Chapter 16: Renal and Urinary Problems

Question 1

The nurse is reviewing the lab values for a patient with risk for urinary problems. Which finding is of most concern to the nurse?

1. Blood urea nitrogen (BUN) of 10 mg/mL (3.6 mmol/L)
2. Presence of glucose and protein in urine
3. Serum creatinine of 0.6 mg/mL (53 mcmol/L)
4. Urinary pH of 8

Answer 1

Ans: 2
When blood glucose levels are greater than 220 mg/dL (12.2 mmol/L), some glucose stays in the filtrate and is present in the urine. Normally, almost all glucose and most proteins are reabsorbed and are not present in the urine. Report the presence of glucose or proteins in the urine of a patient undergoing a screening examination to the health care provider because this is an abnormal finding and requires further assessment. Focus: Prioritization.

Question 2

For which patient is the nurse most concerned about the risk for developing kidney disease?

1. A 25-year-old patient who developed a urinary tract infection (UTI) during pregnancy
2. A 55-year-old patient with a history of kidney stones
3. A 63-year-old patient with type 2 diabetes
4. A 79-year-old patient with stress urinary incontinence

Answer 2

Ans: 3
A history of chronic health problems, especially diabetes and hypertension, increases the risk for development of kidney disease. Focus: Prioritization.

Question 3

The nurse is caring for a patient with risk for kidney disease for whom a urinalysis has been ordered. What time would the nurse instruct the unlicensed assistive personnel is best to collect this sample?

1. With first morning void
2. Before any meal
3. At bedtime
4. Immediately

Answer 3

Ans: 1
Urinalysis is a part of any complete physical examination and is especially useful for patients with suspected kidney or urologic disorders. Ideally, the urine specimen is collected at the morning’s first voiding. Specimens obtained at other times may be too dilute. Focus: Delegation, Supervision.

Question 4

The nurse has delegated collection of a urinalysis specimen to an experienced unlicensed assistive personnel (UAP). For which action must the nurse intervene?

1. The UAP provides the patient with a specimen cup.
2. The UAP reminds the patient of the need for the specimen.
3. The UAP assists the patient to the bathroom.
4. The UAP allows the specimen to sit for more than 1 hour.

Answer 4

Ans: 4
Urine specimens become more alkaline when left standing unrefrigerated for more than 1 hour, when bacteria are present, or when a specimen is left uncovered. Alkaline urine increases cell breakdown; thus, the presence of red blood cells may be missed on analysis. Ensure that urine specimens are covered and delivered to the laboratory promptly or refrigerated. Actions 1, 2, and 3 are appropriate for urinalysis specimen collection. Focus: Delegation, Supervision.

Question 5

The nurse is caring for a patient with risk for incomplete bladder emptying. Which noninvasive finding best supports this problem?

1. Patient is able to void additional 100 mL after nurse massages over the bladder.
2. Patient voids additional 350 mL with insertion of an intermittent catheter.
3. Patient has postvoid residual of 275 mL documented by bedside bladder scanner.
4. Patient has constant dribbling between voidings.

Answer 5

Ans: 3
The use of portable ultrasound scanners in the hospital and rehabilitation setting by nurses is a noninvasive method of estimating bladder volume. Bladder scanners are used to screen for postvoid residual volumes and to determine the need for intermittent catheterization based on the amount of urine in the bladder rather than the time between catheterizations. There is no discomfort with the scan, and no patient preparation beyond an explanation of what to expect is required. Use of bladder massage or presence of urinary dribbling is inexact, and intermittent catheterization is invasive. Focus: Prioritization.

Question 6

The nurse is providing care for a patient after a kidney biopsy. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? Select all that apply.

1. Check vital signs every 4 hours for 24 hours.
2. Remind the patient about strict bed rest for 2 to 6 hours.
3. Reposition the patient by log-rolling with supporting backroll.
4. Measure and record urine output.
5. Assess the dressing site for bleeding and check complete blood count results.
6. Teach the patient to resume normal activities after 24 hours if there is no bleeding.

Answer 6

Ans: 1, 2, 3, 4
Checking vital signs, repositioning patients, and recording intake and output are within the scope of practice for a UAP. Assessing and teaching are more within the scope of practice for professional nurses. If no bleeding occurs, the patient can resume general activities after 24 hours. However, instruct him or her to avoid lifting heavy objects, exercising, and performing other strenuous activities for 1 to 2 weeks after the biopsy procedure. Driving may also be restricted. Focus: Delegation, Supervision.

Question 7

The nurse is providing nursing care for a 24-year-old female patient admitted to the acute care unit with a diagnosis of cystitis. Which intervention should the nurse delegate to the unlicensed assistive personnel (UAP)?

1. Teaching the patient how to secure a clean-catch urine sample
2. Assessing the patient’s urine for color, odor, and sediment
3. Reviewing the nursing care plan and add nursing interventions
4. Providing the patient with a clean-catch urine sample container

Answer 7

Ans: 4
Providing the equipment that the patient needs to collect the urine sample is within the scope of practice of a UAP. Teaching, planning, and assessing all require additional education and skill, which is appropriate to the scope of practice of professional nurses. Focus: Delegation, Supervision.

Question 8

Which laboratory result is of most concern to the nurse for an adult patient with cystitis?

1. Serum white blood cell (WBC) count of 9000/mm3 (9 x 109/L)
2. Urinalysis results showing 1 or 2 WBCs present
3. Urine bacteria count of 100,000 colonies per milliliter
4. Serum hematocrit of 36%

Answer 8

Ans: 3
The presence of 100,000 bacterial colonies per milliliter of urine or the presence of many white blood cells (WBCs) and red blood cells (RBCs) indicates a urinary tract infection. This WBC count is within normal limits, and the hematocrit is a little low, which may need follow-up. Neither of these results indicates infection. Focus: Prioritization; Test Taking Tip: It is essential that the nurse be alert to any signs or symptoms of infection for a patient. In this case, the presence of so many bacterial colonies indicate the presence of an infection in the bladder, which needs to be treated with antibiotics.

Question 9

The charge nurse would assign the nursing care of which patient to an LPN/LVN, working under the supervision of an RN?

1. A 48-year-old patient with cystitis who is taking oral antibiotics
2. A 64-year-old patient with kidney stones who has a new order for lithotripsy
3. A 72-year-old patient with urinary incontinence who needs bladder training
4. A 52-year-old patient with pyelonephritis who has severe acute flank pain

Answer 9

Ans: 1
The patient with cystitis who is taking oral antibiotics is in stable condition with predictable outcomes, and caring for this patient is therefore appropriate to the scope of practice of an LPN/LVN under the supervision of an RN. The patient with a new order for lithotripsy will need teaching about the procedure, which should be accomplished by the RN. The patient in need of bladder training will need the RN to plan this intervention. The patient with flank pain needs careful and skilled assessment by the RN. Focus: Assignment.

Question 10

The nurse is admitting a 66-year-old male patient suspected of having a urinary tract infection (UTI). Which part of the patient’s medical history supports this diagnosis?

1. Patient’s wife had a UTI 1 month ago
2. Followed for prostate disease for 2 years
3. Intermittent catheterization 6 months ago
4. Kidney stone removal 1 year ago

Answer 10

Ans: 2
Prostate disease increases the risk of UTIs in men because of urinary retention. The wife’s UTI should not affect the patient. The times of the catheter usage and kidney stone removal are too distant to cause this UTI. Focus: Prioritization.

Question 11

A patient is being admitted to rule out interstitial cystitis. What should the nurse’s plan of care for this patient include specific to this diagnosis?

1. Take daily urine samples for urinalysis.
2. Maintain accurate intake and output records.
3. Obtain an admission urine sample to determine electrolyte levels.
4. Teach the patient about the cystoscopy procedure.

Answer 11

Ans: 4
A cystoscopy is needed to accurately diagnose interstitial cystitis. Urinalysis may show white blood cells and red blood cells but no bacteria. The patient will probably need a urinalysis upon admission, but daily samples do not need to be obtained. Intake and output may be assessed, but results will not contribute to the diagnosis. Cystitis does not usually affect urine electrolyte levels. Focus: Prioritization.

Question 12

The RN is supervising a new graduate nurse who is orientating to the unit. The new nurse asks why the patient with uncomplicated cystitis is being discharged with a prescription for ciprofloxacin 250 mg twice a day for only 3 days. What is the RN’s best response?

1. “We should check with the health care provider because the patient should take this drug for 10 to 14 days.”
2. “A 3-day course of ciprofloxacin is not the appropriate treatment for a patient with uncomplicated cystitis.”
3. “Research has shown that a 3-day course of ciprofloxacin is effective for uncomplicated cystitis and there is increased patient adherence to the plan of care.”
4. “Longer courses of antibiotic therapy are required for hospitalized patients to prevent nosocomial infections.”

Answer 12

Ans: 3
For uncomplicated cystitis, a 3-day course of antibiotics is an effective treatment, and research has shown that patients are more likely to adhere to shorter antibiotic courses. Seven-day courses of antibiotics are appropriate for complicated cystitis, and 10- to 14-day courses are prescribed for uncomplicated pyelonephritis. This patient is being discharged and should not be at risk for a nosocomial infection. Focus: Prioritization, Supervision.

Question 13

A 28-year-old married female patient with cystitis requires instruction about how to prevent future urinary tract infections (UTIs). The supervising RN has assigned this teaching to a newly graduated nurse. Which statement by the new graduate requires that the supervising RN intervene?

1. “You should always drink 2 to 3 L of fluid every day.”
2. “Empty your bladder regularly even if you do not feel the urge to urinate.”
3. “Drinking cranberry juice daily will decrease the number of bacteria in your bladder.”
4. “It’s okay to soak in the tub with bubble bath because it will keep you clean.”

Answer 13

Ans: 4
Women should avoid irritating substances such as bubble baths, nylon underwear, and scented toilet tissue to prevent UTIs. Adequate fluid intake, consumption of cranberry juice, and regular voiding are all good strategies for preventing UTIs. Focus: Assignment, Supervision, Prioritization.

Question 14

The nurse is creating a care plan for older adult patients with incontinence. For which patient will a bladder-training program be an appropriate intervention?

1. Patient with functional incontinence caused by mental status changes
2. Patient with stress incontinence due to weakened bladder neck support
3. Patient with urge incontinence and abnormal detrusor muscle contractions
4. Patient with transient incontinence related to loss of cognitive function

Answer 14

Ans: 3
A patient with urge incontinence can be taught to control the bladder as long as the patient is alert, aware, and able to resist the urge to urinate by starting a schedule for voiding, then increasing the intervals between voids. Patients with functional incontinence related to mental status changes or loss of cognitive function are not able to follow a bladder-training program. A better treatment for a patient with stress incontinence is exercises such as pelvic floor (Kegel) exercises to strengthen the pelvic floor muscles. Focus: Prioritization.

Question 15

A patient with incontinence will be taking oxybutynin chloride 5 mg by mouth three times a day after discharge. Which information would a nurse be sure to teach this patient before discharge?

1. “Drink fluids or use hard candy when you experience a dry mouth.”
2. “Be sure to notify your health care provider (HCP) if you experience a dry mouth.”
3. “If necessary, your HCP can increase your dose up to 40 mg/day.”
4. “You should take this medication with meals to avoid stomach ulcers.”

Answer 15

Ans: 1
Oxybutynin is an anticholinergic agent, and these drugs often cause an extremely dry mouth. The maximum dosage is 20 mg/day. Oxybutynin should be taken between meals because food interferes with absorption of the drug. Focus: Prioritization.

Question 16

The nurse is providing care for a patient with reflex urinary incontinence. Which action could be appropriately assigned to a new LPN/LVN?

1. Teaching the patient bladder emptying by the Credé method
2. Demonstrating how to perform intermittent self-catheterization
3. Discussing when to report the side effects of bethanechol chloride to the health care provider (HCP)
4. Reinforcing the importance of proper hand washing to prevent infection

Answer 16

Ans: 4
Teaching about bladder emptying, self-catheterization, and when to notify the HCP about medication side effects requires additional knowledge and training and is appropriate to the scope of practice of the RN. The LPN/LVN can reinforce information that has already been taught to the patient. Focus: Assignment, Supervision.

Question 17

A patient has urolithiasis and is passing the stones into the lower urinary

tract. What is the priority nursing concern for the patient at this time?
1. Pain
2. Infection
3. Injury
4. Anxiety

Answer 17

Ans: 1
When patients with urolithiasis pass stones, they can be in excruciating pain for as much as 24 to 36 hours. All of the other nursing concerns for this patient are accurate; however, at this time, pain is the most urgent concern for the patient. Focus: Prioritization.

Question 18

The RN is supervising a nurse orientating to the acute care unit who is discharging a patient admitted with kidney stones and who underwent lithotripsy. Which statement by the orienting nurse to the patient requires that the supervising RN intervene?

1. “You should finish all of your antibiotics to make sure that you don’t get a urinary tract infection (UTI).”
2. “Remember to drink at least 3 L of fluids every day to prevent another stone from forming.”
3. “Report any signs of bruising to your health care provider (HCP) immediately because this indicates bleeding.”
4. “You can return to work in 2 days to 6 weeks, depending on what your HCP prescribes.”

Answer 18

Ans: 3
Bruising is to be expected after lithotripsy. It may be quite extensive and take several weeks to resolve. All of the other statements are accurate for a patient after lithotripsy. Focus: Assignment, Supervision, Prioritization.

Question 19

The RN is teaching a patient how to perform intermittent self-catheterization for a long-term problem with incomplete bladder emptying. Which are important points for teaching this technique? Select all that apply.

1. Always use sterile techniques.
2. Proper hand washing and cleaning of the catheter reduce the risk for infection.
3. A small lumen and good lubrication of the catheter prevent urethral trauma.
4. A regular schedule for bladder emptying prevents distention and mucosal trauma.
5. The social work department can help you with the purchase of sterile supplies.
6. If you are uncomfortable with this procedure, a home health nurse can do it.

Answer 19

Ans: 2, 3, 4
Intermittent self-catheterization is often used to help patients with long-term problems of incomplete bladder emptying. It is not a sterile procedure and does not require sterile equipment. It is a clean procedure. Important teaching points include responses 2, 3, and 4 of this question. Focus: Prioritization.

Question 20

The charge nurse must rearrange room assignments to admit a new patient. Which two patients would be best suited to be roommates?

1. A 58-year-old patient with urothelial cancer receiving multiagent chemotherapy
2. A 63-year-old patient with kidney stones who has just undergone open ureterolithotomy
3. A 24-year-old patient with acute pyelonephritis and severe flank pain
4. A 76-year-old patient with urge incontinence and a urinary tract infection (UTI)

Answer 20

Ans: 3, 4
Both of these patients will need frequent assessments and medications. The patient receiving chemotherapy and the patient who has just undergone surgery should not be exposed to any patient with infection. Focus: Assignment, Prioritization.

Question 21

The patient problem of constipation related to compression of the intestinal tract has been identified in a patient with polycystic kidney disease. Which care action should the nurse assign to a newly-trained LPN/LVN?

1. Instructing the patient about foods that are high in fiber
2. Teaching the patient about foods that assist in promoting bowel regularity
3. Assessing the patient for previous bowel problems and bowel routine
4. Administering docusate sodium 100 mg by mouth twice a day

Answer 21

Ans: 4
Administering oral medications appropriately is covered in the educational program for LPNs/LVNs and is within their scope of practice. Teaching and assessing the patient require additional education and skill and are appropriate to the scope of practice of RNs. Focus: Assignment, Supervision.

Question 22

A male patient must undergo intermittent catheterization. The nurse is preparing to insert a catheter to assess the patient for postvoid residual. Place the steps for intermittent catheterization in the correct order.

1. Assist the patient to the bathroom and ask the patient to attempt to void.
2. Retract the foreskin and hold the penis at a 60- to 90-degree angle.
3. Open the catheterization kit and put on sterile gloves.
4. Lubricate the catheter and insert it through the meatus of the penis.
5. Position the patient supine in bed or with the head slightly elevated.
6. Drain all the urine present in the bladder into a container.
7. Cleanse the glans penis starting at the meatus and working outward.
8. Remove the catheter, clean the penis, and measure the amount of urine returned.

Answer 22

Ans: 1, 5, 3, 2, 7, 4, 6, 8
Before checking postvoid residual, the RN should ask the patient to void and then position him. Next the nurse should open the catheterization kit and put on sterile gloves, position the patient’s penis, clean the meatus, and then lubricate and insert the catheter. All urine must be drained from the bladder to assess the amount of postvoid residual the patient has. Finally, the catheter is removed, the penis cleaned, and the urine measured. Focus: Prioritization; Test Taking Tip: For this type of question, the nurse must stop and think about the correct steps for performing a nursing action and then place them in the correct order.

Question 23

The nurse is admitting a patient with nephrotic syndrome. Which assessment finding supports this diagnosis?

1. Edema formation
2. Hypotension
3. Increased urine output
4. Flank pain

Answer 23

Ans: 1
The underlying pathophysiology of nephrotic syndrome involves increased glomerular permeability, which allows larger molecules to pass through the membrane into the urine and be removed from the blood. This process causes massive loss of protein, edema formation, and decreased serum albumin levels. Key features include hypertension and renal insufficiency (decreased urine output) related to concurrent renal vein thrombosis, which may be a cause or an effect of nephrotic syndrome. Flank pain is seen in patients with acute pyelonephritis. Focus: Prioritization.

Question 24

When the nurse must apply containment strategies for a patient with incontinence, what is the major risk?

1. Incontinence-associated dermatitis
2. Skin breakdown
3. Infection
4. Fluid imbalance

Answer 24

Ans: 2
A major concern with the use of wearable protective pads is the risk for skin breakdown. Some patients may develop incontinence-associated dermatitis even when the skin is kept free of contact with urine because wearable pads generate heat and sweat in the area and can cause dermatitis. Infection becomes a risk when skin breakdown occurs. Focus: Prioritization.

Question 25

The nurse is caring for a patient with renal cell carcinoma (adenocarcinoma of the kidney). While serving as preceptor for a new nurse orienting to the unit, the nurse is asked why this patient is not receiving chemotherapy. What is the best response?

1. “The prognosis for this form of cancer is very poor, and we will be providing only comfort measures.”
2. “Nephrectomy is the preferred treatment because chemotherapy has been shown to have only limited effectiveness against this type of cancer.”
3. “Research has shown that the most effective means of treating this form of cancer is with radiation therapy.”
4. “Radiofrequency ablation is a minimally invasive procedure that is the best way to treat renal cell carcinoma.”

Answer 25

Ans: 2
Chemotherapy has limited effectiveness against renal cell carcinoma. This form of cancer is usually treated surgically with nephrectomy. Focus: Supervision, Prioritization.

Question 26

The nurse is teaching a patient how best to prevent renal trauma after an injury that required a left nephrectomy. Which points would the nurse include in the teaching plan? Select all that apply.

1. Always wear a seat belt.
2. Avoid contact sports.
3. Practice safe walking habits.
4. Wear protective clothing if you participate in contact sports.
5. Use caution when riding a bicycle.
6. Always avoid use of drugs that may damage the kidney.

Answer 26

Ans: 1, 2, 3, 5
A patient with only one kidney should avoid all contact sports and high-risk activities to protect the remaining kidney from injury and preserve kidney function. Protective clothing may not be enough to protect the patient’s remaining kidney. Drugs that may cause kidney damage may still be prescribed, especially to save a patient’s life. All of the other points are key to preventing renal trauma. Focus: Prioritization.

Question 27

The nurse is providing nursing care for a patient with acute kidney failure for whom volume overload has been identified. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? Select all that apply.

1. Measuring and recording vital sign values every 4 hours
2. Weighing the patient every morning using a standing scale
3. Administering furosemide 40 mg orally twice a day
4. Reminding the patient to save all urine for intake and output measurement
5. Assessing breath sounds every 4 hours
6. Ensuring that the patient’s urinal is within reach

Answer 27

Ans: 1, 2, 4, 6
Administering oral medications is appropriate to the scope of practice for an LPN/LVN or RN. Assessing breath sounds requires additional education and skill development and is most appropriately within the scope of practice of an RN, but it may be part of the observations of an experienced and competent LPN/LVN. All other actions are within the educational preparation and scope of practice of an experienced UAP. Focus: Delegation, Supervision.

Question 28

An unlicensed assistive personnel (UAP) reports to the RN that a patient with acute kidney failure had a urine output of 350 mL over the past 24 hours after receiving furosemide 40 mg IV push. The UAP asks the nurse how this can happen. What is the nurse’s best response?

1. “During the oliguric phase of acute kidney failure, patients often do not respond well to either fluid challenges or diuretics.”
2. “There must be some sort of error. Someone must have failed to record the urine output.”
3. “A patient with acute kidney failure retains sodium and water, which counteracts the action of the furosemide.”
4. “The gradual accumulation of nitrogenous waste products results in the retention of water and sodium.”

Answer 28

Ans: 1
During the oliguric phase of acute kidney failure, a patient’s urine output is greatly reduced. Fluid boluses and diuretics do not work well. This phase usually lasts from 8 to 15 days. Although there are occasionally omissions in recording intake and output, this is probably not the cause of the patient’s decreased urine output. Retention of sodium and water is the rationale for giving furosemide, not the reason that it is ineffective. Nitrogenous wastes build up as a result of the kidneys’ inability to perform their elimination function. Focus: Prioritization, Supervision.

Question 29

Which patient will the charge nurse assign to an RN floated to the acute care unit from the surgical intensive care unit (SICU)?

1. A patient with kidney stones scheduled for lithotripsy this morning
2. A patient who has just undergone surgery for renal stent placement
3. A newly admitted patient with an acute urinary tract infection (UTI)
4. A patient with chronic kidney failure who needs teaching on peritoneal dialysis

Answer 29

Ans: 2
A nurse from the surgical ICU will be thoroughly familiar and comfortable with the care of patients who have just undergone surgery. The patient scheduled for lithotripsy may need education about the procedure. The newly admitted patient needs an in-depth admission assessment, and the patient with chronic kidney failure needs teaching about peritoneal dialysis. All of these interventions would best be accomplished by an experienced nurse with expertise in the care of patients with kidney problems. Focus: Assignment.

Question 30

The patient is receiving IV piggyback doses of gentamicin every 12 hours. Which would be the nurse’s priority for monitoring during the period that the patient is receiving this drug?

1. Serum creatinine and blood urea nitrogen levels
2. Patient weight every morning
3. Intake and output every shift
4. Temperature

Answer 30

Ans: 1
Gentamicin can be a highly nephrotoxic substance. The nurse would monitor creatinine and blood urea nitrogen levels for elevations indicating possible nephrotoxicity. All of the other measures are important but are not specific to gentamicin therapy. Focus: Prioritization.

Question 31

A patient diagnosed with acute kidney failure had a urine output of 1560 mL for the past 8 hours. The LPN/LVN who is caring for this patient under the RN’s supervision asks how a patient with kidney failure can have such a large urine output. What is the RN’s best response?

1. “The patient’s kidney failure was caused by hypovolemia, and we have given him IV fluids to correct the problem.”
2. “Acute kidney failure patients go through a diuretic phase when their kidneys begin to recover and may put out as much as 10 L of urine per day.”
3. “With that much urine output, there must have been a mistake in the patient’s diagnosis.”
4. “An increase in urine output like this is an indicator that the patient is entering the recovery phase of acute kidney failure.”

Answer 31

Ans: 2
Patients with acute kidney failure usually go through a diuretic phase 2 to 6 weeks after the onset of the oliguric phase. The diuresis can result in an output of up to 10 L/day of dilute urine. During this phase, it is important to monitor for electrolyte and fluid imbalances. This is followed by the recovery phase. A patient with acute kidney failure caused by hypovolemia would receive IV fluids to correct the problem; however, this would not necessarily lead to the onset of diuresis. Focus: Supervision.

Question 32

A patient on the medical-surgical unit with acute kidney failure is to begin continuous arteriovenous hemofiltration (CAVH) as soon as possible. What is the priority collaborative action at this time?

1. Call the charge nurse and arrange to transfer the patient to the intensive care unit.
2. Develop a teaching plan for the patient that focuses on CAVH.
3. Assist the patient with morning bath and mouth care before transfer.
4. Notify the health care provider (HCP) that the patient’s mean arterial pressure is 68 mm Hg.

Answer 32

Ans: 1
CAVH is a continuous renal replacement therapy that is prescribed for patients with kidney failure who are critically ill and do not tolerate the rapid shifts in fluids and electrolytes that are associated with hemodialysis. A teaching plan is not urgent at this time. A patient must have a mean arterial pressure (MAP) of at least 60 mm Hg or more for CAVH to be of use. The HCP should be notified about this patient’s MAP; it is a priority but not the highest priority. When a patient urgently needs a procedure, morning care does not take priority and may be deferred until later in the day. Focus: Prioritization.

Question 33

The nurse is caring for a patient admitted with dehydration secondary to deficient antidiuretic hormone (ADH). Which specific gravity value supports this diagnosis?

1. 1.010
2. 1.035
3. 1.020
4. 1.002

Answer 33

Ans: 4
A patient with dehydration due to deficient ADH would have diluted urine with a decreased urine specific gravity. Normal urine specific gravity ranges from 1.003 to 1.030. A specific gravity of 1.035 would indicate urine that is concentrated. Focus: Prioritization.

Question 34

The RN is supervising a senior nursing student who is caring for a 78-year- old patient scheduled for an intravenous pyelography test. What information would the RN be sure to stress about this procedure to the nursing student?

1. “After the procedure, monitor urine output because contrast dye increases the risk for kidney failure in older adults.”
2. “The purpose of this procedure is to measure kidney size.”
3. “Because this procedure assesses kidney function, there is no need for a bowel prep.”
4. “Keep the patient NPO after the procedure because during the procedure the patient will receive drugs that affect the gag reflex.”

Answer 34

Ans: 1
The risk for contrast-induced kidney failure is greatest in patients who are older or dehydrated. If possible, arrange for the patient to have this procedure early in the day to prevent dehydration. The purpose of this procedure is to assess kidney function and identify anomalies. The administration of drugs that affect the gag reflex is not done during this procedure. Focus: Supervision, Prioritization.

Question 35

The RN supervising a senior nursing student is discussing methods for preventing acute kidney injury (AKI). Which points would the RN be sure to include in this discussion? Select all that apply.

1. Encourage patients to avoid dehydration by drinking adequate fluids.
2. Instruct patients to drink extra fluids during periods of strenuous exercise.
3. Immediately report a urine output of less than 2 mL/kg/hr.
4. Record intake and output and weigh patients daily.
5. Question any prescriptions for potentially nephrotoxic drugs.
6. Monitor laboratory values that reflect kidney function.

Answer 35

Ans: 1, 2, 4, 6
Dehydration reduces perfusion and can lead to AKI. Patients should be encouraged to take in adequate fluids, and extra fluids should be taken in during strenuous exercise. Intake and output, as well as daily weights, should be documented. Lab values that indicate kidney function should be followed. The health care provider should be notified for a urine output of less than 0.5 mL/kg/hr that persists for more than 2 hours. Many drugs are potentially nephrotoxic but as still administered. Patients are encouraged to take in extra fluids, and nurses must monitor for any nephrotoxic effects when these drugs are prescribed. Focus: Prioritization.

Question 36

The nurse is caring for a patient with chronic kidney disease after hemodialysis. Which patient care action should the nurse delegate to the experienced unlicensed assistive personnel (UAP)?

1. Assess the patient’s access site for a thrill and bruit.
2. Monitor for signs and symptoms of postdialysis bleeding.
3. Check the patient’s postdialysis blood pressure and weight.
4. Instruct the patient to report signs of dialysis disequilibrium syndrome immediately.

Answer 36

Ans: 3
Checking vital signs and weighing patients are within the scope of practice for the UAP. However, the nurse must be sure to caution the UAP to check BP in the arm opposite to the access site. Assessing, teaching, and monitoring require additional skills that fit within the scope of practice for the professional nurse. Focus: Delegation.