysis, which finding would alert the nurse that the client has developed an acute complication? A. Pulse 86 and blood pressure 112/74 B. Respiration rate of 30 with rales (use bibasilar C. Client sleeps throughout fluid exchange D. Catheter dressing saturated with clear fluid 44. The RN is doing initial discharge teaching to a 65 year-old female client with renal calculi. Which of the following should be included as dietary recommendations to prevent recurrence? A. Consume foods high in vitamin E B. Reduce dietary calcium C. Increase sources of vitamin C D. Increase protein levels 45. An 18 month-old child is on peritoneal dialysis in preparation for a renal transplant in the near future. When the nurse obtains the child's health history, the mother indicates that the child has not had the first measles, mumps, rubella (MMR) immunization. The nurse understands that which of the following is true in regards to giving immunizations to this child? A. Live vaccines are withheld in children with renal chronic illness B. The MMR vaccine should be given now, prior to the transplant C. An inactivated form of the vaccine can be given at any time D. The risk of vaccine side effects precludes giving the vaccine 46. During a situation of pain management in patient with kidney disorder, which statement is a priority to consider for the ethical guidelines of the nurse? A. The client's self-report is the most important consideration B. Cultural sensitivity is fundamental to pain management C. Clients have the right to have their pain relieved D. Nurses should not prejudge a client's pain using their own values 47. A week after transplantation, the client develops a temp of 101 F, the blood pressure is elevated, the kidney is tender. The x-ray indicates is enlarged. Based on the assessment findings, the nurse would suspect which of the following complications? A. Acute rejection B. Kidney infection C. Chronic rejection D. Kidney obstruction 48. After four hours of transurethral resection surgery of the prostate because of BPH. The nurse takes the clients V/S and empties the urinary drainage bag. Which of the

following assessment findings would indicate the need to notify the physician? A. Red bloody urine B. Pain RT bladder spasm C. Urinary output of 200ml higher than intake D. BP 100/50mmhg; P 130 beats/min 49. A client dx with polycystic kidney disease has been taught about the tx plan for this disease. The nurse determines that the client needs additional teaching if the client states that the treatment plan includes: A. Genetic counseling B. Sodium restriction C. Increased water intake D. Antihypertensive medications 50. The nurse is documenting the assessment and care of hospitalized client following an uncomplicated cystoscopy. Which one of the following would be an unlikely notation post procedure for this client? A. Voiding pink tinged urine B. Assisted to tub room for sitz bath C. Traction applied to Foley catheter D. Increasing fluid intake without nausea

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