Congratulations - you have completed NCLEX Exam: Renal Disorders and

Management 1 (50 Items).

You scored 37 out of 50.
Your performance has been rated as Not bad!

Your answers are highlighted below.

Question1
CORRECT

You expect a patient in the oliguric phase of renal failure to have a 24 hour urine
output less than:
200ml
400ml
800ml
1000ml

Question 1 Explanation:
Oliguria is defined as urine output of less than 400ml/24hours.
Question2
CORRECT

Your patient with chronic renal failure reports pruritus. Which instruction should
you include in this patients teaching plan?
Rubtheskinvigorouslywithatowel
Takefrequentbaths
Applyalcoholbasedemollientstotheskin
Keepfingernailsshortandclean

Question 2 Explanation:
Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to
excoriation and breaks in the skin that increase the patients risk of infection.
Keeping fingernails short and clean helps reduce the risk of infection.
Question3

CORRECT

You have a patient that might have a urinary tract infection (UTI). Which
statement by the patient suggests that a UTI is likely?
Ipeealot.
ItburnswhenIpee.
Igohourswithouttheurgetopee.
Mypeesmellssweet.

Question 3 Explanation:
A common symptom of a UTI is dysuria. A patient with a UTI often reports
frequent voiding of small amounts and the urgency to void. Urine that smells
sweet is often associated with diabetic ketoacidosis.
Question4
CORRECT

Youre planning your medication teaching for your patient with a UTI prescribed
phenazopyridine (Pyridium). What do you include?
Yoururinemightturnbrightorange.
Youneedtotakethisantibioticfor7days.
Takethisdrugbetweenmealsandatbedtime.
Donttakethisdrugifyoureallergictopenicillin.

Question 4 Explanation:
The drug turns the urine orange. It may be prescribed for longer than 7 days and
is usually ordered three times a day after meals. Phenazopyridine is an azo
(nitrogenous) analgesic; not an antibiotic.
Question5
CORRECT

You have a paraplegic patient with renal calculi. Which factor contributes to the
development of calculi?
Increasedcalciumlossfromthebones
Decreasedkidneyfunction

Decreasedcalciumintake
Highfluidintake

Question 5 Explanation:
Bones lose calcium when a patient can no longer bear weight. The calcium lost
from bones form calculi, a concentration of mineral salts also known as a stone,
in the renal system.
Question6
CORRECT

You suspect kidney transplant rejection when the patient shows which
symptoms?
Painintheincision,generalmalaise,andhypotension
Painintheincision,generalmalaise,anddepression
Fever,weightgain,anddiminishedurineoutput
Diminishedurineoutputandhypotension

Question 6 Explanation:
Symptoms of rejection include fever, rapid weight gain, hypertension, pain over
the graft site, peripheral edema, and diminished urine output.
Question7
CORRECT

Which sign indicated the second phase of acute renal failure?

Dailydoublingofurineoutput(4to5L/day)
Urineoutputlessthan400ml/day
Urineoutputlessthan100ml/day
Stabilizationofrenalfunction

Question 7 Explanation:
Daily doubling of the urine output indicates that the nephrons are healing. This
means the patient is passing into the second phase (dieresis) of acute renal
failure.
Question8
CORRECT

Your patient has complaints of severe right-sided flank pain, nausea, vomiting
and restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP
140/90 mmHg, Pulse 118 beats/min., respirations 33 breaths/minute, and
temperature, 98.0F. Which subjective data supports a diagnosis of renal calculi?
Painradiatingtotherightupperquadrant
Historyofmildflusymptomslastweek
Darkcoloredcoffeegroundemesis
Dark,scantyurineoutput

Question 8 Explanation:
Patients with renal calculi commonly have blood in the urine caused by the
stones passage through the urinary tract. The urine appears dark, tests positive
for blood, and is typically scant.
Question9
CORRECT

What change indicates recovery in a patient with nephrotic syndrome?

Disappearanceofproteinfromtheurine
Decreaseinbloodpressuretonormal
Increaseinserumlipidlevels
Gaininbodyweight

Question 9 Explanation:
With nephrotic syndrome, the glomerular basement membrane of the kidney
becomes more porous, leading to loss of protein in the urine. As the patient
recovers, less protein is found in the urine.
Question10
CORRECT

A patient who received a kidney transplant returns for a follow-up visit to the
outpatient clinic and reports a lump in her breast. Transplant recipients are:
Atincreasedriskforcancerduetoimmunosuppressioncausedbycyclosporine(Neoral)
Consumedwithfearafterthelifethreateningexperienceofhavingatransplant
Atincreasedriskfortumorsbecauseofthekidneytransplant

Atdecreasedriskforcancer,sothelumpismostlikelybenign

Question 10 Explanation:
Cyclosporine suppresses the immune response to prevent rejection of the
transplanted kidney. The use of cyclosporine places the patient at risk for
tumors.
Question11
CORRECT

A patient returns from surgery with an indwelling urinary catheter in place and
empty. Six hours later, the volume is 120ml. The drainage system has no
obstructions. Which intervention has priority?
Givea500mlbolusofisotonicsaline
Evaluatethepatientscirculationandvitalsigns
Flushtheurinarycatheterwithsterilewaterorsaline
Placethepatientintheshockposition,andnotifythesurgeon

Question 11 Explanation:
A total UO of 120ml is too low. Assess the patients circulation and hemodynamic
stability for signs of hypovolemia. A fluid bolus may be required, but only after
further nursing assessment and a doctors order.
Question12
CORRECT

Which of the following symptoms do you expect to see in a patient diagnosed

with acute pyelonephritis?
Jaundiceandflankpain
Costovertebralangletendernessandchills
Burningsensationonurination
Polyuriaandnocturia

Question 12 Explanation:
Costovertebral angle tenderness, flank pain, and chills are symptoms of acute
pyelonephritis. Jaundice indicates gallbladder or liver obstruction. A burning
sensation on urination is a sign of lower urinary tract infection.
Question13

CORRECT

Which of the following causes the majority of UTIs in hospitalized patients?

Lackoffluidintake
Inadequateperinealcare
Invasiveprocedures
Immunosuppression

Question 13 Explanation:
Invasive procedures such as catheterization can introduce bacteria into the
urinary tract. A lack of fluid intake could cause concentration of urine, but
wouldnt necessarily cause infection.
Question14
CORRECT

A patient is experiencing which type of incontinence if she experiences leaking

urine when she coughs, sneezes, or lifts heavy objects?
Overflow
Reflex
Stress
Urge

Question 14 Explanation:
Stress incontinence is an involuntary loss of a small amount of urine due to
sudden increased intra-abdominal pressure, such as with coughing or sneezing.
Question15
WRONG

What is the appropriate infusion time for the dialysate in your 38 y.o. patient
with chronic renal failure?
15minutes
30minutes
1hour
2to3hours

Question 15 Explanation:

Dialysate should be infused quickly. The dialysate should be infused over 15

minutes or less when performing peritoneal dialysis. The fluid exchange takes
place over a period ranging from 30 minutes to several hours.
Question16
CORRECT

Which intervention do you plan to include with a patient who has renal calculi?
Maintainbedrest
Increasedietarypurines
Restrictfluids
Strainallurine

Question 16 Explanation:
All urine should be strained through gauze or a urine strainer to catch stones
that are passed. The stones are then analyzed for composition. Ambulation may
help the movement of the stone down the urinary tract. Encourage fluid to help
flush the stones out.
Question17
CORRECT

What is the most important nursing diagnosis for a patient in end-stage renal
disease?
Riskforinjury
Fluidvolumeexcess
Alterednutrition:lessthanbodyrequirements
Activityintolerance

Question 17 Explanation:
Kidneys are unable to rid the body of excess fluids which results in fluid volume
excess during ESRD.
Question18
CORRECT

Youre preparing for urinary catheterization of a trauma patient and you observe
bleeding at the urethral meatus. Which action has priority?
Irrigateandcleanthemeatusbeforecatheterization

Checkthedischargeforoccultbloodbeforecatheterization
Heavilylubricatethecatheterbeforeinsertion
Delaycatheterizationandnotifythedoctor

Question 18 Explanation:
Bleeding at the urethral meatus is evidence that the urethra is injured. Because
catheterization can cause further harm, consult with the doctor.
Question19
CORRECT

Clinical manifestations of acute glomerulonephritis include which of the

following?
Chillsandflankpain
Oliguriaandgeneralizededema
Hematuriaandproteinuria
Dysuriaandhypotension

Question 19 Explanation:
Hematuria and proteinuria indicate acute glomerulonephritis. These finding result
from increased permeability of the glomerular membrane due to the antigenantibody reaction. Generalized edema is seen most often in nephrosis.
Question20
WRONG

A 30 y.o. female patient is undergoing hemodialysis with an internal

arteriovenous fistula in place. What do you do to prevent complications
associated with this device?
InsertI.V.linesabovethefistula.
Avoidtakingbloodpressuresinthearmwiththefistula
Palpatepulsesabovethefistula
Reportabruitorthrilloverthefistulatothedoctor

Question 20 Explanation:
Dont take blood pressure readings in the arm with the fistula because the
compression could damage the fistula. IV lines shouldnt be inserted in the arm

used for hemodialysis. Palpate pulses below the fistula. Lack of bruit or thrill
should be reported to the doctor.
Question21
CORRECT

Immunosuppression following Kidney transplantation is continued:

Forlife
24hoursaftertransplantation
Aweekaftertransplantation
Untilthekidneyisnotanymorerejected

Question 21 Explanation:
For life.
Question22
CORRECT

What is the priority nursing diagnosis with your patient diagnosed with end-stage
renal disease?
Activityintolerance
Fluidvolumeexcess
Knowledgedeficit
Pain

Question 22 Explanation:
Fluid volume excess because the kidneys arent removing fluid and wastes. The
other diagnoses may apply, but they dont take priority.
Question23
WRONG

Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which
information is important for providing care for the patient?
Thepatientshouldntfeelpainduringinitiationofdialysis
Thepatientfeelsbestimmediatelyafterthedialysistreatment
Usingastethoscopeforauscultatingthefistulaiscontraindicated
Takingabloodpressurereadingontheaffectedarmcancauseclottingofthefistula

Question 23 Explanation:
Pressure on the fistula or the extremity can decrease blood flow and precipitate
clotting, so avoid taking blood pressure on the affected arm.
Question24
WRONG

Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal
disease. The priority intervention is:
Callthedoctorimmediately
GivethepatientIVlidocaine(Xylocaine)
Preparetodefibrillatethepatient
Checkthepatientslatestpotassiumlevel

Question 24 Explanation:
The patient with ESRD may develop arrhythmias caused by hypokalemia. Call the
doctor after checking the patients potassium values. Lidocaine may be ordered if
the PVCs are frequent and the patient is symptomatic.
Question25
CORRECT

Which patient is at greatest risk for developing a urinary tract infection (UTI)?
A35y.o.womanwithafracturedwrist
A20y.o.womanwithasthma
A50y.o.postmenopausalwoman
A28y.o.withangina

Question 25 Explanation:
Women are more prone to UTIs after menopause due to reduced estrogen
levels. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli
bacteria, which protect against infection. Angina, asthma and fractures dont
increase the risk of UTI.
Question26
CORRECT

Your patient returns from the operating room after abdominal aortic aneurysm
repair. Which symptom is a sign of acute renal failure?

Anuria
Diarrhea
Oliguria
Vomiting

Question 26 Explanation:
Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal
failure. Anuria is uncommon except in obstructive renal disorders.
Question27
CORRECT

Which finding leads you to suspect acute glomerulonephritis in your 32 y.o.

patient?
Dysuria,frequency,andurgency
Backpain,nausea,andvomiting
Hypertension,oliguria,andfatigue
Fever,chills,andrightupperquadrantpainradiatingtotheback

Question 27 Explanation:
Mild to moderate HTN may result from sodium or water retention and
inappropriate renin release from the kidneys. Oliguria and fatigue also may be
seen. Other signs are proteinuria and azotemia.
Question28
CORRECT

Which instructions do you include in the teaching care plan for a patient with
cystitis receiving phenazopyridine (Pyridium).
Iftheurineturnsorangered,callthedoctor.
Takephenazopyridinejustbeforeurinationtorelievepain.
Oncepainfulurinationisrelieved,discontinueprescribedantibiotics.
Afterpainfulurinationisrelieved,stoptakingphenazopyridine.

Question 28 Explanation:
Pyridium is taken to relieve dysuria because is provides an analgesic and
anesthetic effect on the urinary tract mucosa. The patient can stop taking it after

the dysuria is relieved. The urine may temporarily turn red or orange due to the
dye in the drug. The drug isnt taken before voiding, and is usually taken 3 times
a day for 2 days.
Question29
CORRECT

A patient with diabetes has had many renal calculi over the past 20 years and
now has chronic renal failure. Which substance must be reduced in this patients
diet?
Carbohydrates
Fats
Protein
VitaminC

Question 29 Explanation:
Because of damage to the nephrons, the kidney cant excrete all the metabolic
wastes of protein, so this patients protein intake must be restricted. A higher
intake of carbs, fats, and vitamin supplements is needed to ensure the growth
and maintenance of the patients tissues.
Question30
WRONG

Your patient is complaining of muscle cramps while undergoing hemodialysis.

Which intervention is effective in relieving muscle cramps?
Increasetherateofdialysis
Infusenormalsalinesolution
Administera5%dextrosesolution
EncourageactiveROMexercises

Question 30 Explanation:
Treatment includes administering normal saline or hypertonic normal saline
solution because muscle cramps can occur when the sodium and water are
removed to quickly during dialysis. Reducing the rate of dialysis, not increasing
it, may alleviate muscle cramps.
Question31

CORRECT

A patient diagnosed with sepsis from a UTI is being discharged. What do you
plan to include in her discharge teaching?
Takecoolbaths
Avoidtamponuse
Avoidsexualactivity
Drink8to10eightozglassesofwaterdaily

Question 31 Explanation:
Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps
flush the bacteria from the bladder. The patient should be instructed to void after
sexual activity.
Question32
WRONG

After the first hemodialysis treatment, your patient develops a headache,

hypertension, restlessness, mental confusion, nausea, and vomiting. Which
condition is indicated?
Disequilibriumsyndrome
Respiratorydistress
Hypervolemia
Peritonitis

Question 32 Explanation:
Disequilibrium occurs when excess solutes are cleared from the blood more
rapidly than they can diffuse from the bodys cells into the vascular system.
Question33
WRONG

A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis.
Which intervention do you include in his plan of care?
Applypressuretotheneedlesiteupondiscontinuinghemodialysis
Keeptheheadofthebedelevated45degrees
Placetheleftarmonanarmboardforatleast30minutes

Keeptheleftarmdry

Question 33 Explanation:
Apply pressure when discontinuing hemodialysis and after removing the
venipuncture needle until all the bleeding has stopped. Bleeding may continue
for 10 minutes in some patients.
Question34
CORRECT

A 22 y.o. patient with diabetic nephropathy says, I have two kidneys and Im
still young. If I stick to my insulin schedule, I dont have to worry about kidney
damage, right? Which of the following statements is the best response?
Youhavelittletoworryaboutaslongasyourkidneyskeepmakingurine.
Youshouldtalktoyourdoctorbecausestatisticsshowthatyourebeingunrealistic.
Youwouldbecorrectifyourdiabetescouldbemanagedwithinsulin.
Evenwithinsulin,kidneydamageisstillaconcern.

Question 34 Explanation:
Kidney damage is still a concern. Microvascular changes occur in both of the
patients kidneys as a complication of the diabetes. Diabetic nephropathy is the
leading cause of end-stage renal disease. The kidneys continue to produce urine
until the end stage. Nephropathy occurs even with insulin management.
Question35
WRONG

Which criterion is required before a patient can be considered for continuous

peritoneal dialysis?
Thepatientmustbehemodynamicallystable
Thevascularaccessmusthavehealed
Thepatientmustbeinahomesetting
Hemodialysismusthavefailed

Question 35 Explanation:
Hemodynamic stability must be established before continuous peritoneal dialysis
can be started.
Question36

CORRECT

Which action is most important during bladder training in a patient with a

neurogenic bladder?
Encouragetheuseofanindwellingurinarycatheter
Setupspecifictimestoemptythebladder
EncourageKegelexercises
Forcefluids

Question 36 Explanation:
Instruct the patient with neurogenic bladder to write down his voiding pattern
and empty the bladder at the same times each day.
Question37
CORRECT

Which drug is indicated for pain related to acute renal calculi?

Narcoticanalgesics
Nonsteroidalantiinflammatorydrugs(NSAIDS)
Musclerelaxants
Salicylates

Question 37 Explanation:
Narcotic analgesics are usually needed to relieve the severe pain of renal calculi.
Muscle relaxants are typically used to treat skeletal muscle spasms. NSAIDS and
salicylates are used for their anti-inflammatory and antipyretic properties and to
treat less severe pain.
Question38
CORRECT

You have a patient that is receiving peritoneal dialysis. What should you do when
you notice the return fluid is slowly draining?
Checkforkinksintheoutflowtubing
Raisethedrainagebagabovetheleveloftheabdomen
PlacethepatientinareverseTrendelenburgposition
Askthepatienttocough

Question 38 Explanation:
Tubing problems are a common cause of outflow difficulties, check the tubing for
kinks and ensure that all clamps are open. Other measures include having the
patient change positions (moving side to side or sitting up), applying gentle
pressure over the abdomen, or having a bowel movement.
Question39
WRONG

An 18 y.o. student is admitted with dark urine, fever, and flank pain and is
diagnosed with acute glomerulonephritis. Which would most likely be in this
students health history?
Renalcalculi
Renaltrauma
Recentsorethroat
Familyhistoryofacuteglomerulonephritis

Question 39 Explanation:
The most common form of acute glomerulonephritis is caused by group A betahemolytic streptococcal infection elsewhere in the body.
Question40
CORRECT

What is the best way to check for patency of the arteriovenous fistula for
hemodialysis?
Pinchthefistulaandnotethespeedoffillingonrelease
Useaneedleandsyringetoaspiratebloodfromthefistula
Checkforcapillaryrefillofthenailbedsonthatextremity
Palpatethefistulathroughoutitslengthtoassessforathrill

Question 40 Explanation:
The vibration or thrill felt during palpation ensures that the fistula has the
desired turbulent blood flow. Pinching the fistula could cause damage. Aspirating
blood is a needless invasive procedure.
Question41
WRONG

Youre developing a care plan with the nursing diagnosis risk for infection for
your patient that received a kidney transplant. A goal for this patient is to:
Remainafebrileandhavenegativecultures
Resumenormalfluidintakewithin2to3days
Resumethepatientsnormaljobwithin2to3weeks
Trytodiscontinuecyclosporine(Neoral)asquicklyaspossible

Question 41 Explanation:
The immunosuppressive activity of cyclosporine places the patient at risk for
infection, and steroids can mask the signs of infection. The patient may not be
able to resume normal fluid intake or return to work for an extended period of
time and the patient may need cyclosporine therapy for life.
Question42
CORRECT

A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet
is best on days between dialysis treatments?
Lowproteindietwithunlimitedamountsofwater
Lowproteindietwithaprescribedamountofwater
Noproteininthedietanduseofasaltsubstitute
Norestrictions

Question 42 Explanation:
The patient should follow a low-protein diet with a prescribed amount of water.
The patient requires some protein to meet metabolic needs. Salt substitutes
shouldnt be used without a doctors order because it may contain potassium,
which could make the patient hyperkalemic. Fluid and protein restrictions are
needed.
Question43
CORRECT

Your 60 y.o. patient with pyelonephritis and possible septicemia has had five
UTIs over the past two years. She is fatigued from lack of sleep, has lost weight,
and urinates frequently even in the night. Her labs show: sodium, 154 mEq/L;
osmolarity 340 mOsm/L; glucose, 127 mg/dl; and potassium, 3.9 mEq/L. Which
nursing diagnosis is priority?

Fluidvolumedeficitrelatedtoosmoticdiuresisinducedbyhyponatremia
Fluidvolumedeficitrelatedtoinabilitytoconservewater
Alterednutrition:Lessthanbodyrequirementsrelatedtohypermetabolicstate
Alterednutrition:Lessthanbodyrequirementsrelatedtocataboliceffectsofinsulindeficiency
Question44
WRONG

Polystyrene sulfonate (Kayexalate) is used in renal failure to:

Correctacidosis
Reduceserumphosphatelevels
Exchangepotassiumforsodium
Preventconstipationfromsorbitoluse

Question 44 Explanation:
In renal failure, patients become hyperkalemic because they cant excrete
potassium in the urine. Polystyrene sulfonate acts to excrete potassium by
pulling potassium into the bowels and exchanging it for sodium.
Question45
CORRECT

Which statement correctly distinguishes renal failure from prerenal failure?

Withprerenalfailure,vasoactivesubstancessuchasdopamine(Intropin)increaseblood
pressure
Withprerenalfailure,thereislessresponsetosuchdiureticsasfurosemide(Lasix)
Withprerenalfailure,anIVisotonicsalineinfusionincreasesurineoutput
Withprerenalfailure,hemodialysisreducestheBUNlevel

Question 45 Explanation:
Prerenal failure is caused by such conditions as hypovolemia that impairs kidney
perfusion; giving isotonic fluids improves urine output. Vasoactive substances
can increase blood pressure in both conditions.
Question46
WRONG

The most common early sign of kidney disease is:

Sodiumretention
ElevatedBUNlevel
Developmentofmetabolicacidosis
Inabilitytodiluteorconcentrateurine

Question 46 Explanation:
Increased BUN is usually an early indicator of decreased renal function.
Question47
WRONG

The most indicative test for prostate cancer is:

Athoroughdigitalrectalexamination
Magneticresonanceimaging(MRI)
Excretoryurography
Prostatespecificantigen

Question 47 Explanation:
An elevated prostate-specific antigen level indicates prostate cancer, but it can
be falsely elevated if done after the prostate gland is manipulated. A digital
rectal examination should be done as part of the yearly screening, and then the
antigen test is done if the digital exam suggests cancer. MRI is used in staging
the cancer.
Question48
CORRECT

Which cause of hypertension is the most common in acute renal failure?

Pulmonaryedema
Hypervolemia
Hypovolemia
Anemia

Question 48 Explanation:
Acute renal failure causes hypervolemia as a result of overexpansion of
extracellular fluid and plasma volume with the hypersecretion of renin.
Therefore, hypervolemia causes hypertension.

Question49
CORRECT

Your patient becomes restless and tells you she has a headache and feels
nauseous during hemodialysis. Which complication do you suspect?
Infection
Disequilibriumsyndrome
Airembolus
Acutehemolysis

Question 49 Explanation:
Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and
other solutes from the blood. This can lead to cerebral edema and increased
intracranial pressure (ICP). Signs and symptoms include headache, nausea,
restlessness, vomiting, confusion, twitching, and seizures.
Question50
CORRECT

Immediately post-op after a prostatectomy, which complications requires priority

assessment of your patient?
Pneumonia
Hemorrhage
Urineretention
Deepveinthrombosis

Question 50 Explanation:
Hemorrhage is a potential complication. Urine retention isnt a problem soon
after surgery because a catheter is in place. Pneumonia may occur if the patient
doesnt cough and deep breathe. Thrombosis may occur later if the patient
doesnt ambulate.

Congratulations - you have completed NCLEX Exam: Genitourinary System

Disorders 1 (50 Items).

You scored 30 out of 50.

Your performance has been rated as Not bad!

Your answers are highlighted below.

Question1
CORRECT

A 55-year old client with benign prostatic hyperplasia doesnt respond to medical
treatment and is admitted to the facility for prostate gland removal. Before
providing preoperative and postoperative instructions to the client, Nurse Gerry
asks the surgeon which prostatectomy procedure will be done. What is the most
widely used procedure for prostate gland removal?
Transurethralresectionoftheprostate(TURP)
Suprapubicprostatectomy
Retropubicprostatectomy
Transurethrallaserincisionoftheprostate

Question 1 Explanation:
TURP is the most widely used procedure for prostate gland removal. Because it
requires no incision, TURP is especially suitable for men with relatively minor
prostatic enlargements and for those who are poor surgical risks. Suprapubic
prostatectomy, retropubic prostatectomy, and transurethral laser incision of the
prostate are less common procedures; they all require an incision.
Question2
WRONG

Dr. Grey prescribes norfloxacin (Noroxin), 400 mg P.O. twice daily, for a client
with a urinary tract infection (UTI). The client asks the nurse how long to
continue taking the drug. For an uncomplicated UTI, the usual duration of
norfloxacin therapy is:
3to5days.
7to10days.
12to14days.

10to21days.

Question 2 Explanation:
For an uncomplicated UTI, norfloxacin therapy usually lasts 7 to 10 days. Taking
the drug for less than 7 days wouldnt eradicate such an infection. Taking it for
more than 10 days isnt necessary. Only a client with a complicated UTI must
take norfloxacin for 10 to 21 days.
Question3
WRONG

The nurse is aware that the following findings would be further evidence of a
urethral injury in a male client during rectal examination?
Alowridingprostate
Thepresenceofaboggymass
Absentsphinctertone
ApositiveHemoccult

Question 3 Explanation:
When the urethra is ruptured, a hematoma or collection of blood separates the
two sections of urethra. This may feel like a boggy mass on rectal examination.
Because of the rupture and hematoma, the prostate becomes high riding. A
palpable prostate gland usually indicates a non-urethral injury. Absent sphincter
tone would refer to a spinal cord injury. The presence of blood would probably
correlate with GI bleeding or a colon injury.
Question4
WRONG

A 24-year old female client has just been diagnosed with condylomata acuminata
(genital warts). What information is appropriate to tell this client?
Thisconditionputsheratahigherriskforcervicalcancer;therefore,sheshouldhavea
Papanicolaou(Pap)smearannually.
Themostcommontreatmentismetronidazole(Flagyl),whichshoulderadicatetheproblem
within7to10days.
Thepotentialfortransmissiontohersexualpartnerwillbeeliminatedifcondomsare
usedeverytimetheyhavesexualintercourse.
Thehumanpapillomavirus(HPV),whichcausescondylomataacuminata,cantbetransmitted
duringoralsex.

Question 4 Explanation:
Women with condylomata acuminata are at risk for cancer of the cervix and
vulva. Yearly Pap smears are very important for early detection. Because
condylomata acuminata is a virus, there is no permanent cure. Because
condylomata acuminata can occur on the vulva, a condom wont protect sexual
partners. HPV can be transmitted to other parts of the body, such as the mouth,
oropharynx, and larynx.
Question5
WRONG

The client underwent a transurethral resection of the prostate gland 24 hours

ago and is on continuous bladder irrigation. Nurse Yonny is aware that the
following nursing interventions is appropriate?
Telltheclienttotrytourinatearoundthecathetertoremovebloodclots
Restrictfluidstopreventtheclientsbladderfrombecomingdistended
Preparetoremovethecatheter
Useaseptictechniquewhenirrigatingthecatheter

Question 5 Explanation:
If the catheter is blocked by blood clots, it may be irrigated according to
physicians orders or facility protocol. The nurse should use sterile technique to
reduce the risk of infection. Urinating around the catheter can cause painful
bladder spasms. Encourage the client to drink fluids to dilute the urine and
maintain urine output. The catheter remains in place for 2 to 4 days after
surgery and is only removed with a physicians order.
Question6
CORRECT

The nurse is aware that the following laboratory values supports a diagnosis of
pyelonephritis?
Myoglobinuria
Ketonuria
Pyuria
Lowwhitebloodcell(WBC)count

Question 6 Explanation:

Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria,

and bacteriuria. The client exhibits fever, chills, and flank pain. Because there is
often a septic picture, the WBC count is more likely to be high rather than low,
as indicated in option D. Ketonuria indicates a diabetic state.
Question7
WRONG

A female client requires hemodialysis. Which of the following drugs should be

withheld before this procedure?
Phosphatebinders
Insulin
Antibiotics
Cardiacglycosides

Question 7 Explanation:
Cardiac glycosides such as digoxin should be withheld before hemodialysis.
Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a
hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity.
Phosphate binders and insulin can be administered because they arent removed
from the blood by dialysis. Some antibiotics are removed by dialysis and should
be administered after the procedure to ensure their therapeutic effects. The
nurse should check a formulary to determine whether a particular antibiotic
should be administered before or after dialysis.
Question8
WRONG

Nurse Vic is monitoring the fluid intake and output of a female client recovering
from an exploratory laparotomy. Which nursing intervention would help the client
avoid a urinary tract infection (UTI)?
Maintainingaclosedindwellingurinarycathetersystemandsecuringthecathetertotheleg
Limitingfluidintaketo1L/day
Encouragingtheclienttouseafemininedeodorantafterbathing
Encouragingtheclienttodoucheonceadayafterremovaloftheindwellingurinarycatheter

Question 8 Explanation:

Maintaining a closed indwelling urinary catheter system helps prevent

introduction of bacteria; securing the catheter to the clients leg also decreases
the risk of infection by helping to prevent urethral trauma. To flush bacteria from
the urinary tract, the nurse should encourage the client to drink at least 10
glasses of fluid daily, if possible. Douching and feminine deodorants may irritate
the urinary tract and should be discouraged.
Question9
CORRECT

A male client develops acute renal failure (ARF) after receiving I.V. therapy with
a nephrotoxic antibiotic. Because the clients 24-hour urine output totals 240 ml,
Nurse Billy suspects that the client is at risk for:
cardiacarrhythmia
paresthesia
dehydration
pruritus

Question 9 Explanation:
As urine output decreases, the serum potassium level rises; if it rises sufficiently,
hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia
doesnt cause paresthesia (sensations of numbness and tingling). Dehydration
doesnt occur during this oliguric phase of ARF, although typically it does arise
during the diuretic phase. In a client with ARF, pruritus results from increased
phosphates and isnt associated with hyperkalemia.
Question10
WRONG

Nurse Lily is assessing a male client diagnosed with gonorrhea. Which symptom
most likely prompted the client to seek medical attention?
Rashesonthepalmsofthehandsandsolesofthefeet
Cauliflowerlikewartsonthepenis
Painfulredpapulesontheshaftofthepenis
Foulsmellingdischargefromthepenis

Question 10 Explanation:

Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the

penis and painful urination. Rashes on the palms of the hands and soles of the
feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on
the penis are a sign of human papillomavirus. Painful red papules on the shaft of
the penis may be a sign of the first stage of genital herpes.
Question11
CORRECT

Nurse Pete is reviewing the report of a clients routine urinalysis. Which value
should the nurse consider abnormal?
Specificgravityof1.03
UrinepHof3.0
Absenceofprotein
Absenceofglucose

Question 11 Explanation:
Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal. Urine
specific gravity normally ranges from 1.002 to 1.035, making this clients value
normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria,
casts, or crystals. Red blood cells should measure 0 to 3 per high-power field;
white blood cells, 0 to 4 per high-power field. Urine should be clear, its color
ranging from pale yellow to deep amber.
Question12
CORRECT

Nurse Pippy is reviewing a clients fluid intake and output record. Fluid intake and
urine output should relate in which way?
Fluidintakeshouldbedoubletheurineoutput
Fluidintakeshouldbeapproximatelyequaltotheurineoutput
Fluidintakeshouldbehalftheurineoutput
Fluidintakeshouldbeinverselyproportionaltotheurineoutput

Question 12 Explanation:
Normally, fluid intake is approximately equal to the urine output. Any other
relationship signals an abnormality. For example, fluid intake that is double the
urine output indicates fluid retention; fluid intake that is half the urine output

indicates dehydration. Normally, fluid intake isnt inversely proportional to the

urine output.
Question13
CORRECT

A female client with chronic renal failure (CRF) is receiving a hemodialysis

treatment. After hemodialysis, nurse Sarah knows that the client is most likely to
experience:
hematuria
weightloss
increasedurineoutput
increasedbloodpressure

Question 13 Explanation:
Because CRF causes loss of renal function, the client with this disorder retains
fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely
to follow hemodialysis because the client with CRF usually forms little or no
urine. Hemodialysis doesnt increase urine output because it doesnt correct the
loss of kidney function, which severely decreases urine production in this
disorder. By removing fluids, hemodialysis decreases rather than increases the
blood pressure.
Question14
CORRECT

Nurse Karen is caring for a client who had a cerebrovascular accident (CVA).
Which nursing intervention promotes urinary continence?
Encouragingintakeofatleast2Loffluiddaily
Givingtheclientaglassofsodabeforebedtime
Takingtheclienttothebathroomtwiceperday
Consultingwithadietitian

Question 14 Explanation:
By encouraging a daily fluid intake of at least 2 L, the nurse helps fill the clients
bladder, thereby promoting bladder retraining by stimulating the urge to void.
The nurse shouldnt give the client soda before bedtime; soda acts as a diuretic
and may make the client incontinent. The nurse should take the client to the

bathroom or offer the bedpan at least every 2 hours throughout the day; twice
per day is insufficient. Consultation with a dietitian wont address the problem of
urinary incontinence.
Question15
CORRECT

A female client with an indwelling urinary catheter is suspected of having a

urinary tract infection. Nurse Angel should collect a urine specimen for culture
and sensitivity by:
disconnectingthetubingfromtheurinarycatheterandlettingtheurineflowintoasterile
container
wipingtheselfsealingaspirationportwithantisepticsolutionandaspiratingurinewitha
sterileneedle
drainingurinefromthedrainagebagintoasterilecontainer
clampingthetubingfor60minutesandinsertingasterileneedleintothetubingabovethe
clamptoaspirateurine

Question 15 Explanation:
Most catheters have a self-sealing port for obtaining a urine specimen. Antiseptic
solution is used to reduce the risk of introducing microorganisms into the
catheter. Tubing shouldnt be disconnected from the urinary catheter. Any break
in the closed urine drainage system may allow the entry of microorganisms.
Urine in urine drainage bags may not be fresh and may contain bacteria, giving
false test results. When there is no urine in the tubing, the catheter may be
clamped for no more than 30 minutes to allow urine to collect.
Question16
CORRECT

A male client with bladder cancer has had the bladder removed and an ileal
conduit created for urine diversion. While changing this clients pouch, the nurse
observes that the area around the stoma is red, weeping, and painful. What
should Nurse Kaye conclude?
Theskinwasntlubricatedbeforethepouchwasapplied
Thepouchfaceplatedoesntfitthestoma
Askinbarrierwasappliedproperly
Stomadilationwasntperformed.

Question 16 Explanation:
If the pouch faceplate doesnt fit the stoma properly, the skin around the stoma
will be exposed to continuous urine flow from the stoma, causing excoriation and
red, weeping, and painful skin. A lubricant shouldnt be used because it would
prevent the pouch from adhering to the skin. When properly applied, a skin
barrier prevents skin excoriation. Stoma dilation isnt performed with an ileal
conduit, although it may be done with a colostomy if ordered.
Question17
WRONG

Nurse Harry is providing postprocedure care for a client who underwent

percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through
a nephrostomy tube into the renal pelvis generates ultrahigh-frequency sound
waves to shatter renal calculi. The nurse should instruct the client to:
limitoralfluidintakefor1to2weeks.
reportthepresenceoffine,sandlikeparticlesthroughthenephrostomytube.
notifythephysicianaboutcloudyorfoulsmellingurine.
reportbrightpinkurinewithin24hoursaftertheprocedure.

Question 17 Explanation:
The client should report the presence of foul-smelling or cloudy urine. Unless
contraindicated, the client should be instructed to drink large quantities of fluid
each day to flush the kidneys. Sand-like debris is normal due to residual stone
products. Hematuria is common after lithotripsy.
Question18
CORRECT

A male client is admitted for treatment of glomerulonephritis. On initial

assessment, Nurse Miley detects one of the classic signs of acute
glomerulonephritis of sudden onset. Such signs include:
generalizededema,especiallyofthefaceandperiorbitalarea.
greentingedurine.
moderatetoseverehypotension.
polyuria.

Question 18 Explanation:

Generalized edema, especially of the face and periorbital area, is a classic sign of
acute glomerulonephritis of sudden onset. Other classic signs and symptoms of
this disorder include hematuria (not green-tinged urine), proteinuria, fever,
chills, weakness, pallor, anorexia, nausea, and vomiting. The client also may
have moderate to severe hypertension (not hypotension), oliguria or anuria (not
polyuria), headache, reduced visual acuity, and abdominal or flank pain.
Question19
CORRECT

Nurse Erica is planning to administer a sodium polystyrene sulfonate

(Kayexalate) enema to a client with a potassium level of 5.9 mEq/L. Correct
administration and the effects of this enema would include having the client:
retaintheenemafor30minutestoallowforsodiumexchange;afterward,theclient
shouldhavediarrhea
retaintheenemafor30minutestoallowforglucoseexchange;afterward,theclientshould
havediarrhea
retaintheenemafor60minutestoallowforsodiumexchange;diarrheaisntnecessaryto
reducethepotassiumlevel
retaintheenemafor60minutestoallowforglucoseexchange;diarrheaisntnecessaryto
reducethepotassiumlevel

Question 19 Explanation:
Kayexalate is a sodium exchange resin. Thus the client will gain sodium as
potassium is lost in the bowel. For the exchange to occur, Kayexalate must be in
contact with the bowel for at least 30 minutes. Sorbitol in the Kayexalate enema
causes diarrhea, which increases potassium loss and decreases the potential for
Kayexalate retention.
Question20
CORRECT

A male client who has been treated for chronic renal failure (CRF) is ready for
discharge. Nurse Billy should reinforce which dietary instruction?
Besuretoeatmeatateverymeal.
Monitoryourfruitintake,andeatplentyofbananas.
Increaseyourcarbohydrateintake.
Drinkplentyoffluids,anduseasaltsubstitute.

Question 20 Explanation:
In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid
may lead to a dangerous accumulation of electrolytes and protein metabolic
products, such as amino acids and ammonia. Therefore, the client must limit
intake of sodium; meat, which is high in protein; bananas, which are high in
potassium; and fluid, because the failing kidneys cant secrete adequate urine.
Salt substitutes are high in potassium and should be avoided. Extra
carbohydrates are needed to prevent protein catabolism.
Question21
WRONG

A male client is scheduled for a renal clearance test. Nurse Sheldon should
explain that this test is done to assess the kidneys ability to remove a substance
from the plasma in:
1minute
30minutes
1hour
24hours

Question 21 Explanation:
The renal clearance test determines the kidneys ability to remove a substance
from the plasma in 1 minute. It doesnt measure the kidneys ability to remove a
substance over a longer period.
Question22
CORRECT

After trying to conceive for a year, a couple consults an infertility specialist.

When obtaining a history from the husband, Nurse Jessica inquires about
childhood infectious diseases. Which childhood infectious disease most
significantly affects male fertility?
Chickenpox
Measles
Mumps
Scarletfever

Question 22 Explanation:

Mumps is the most significant childhood infectious disease affecting male fertility.
Chickenpox, measles, and scarlet fever dont affect male fertility.
Question23
CORRECT

A female client has just been diagnosed with condylomata acuminata (genital
warts). What information is appropriate to tell this client?
Thisconditionputsheratahigherriskforcervicalcancer;therefore,sheshouldhavea
Papanicolaou(Pap)smearannually.
Themostcommontreatmentismetronidazole(Flagyl),whichshoulderadicatetheproblem
within7to10days.
Thepotentialfortransmissiontohersexualpartnerwillbeeliminatedifcondomsareused
everytimetheyhavesexualintercourse.
Thehumanpapillomavirus(HPV),whichcausescondylomataacuminata,cantbetransmitted
duringoralsex.

Question 23 Explanation:
Women with condylomata acuminata are at risk for cancer of the cervix and
vulva. Yearly Pap smears are very important for early detection. Because
condylomata acuminata is a virus, there is no permanent cure. Because
condylomata acuminata can occur on the vulva, a condom wont protect sexual
partners. HPV can be transmitted to other parts of the body, such as the mouth,
oropharynx, and larynx.
Question24
CORRECT

A female client with a urinary tract infection is prescribed co-trimoxazole

(trimethoprim-sulfamethoxazole). Nurse Dolly should provide which medication
instruction?
Takethemedicationwithfood.
Drinkatleasteight8ozglassesoffluiddaily.
Avoidtakingantacidsduringcotrimoxazoletherapy.
Dontbeafraidtogooutinthesun.

Question 24 Explanation:
When receiving a sulfonamide such as co-trimoxazole, the client should drink at
least eight 8-oz glasses of fluid daily to maintain a urine output of at least 1,500

ml/day. Otherwise, inadequate urine output may lead to crystalluria or tubular

deposits. For maximum absorption, the client should take this drug at least 1
hour before or 2 hours after meals. No evidence indicates that antacids interfere
with the effects of sulfonamides. To prevent a photosensitivity reaction, the client
should avoid direct sunlight during co-trimoxazole therapy.
Question25
CORRECT

Nurse Eve is caring for a client who had a cerebrovascular accident (CVA). Which
nursing intervention promotes urinary continence?
Encouragingintakeofatleast2Loffluiddaily
Givingtheclientaglassofsodabeforebedtime
Takingtheclienttothebathroomtwiceperday
Consultingwithadietitian

Question 25 Explanation:
By encouraging a daily fluid intake of at least 2 L, the nurse helps fill the clients
bladder, thereby promoting bladder retraining by stimulating the urge to void.
The nurse shouldnt give the client soda before bedtime; soda acts as a diuretic
and may make the client incontinent. The nurse should take the client to the
bathroom or offer the bedpan at least every 2 hours throughout the day; twice
per day is insufficient. Consultation with a dietitian wont address the problem of
urinary incontinence.
Question26
CORRECT

After having transurethral resection of the prostate (TURP), a Mr. Lim returns to
the unit with a three-way indwelling urinary catheter and continuous closed
bladder irrigation. Which finding suggests that the clients catheter is occluded?
Theurineinthedrainagebagappearsredtopink
Theclientreportsbladderspasmsandtheurgetovoid
Thenormalsalineirrigantisinfusingatarateof50drops/minute
About1,000mlofirriganthavebeeninstilled;1,200mlofdrainagehavebeenreturned

Question 26 Explanation:

Reports of bladder spasms and the urge to void suggest that a blood clot may be
occluding the catheter. After TURP, urine normally appears red to pink, and
normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or
according to facility protocol. The amount of retained fluid (1,200 ml) should
correspond to the amount of instilled fluid, plus the clients urine output (1,000
ml + 200 ml), which reflects catheter patency.
Question27
WRONG

For a male client in the oliguric phase of acute renal failure (ARF), which nursing
intervention is most important?
Encouragingcoughinganddeepbreathing
Promotingcarbohydrateintake
Limitingfluidintake
Providingpainreliefmeasures

Question 27 Explanation:
During the oliguric phase of ARF, urine output decreases markedly, possibly
leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid
overload and its complications, such as heart failure and pulmonary edema.
Encouraging coughing and deep breathing is important for clients with various
respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but
doesnt take precedence over fluid limitation. Controlling pain isnt important
because ARF rarely causes pain.
Question28
CORRECT

A female client with acute renal failure is undergoing dialysis for the first time.
The nurse in charge monitors the client closely for dialysis equilibrium syndrome,
a complication that is most common during the first few dialysis sessions.
Typically, dialysis equilibrium syndrome causes:
confusion,headache,andseizures
acutebonepainandconfusion
weakness,tingling,andcardiacarrhythmias
hypotension,tachycardia,andtachypnea

Question 28 Explanation:
Dialysis equilibrium syndrome causes confusion, a decreasing level of
consciousness, headache, and seizures. These findings, which may last several
days, probably result from a relative excess of interstitial or intracellular solutes
caused by rapid solute removal from the blood. The resultant organ swelling
interferes with normal physiologic functions. To prevent this syndrome, many
dialysis centers keep first-time sessions short and use a reduced blood flow rate.
Acute bone pain and confusion are associated with aluminum intoxication,
another potential complication of dialysis. Weakness, tingling, and cardiac
arrhythmias suggest hyperkalemia, which is associated with renal failure.
Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis
complication.
Question29
WRONG

A triple-lumen indwelling urinary catheter is inserted for continuous bladder

irrigation following a transurethral resection of the prostate. In addition to
balloon inflation, the nurse is aware that the functions of the three lumens
include:
Continuousinflowandoutflowofirrigationsolution
Intermittentinflowandcontinuousoutflowofirrigationsolution
Continuousinflowandintermittentoutflowofirrigationsolution
Intermittentflowofirrigationsolutionandpreventionofhemorrhage

Question 29 Explanation:
When preparing for continuous bladder irrigation, a triple-lumen indwelling
urinary catheter is inserted. The three lumens provide for balloon inflation and
continuous inflow and outflow of irrigation solution.
Question30
WRONG

A male client comes to the emergency department complaining of sudden onset

of sharp, severe pain in the lumbar region, which radiates around the side and
toward the bladder. The client also reports nausea and vomiting and appears
pale, diaphoretic, and anxious. The physician tentatively diagnosed renal calculi

and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the
urinary tract. What is their most common formation site?
Kidney
Ureter
Bladder
Urethra

Question 30 Explanation:
The most common site of renal calculi formation is the kidney. Calculi may travel
down the urinary tract with or without causing damage and may lodge anywhere
along the tract or may stay within the kidney. The ureter, bladder, and urethra
are less common sites of renal calculi formation.
Question31
WRONG

Nurse Harry is aware that the following is an appropriate nursing diagnosis for a
client with renal calculi?
Ineffectivetissueperfusion
Functionalurinaryincontinence
Riskforinfection
Decreasedcardiacoutput

Question 31 Explanation:
Infection can occur with renal calculi from urine stasis caused by obstruction.
Options A and D arent appropriate for this diagnosis, and retention of urine
usually occurs, rather than incontinence.
Question32
WRONG

A client comes to the outpatient department complaining of vaginal discharge,

dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD),
Dr. Smith orders diagnostic tests of the vaginal discharge. Which STD must be
reported to the public health department?
Chlamydia
Gonorrhea

Genitalherpes
Humanpapillomavirusinfection

Question 32 Explanation:
Gonorrhea must be reported to the public health department. Chlamydia, genital
herpes, and human papillomavirus infection arent reportable diseases.
Question33
WRONG

When caring for a male client with acute renal failure (ARF), Nurse Fatrishia
expects to adjust the dosage or dosing schedule of certain drugs. Which of the
following drugs would not require such adjustment?
acetaminophen(Tylenol)
gentamicinsulfate(Garamycin)
cyclosporine(Sandimmune)
ticarcillindisodium(Ticar)

Question 33 Explanation:
Because acetaminophen is metabolized in the liver, its dosage and dosing
schedule need not be adjusted for a client with ARF. In contrast, the dosages and
schedules for gentamicin and ticarcillin, which are metabolized and excreted by
the kidney, should be adjusted. Because cyclosporine may cause nephrotoxicity,
the nurse must monitor both the dosage and blood drug level in a client
receiving this drug.
Question34
WRONG

A client reports experiencing vulvar pruritus. Which assessment factor may

indicate that the client has an infection caused by Candida albicans?
Cottagecheeselikedischarge
Yellowgreendischarge
Graywhitedischarge
Dischargewithafishyodor

Question 34 Explanation:

The symptoms of C. albicans include itching and a scant white discharge that has
the consistency of cottage cheese. Yellow-green discharge is a sign of
Trichomonas vaginalis. Gray-white discharge and a fishy odor are signs of
Gardnerella vaginalis.
Question35
WRONG

A male client in the short-procedure unit is recovering from renal angiography in

which a femoral puncture site was useD. When providing postprocedure care, the
nurse should:
keeptheclientskneeontheaffectedsidebentfor6hours.
applypressuretothepuncturesitefor30minutes.
checktheclientspedalpulsesfrequently.
removethedressingonthepuncturesiteaftervitalsignsstabilize.

Question 35 Explanation:
After renal angiography involving a femoral puncture site, the nurse should check
the clients pedal pulses frequently to detect reduced circulation to the feet
caused by vascular injury. The nurse also should monitor vital signs for evidence
of internal hemorrhage and should observe the puncture site frequently for fresh
bleeding. The client should be kept on bed rest for several hours so the puncture
site can seal completely. Keeping the clients knee bent is unnecessary. By the
time the client returns to the short-procedure unit, manual pressure over the
puncture site is no longer needed because a pressure dressing is in place. The
nurse shouldnt remove this dressing for several hours and only if instructed
to do so.
Question36
CORRECT

When a female client with an indwelling urinary (Foley) catheter insists on

walking to the hospital lobby to visit with family members, nurse Rose teaches
how to do this without compromising the catheter. Which client action indicates
an accurate understanding of this information?
Theclientsetsthedrainagebagonthefloorwhilesittingdown.
Theclientkeepsthedrainagebagbelowthebladderatalltimes

Theclientclampsthecatheterdrainagetubingwhilevisitingwiththefamily
Theclientloopsthedrainagetubingbelowitspointofentryintothedrainagebag

Question 36 Explanation:
To maintain effective drainage, the client should keep the drainage bag below the
bladder; this allows the urine to flow by gravity from the bladder to the drainage
bag. The client shouldnt lay the drainage bag on the floor because it could
become grossly contaminated. The client shouldnt clamp the catheter drainage
tubing because this impedes the flow of urine. To promote drainage, the client
may loop the drainage tubing above not below its point of entry into the
drainage bag.
Question37
CORRECT

A female adult client admitted with a gunshot wound to the abdomen is

transferred to the intensive care unit after an exploratory laparotomy. Which
assessment finding suggests that the client is experiencing acute renal failure
(ARF)?
Bloodureanitrogen(BUN)levelof22mg/dl
Serumcreatininelevelof1.2mg/dl
Serumcreatininelevelof1.2mg/dl
Urineoutputof400ml/24hours

Question 37 Explanation:
ARF, characterized by abrupt loss of kidney function, commonly causes oliguria,
which is demonstrated by a urine output of 400 ml/24 hours. A serum creatinine
level of 1.2 mg/dl isnt diagnostic of ARF. A BUN level of 22 mg/dl or a
temperature of 100.2 F (37.8 C) wouldnt result from this disorder.
Question38
CORRECT

When examining a female clients genitourinary system, Nurse Sandy assesses

for tenderness at the costovertebral angle by placing the left hand over this area
and striking it with the right fist. Normally, this percussion technique produces
which sound?
Aflatsound

Adullsound
Hyperresonance
Tympany

Question 38 Explanation:
Percussion over the costovertebral angle normally produces a dull, thudding
sound, which is soft to moderately loud with a moderate pitch and duration. This
sound occurs over less dense, mostly fluid-filled matter, such as the kidneys,
liver, and spleen. In contrast, a flat sound occurs over highly dense matter such
as muscle; hyperresonance occurs over the air-filled, overinflated lungs of a
client with pulmonary emphysema or the lungs of a child (because of a thin chest
wall); and tympany occurs over enclosed structures containing air, such as the
stomach and bowel.
Question39
CORRECT

When performing a scrotal examination, Nurse Payne finds a nodule. What

should the nurse do next?
Whenperformingascrotalexamination,NursePaynefindsanodule.Whatshouldthenursedo
next?
Changetheclientspositionandrepeattheexamination
Performarectalexamination
Transilluminatethescrotum

Question 39 Explanation:
A nurse who discovers a nodule, swelling, or other abnormal finding during a
scrotal examination should transilluminate the scrotum by darkening the room
and shining a flashlight through the scrotum behind the mass. A scrotum filled
with serous fluid transilluminates as a red glow; a more solid lesion, such as a
hematoma or mass, doesnt transilluminate and may appear as a dark shadow.
Although the nurse should notify the physician of the abnormal finding,
performing transillumination first provides additional information. The nurse cant
uncover more information about a scrotal mass by changing the clients position
and repeating the examination or by performing a rectal examination.
Question40

CORRECT

After undergoing transurethral resection of the prostate to treat benign prostatic

hyperplasia, a male client returns to the room with continuous bladder irrigation.
On the first day after surgery, the client reports bladder pain. What should Nurse
Anthony do first?
IncreasetheI.V.flowrate
Notifythephysicianimmediately
Assesstheirrigationcatheterforpatencyanddrainage
Administermeperidine(Demerol),50mgI.M.,asprescribed

Question 40 Explanation:
Although postoperative pain is expected, the nurse should make sure that other
factors, such as an obstructed irrigation catheter, arent the cause of the pain.
After assessing catheter patency, the nurse should administer an analgesic, such
as meperidine, as prescribed. Increasing the I.V. flow rate may worsen the pain.
Notifying the physician isnt necessary unless the pain is severe or unrelieved by
the prescribed medication.
Question41
WRONG

A female client with suspected renal dysfunction is scheduled for excretory

urography. Nurse January reviews the history for conditions that may warrant
changes in client preparation. Normally, a client should be mildly hypovolemic
(fluid depleted) before excretory urography. Which history finding would call for
the client to be well hydrated instead?
Cysticfibrosis
Multiplemyeloma
Gout
Myastheniagravis

Question 41 Explanation:
Fluid depletion before excretory urography is contraindicated in clients with
multiple myeloma, severe diabetes mellitus, and uric acid nephropathy
conditions that can seriously compromise renal function in fluid-depleted clients
with reduced renal perfusion. If these clients must undergo excretory urography,

they should be well hydrated before the test. Cystic fibrosis, gout, and
myasthenia gravis dont necessitate changes in client preparation for excretory
urography.
Question42
WRONG

Nurse Grace is assessing a male client diagnosed with gonorrheA. Which

symptom most likely prompted the client to seek medical attention?
Rashesonthepalmsofthehandsandsolesofthefeet
Cauliflowerlikewartsonthepenis
Painfulredpapulesontheshaftofthepenis
Foulsmellingdischargefromthepenis

Question 42 Explanation:
Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the
penis and painful urination. Rashes on the palms of the hands and soles of the
feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on
the penis are a sign of human papillomavirus. Painful red papules on the shaft of
the penis may be a sign of the first stage of genital herpes.
Question43
CORRECT

Nurse Mary is inserting a urinary catheter into a client who is extremely anxious
about the procedure. The nurse can facilitate the insertion by asking the client
to:
initiateastreamofurine
breathedeeply
turntotheside
holdthelabiaorshaftofpenis

Question 43 Explanation:
When inserting a urinary catheter, facilitate insertion by asking the client to
breathe deeply. Doing this will relax the urinary sphincter. Initiating a stream of
urine isnt recommended during catheter insertion. Turning to the side or holding
the labia or penis wont ease insertion, and doing so may contaminate the sterile
field.

Question44
CORRECT

Nurse Gil is aware that the following statements describing urinary incontinence
in the elderly is true?
Urinaryincontinenceisanormalpartofaging
Urinaryincontinenceisntadisease
Urinaryincontinenceintheelderlycantbetreated
Urinaryincontinenceisadisease

Question 44 Explanation:
Urinary incontinence isnt a normal part of aging nor is it a disease. It may be
caused by confusion, dehydration, fecal impaction, restricted mobility, or other
causes. Certain medications, including diuretics, hypnotics, sedatives,
anticholinergics, and antihypertensives, may trigger urinary incontinence. Most
clients with urinary incontinence can be treated; some can be cured.
Question45
CORRECT

A 26-year-old female client seeks care for a possible infection. Her symptoms
include burning on urination and frequent, urgent voiding of small amounts of
urine. Shes placed on trimethoprim-sulfamethoxazole (Bactrim) to treat possible
infection. Another medication is prescribed to decrease the pain and frequency.
Which of the following is the most likely medication prescribed?
nitrofurantoin(Macrodantin)
ibuprofen(Motrin)
acetaminophenwithcodeine
phenazopyridine(Pyridium)

Question 45 Explanation:
Phenazopyridine may be prescribed in conjunction with an antibiotic for painful
bladder infections to promote comfort. Because of its local anesthetic action on
the urinary mucosa, phenazopyridine specifically relieves bladder pain.
Nitrofurantoin is a urinary antiseptic with no analgesic properties. While
ibuprofen and acetaminophen with codeine are analgesics, they dont exert a
direct effect on the urinary mucosa.

Question46
WRONG

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a

female clients uremia. Which finding signals a significant problem during this
procedure?
Potassiumlevelof3.5mEq/L
Hematocrit(HCT)of35%
Bloodglucoselevelof200mg/dl
Whitebloodcell(WBC)countof20,000/mm3

Question 46 Explanation:
An increased WBC count indicates infection, probably resulting from peritonitis,
which may have been caused by insertion of the peritoneal catheter into the
peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability
to filter solutes; therefore, peritoneal dialysis would no longer be a treatment
option for this client. Hyperglycemia occurs during peritoneal dialysis because of
the high glucose content of the dialysate; its readily treatable with sliding-scale
insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to
the dialysate solution. An HCT of 35% is lower than normal. However, in this
client, the value isnt abnormally low because of the daily blood samplings. A
lower HCT is common in clients with chronic renal failure because of the lack of
erythropoietin.
Question47
CORRECT

A client is frustrated and embarrassed by urinary incontinence. Which of the

following measures should Nurse Ginny include in a bladder retraining program?
Establishingapredeterminedfluidintakepatternfortheclient
Encouragingtheclienttoincreasethetimebetweenvoidings
Restrictingfluidintaketoreducetheneedtovoid
Assessingpresenteliminationpatterns

Question 47 Explanation:
The guidelines for initiating bladder retraining include assessing the clients
intake patterns, voiding patterns, and reasons for each accidental voiding.

Lowering the clients fluid intake wont reduce or prevent incontinence. The client
should actually be encouraged to drink 1.5 to 2 L of water per day. A voiding
schedule should be established after assessment.
Question48
CORRECT

A male client with acute pyelonephritis receives a prescription for co-trimoxazole

(Septra) P.O. twice daily for 10 days. Which finding best demonstrates that the
client has followed the prescribed regimen?
Urineoutputincreasesto2,000ml/day.
Flankandabdominaldiscomfortdecrease.
Bacteriaareabsentonurineculture.
Theredbloodcell(RBC)countisnormal.

Question 48 Explanation:
Co-trimoxazole is a sulfonamide antibiotic used to treat urinary tract infections.
Therefore, absence of bacteria on urine culture indicates that the drug has
achieved its desired effect. Although flank pain may decrease as the infection
resolves, this isnt a reliable indicator of the drugs effectiveness. Co-trimoxazole
doesnt affect urine output or the RBC count.
Question49
CORRECT

A male client with chronic renal failure has a serum potassium level of 6.8
mEq/L. What should nurse Olivia assess first?
Bloodpressure
Respirations
Temperature
Pulse

Question 49 Explanation:
An elevated serum potassium level may lead to a life-threatening cardiac
arrhythmia, which the nurse can detect immediately by palpating the pulse. The
clients blood pressure may change, but only as a result of the arrhythmia.
Therefore, the nurse should assess blood pressure later. The nurse also can delay

assessing respirations and temperature because these arent affected by the

serum potassium level.
Question50
CORRECT

A female client is admitted for treatment of chronic renal failure (CRF). Nurse
Julian knows that this disorder increases the clients risk of:
waterandsodiumretentionsecondarytoaseveredecreaseintheglomerularfiltration
rate.
adecreasedserumphosphatelevelsecondarytokidneyfailure.
anincreasedserumcalciumlevelsecondarytokidneyfailure.
metabolicalkalosissecondarytoretentionofhydrogenions.

Question 50 Explanation:
A client with CRF is at risk for fluid imbalance dehydration if the kidneys fail to
concentrate urine, or fluid retention if the kidneys fail to produce urine.
Electrolyte imbalances associated with this disorder result from the kidneys
inability to excrete phosphorus; such imbalances may lead to
hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic
acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete
hydrogen ions.