nclex question
halago73
RENAL.pdf
1- When a client diagnosed with acute urinary retention is emergently catheterized, the nurse should initially assess for which priority manifestation that may occur as a result of the catheterization?
1.
Dysuria
2.
Hypotension
3.
Infection
4.
Tachycardia
2- The nurse provides post-procedure teaching for a female client who had a
cystoscopy as an outpatient. Which client statement indicates the need for additional instruction?
1.
"I can expect pink-tinged urine for at least 24 hours."
2.
"I can take a warm bath and acetaminophen if I have discomfort or bladder spasms."
3.
"I should expect frequency and burning when I urinate."
4.
"I should expect to see blood clots in my urine for up to 24 hours."
3- A 65-year-old client with end-stage renal disease comes to the emergency department after missing 5 hemodialysis sessions. Serum potassium level is 7.5 mEq/L (7.5 mmol/L) and ECG shows tall, peaked T waves. Which prescription will immediately protect the client from experiencing dysrhythmias associated with hyperkalemia?
1.
Intravenous calcium gluconate
2.
Intravenous regular insulin with dextrose
3.
Oral sodium polystyrene sulfonate
4.
Transport to hemodialysis unit
4- A client with chronic kidney disease is admitted with pneumonia and pleurisy. The client's laboratory results are shown in the exhibit. Which prescription will the nurse question?
1.
Acetaminophen 500 mg PO every 6 hours, as needed for fever
2.
Epoetin alfa 15,000 units subcutaneus injection, once weekly
3.
Ketorolac 15 mg IV every 6 hours, as needed for pain
4.
Levofloxacin 500 mg IV, once daily
5- A nurse is caring for a child with acute glomerulonephritis. Frequent monitoring of which of the following is a priority?
1.
Blood pressure
2.
Hematuria
3.
Intake and output
4.
Peripheral edema
6- A nurse is reviewing the laboratory values for a 3-year-old client with nephrotic syndrome. The nurse interprets the results to most clearly reflect which physiologic process related to nephrotic syndrome?
1.
Glomerular injury
2.
Hepatic impairment
3.
Inherited hypercholesterolemia
4.
Malnutrition
7- The nurse assesses a pediatric client who was diagnosed with diarrhea caused by Escherichia coli. The nurse is most concernedwith which finding?
1.
Blood-streaked stools
2.
Client drank fruit juice
3.
Dry mucous membranes
4.
Petechiae noted on the trunk
8- The nurse is providing discharge instructions to a client receiving oxybutynin for overactive bladder. Which client statement indicates that further teaching is required?
1.
"I am looking forward to our summer vacation at the beach."
2.
"I plan to eat more fruits and vegetables to prevent constipation."
3.
"I should not drive until I know how this drug affects me."
4.
"I will drink at least 6-8 glasses of water daily."
9- The nurse is caring for a 68-year-old male client following a laparoscopic cholecystectomy 8 hours ago. The client has not urinated since surgery. Which would be the most appropriate initial intervention?
1.
Conduct a bladder scan
2.
Help the client out of bed
3.
Insert an indwelling catheter using sterile technique
4.
Obtain a prescription for intermittent catheterization
10- A client underwent a transurethral resection of the prostate (TURP) today and has a 3-way Foley urinary catheter with continuous bladder irrigation (CBI). The client reports lower abdominal pain rated as an 8 on a scale of 0-10. What action should the nurse carry out first?
1.
Administer prescribed belladonna-opium suppositories prn
2.
Administer prescribed morphine intravenous push prn
3.
Check amount and characteristics of urine output
4.
Check when the client had the last flatus or bowel movement
11- The nurse reviews the serum laboratory results of assigned clients. Which results are most important to report to the health care provider? Select all that apply.
1.
Client with a malignancy prescribed filgrastim has neutropenia
2.
Client with acute osteomyelitis prescribed vancomycin has leukocytosis
3.
Client with acute pancreatitis prescribed hydromorphone has an elevated lipase level
4.
Client with hypertension prescribed candesartan has hyperkalemia
5.
Client with peritonitis prescribed tobramycin has an elevated creatinine level
12- The nurse reinforces teaching about self-management strategies for a client with urge incontinence. Which of the following statements indicate that teaching has been effective? Select all that apply.
1.
"I am going to join a walking program to lose excess weight."
2.
"I may have dry mouth as a side effect from the oxybutynin."
3.
"I really need caffeine to get myself going in the morning."
4.
"I should perform Kegel exercises several times daily."
5.
"I will void every 2 hours until I am having fewer accidents."
13- A nurse is preparing an educational presentation on herbal supplements for the local community center. Saw palmetto is one herbal medicine being discussed. Which audience participants would find this information beneficial?
1.
Clients diagnosed with heart failure
2.
Clients experiencing major depressive disorder
3.
Elderly clients with benign prostatic hyperplasia
4.
Perimenopausal clients experiencing hot flashes
14- The nurse is caring for a client with overflow urinary incontinence related to diabetic neuropathy. Which of the following interventions are appropriate? Select all that apply.
1.
Decrease fluid intake to 1 glass with each meal and at bedtime
2.
Encourage the client to bear down while attempting to void
3.
Inspect the perineal area for evidence of skin breakdown
4.
Measure postvoid residual volumes as prescribed
5.
Tell the client to wait 30 seconds after voiding and then attempt to void again
15- A nurse is caring for a client 2 days after surgical creation of an arteriovenous fistula in the forearm. Which finding should the nurse report immediately to the health care provider?
1.
2+ pitting edema of the extremity with the arteriovenous fistula
2.
Loud swooshing sound auscultated over the arteriovenous fistula
3.
Pale skin of the hand of the arm with the arteriovenous fistula
4.
Surgical site pain reported by the client as 3 on a scale of 0-10 during hand exercises
16- The nurse is caring for a 72-year-old client with a history of renal calculi and diabetes mellitus who was admitted for acute pyelonephritis. The nurse assesses shaking chills, temperature of 101.2 F (38.4 C), and flank pain. Which of the following is the priority nursing intervention?
1.
Administer intravenous antibiotics
2.
Check baseline serum creatinine level
3.
Have the client strain all urine
4.
Obtain blood and urine cultures
17- The nurse is caring for a client whose peritoneal dialysis is beginning to exhibit insufficient outflow. What actions should the nurse perform initially? Select all that apply.
1.
Assess for abdominal distention and constipation
2.
Contact the client's health care provider
3.
Examine the catheter for kinks and obstructions
4.
Flush the tubing with 100 mL of dialysate
5.
Place the client in a side-lying position
18- The health care provider prescribes phenazopyridine hydrochloride for a client with a urinary tract infection. What would the office nurse teach the client to expect while taking this medication?
1.
Constipation
2.
Difficulty sleeping
3.
Discoloration of urine
4.
Dry mouth
19- The nurse gathers a health history from a 58-year-old male client with acute urinary
retention. Which of the following questions should the nurse ask to aid in assessing for
benign prostatic hyperplasia? Select all that apply.
1.
"Do you feel the need to urinate again immediately after urinating?"
2.
"Do you have to strain to begin your stream of urine?"
3.
"How often do you engage in sexual intercourse?"
4.
"How often do you wake at night with the urge to urinate?"
5.
"Is your stream of urine weak or intermittent?"
20- The nurse cares for a client scheduled for a percutaneous left kidney biopsy as an outpatient. Which intervention should the nurse include in the client's post- procedure care plan?
1.
Compare pre- and post-procedure BUN and creatinine levels
2.
Insert and maintain the patency of an indwelling urinary catheter
3.
Maintain prone position for at least 30 minutes
4.
Monitor vital signs every 15 minutes for the first hour
21- The health care provider is starting an elderly client on terazosin to treat benign prostatic hyperplasia (BPH). Which information should be included when teaching this client about the new medication?
1.
Change positions slowly when going from lying to standing
2.
Do not drink grapefruit juice when taking this drug
3.
Take this medication first thing in the morning, before breakfast
4.
Your stool may become darker and that's normal
22- A client diagnosed with acute glomerulonephritis has pitting edema in both lower extremities, blood pressure of 170/80 mm Hg, and proteinuria. When developing a plan of care for this client, the nurse should include which most accurate indicator of fluid loss or gain?
1.
Blood pressure measurements
2.
Daily weight measurements
3.
Intake and output measurements
4.
Severity of pitting edema
23- The nurse is caring for a client who received extracorporeal shock wave lithotripsy with ureteral stent placement for treatment of a kidney stone. Which discharge instructions provided by the nurse are appropriate? Select all that apply.
1.
"Contact your health care provider if you develop a fever or chills."
2.
"Except for using the bathroom, you should stay on bed rest for the next 48 hours."
3.
"Increase your fluid intake to help flush out the kidney stone fragments."
4.
"It is common to have some blood in the urine up to 24 hours after this procedure."
5.
"You may develop some bruising on your back or on the side of your abdomen."
24- A client is receiving IV sodium bicarbonate for acute metabolic acidosis. Which of these laboratory values would best indicate that the sodium bicarbonate has been effective?
1.
Serum pH 7.32, HCO3- 26 mEq/L (26 mmol/L), potassium 4.9 mEq/L (4.9 mmol/L)
2.
Serum pH 7.34, HCO3- 21 mEq/L (21 mmol/L), potassium 5.1 mEq/L (5.1 mmol/L)
3.
Serum pH 7.39, HCO3- 24 mEq/L (24 mmol/L), potassium 3.8 mEq/L (3.8 mmol/L)
4.
Serum pH 7.41, HCO3- 18 mEq/L (18 mmol/L), potassium 4.3 mEq/L (4.3 mmol/L)
25- A client with chronic kidney disease has blood laboratory results as shown in the exhibit. What is the best afternoon snack to provide to this client?
1.
Apple slices with caramel dip
2.
Chips and avocado dip
3.
Nonfat yogurt with orange slices
4.
Vanilla pudding with strawberries
26- The charge nurse is making rounds and should immediately intervene when making which observation?
1.
A new nurse is using gentle pressure to flush a kidney pelvis catheter with 5 mL of fluid
2.
A nursing assistant is hanging a urinary drainage bag on the back of a wheelchair when
transporting a client
3.
Indwelling urinary catheter is taped to a male client's inner thigh
4.
Total oral fluid intake in 24 hours for a client with a urinary diversion device is 2,800 mL
27- The nurse is conducting a pain assessment on a client with dysuria. Which pain description is most likely associated with pyelonephritis?
1.
Constant; increased by pressure over the suprapubic area
2.
Dull and continuous; occasional spasms over the suprapubic area
3.
Dull flank pain; extending toward the umbilicus
4.
Excruciating; sharp flank pain radiating to the groin
28- A client returns to the unit after receiving hemodialysis for the first time. The client vomits once, reports headache, and appears restless and disoriented. What is the priority intervention?
1.
Administer antihypertensives that were held prior to dialysis
2.
Administer PRN ondansetron to relieve nausea
3.
Contact the health care provider
4.
Place client in Trendelenburg position
29- The nurse is caring for a client with multiple renal calculi. Which nursing interventions should be included in the plan of care? Select all that apply.
1.
Administer analgesics at regularly scheduled intervals
2.
Encourage fluid intake of up to 3 L/day
3.
Instruct client to stay on bed rest
4.
Provide massage to the client's flank
5.
Strain all urine for the presence of stones
30- After reviewing the urinalysis report data on a client, which question is most
appropriate for the nurse to ask?
1.
"Do you have a family history of diabetes?"
2.
"Do you have any burning or difficulty urinating?"
3.
"Have you suffered any recent kidney trauma?"
4.
"What has your fluid intake been for the last 24 hours?"
31- The nurse assesses a client with benign prostatic hyperplasia. Which client statement requires further assessment?
1.
"I have a burning sensation when I urinate."
2.
"I have been having some dribbling after I finish urinating."
3.
"I missed 3 days of finasteride while on a trip last week."
4.
"I was awakened 3 times last night by the need to urinate."
32- A client with a chronic kidney disease has blood laboratory values as shown in the exhibit. The nurse administers sodium polystyrene sulfonate by mouth per the health care provider's prescription. The nurse evaluates that the therapy is effective when which value is noted on the follow-up results?
1.
Calcium 7.4 mg/dL (1.85 mmol/L)
2.
Creatinine 4.0 mg/dL (353 µmol/L)
3.
Phosphorus 3.9 mg/dL (1.26 mmol/L)
4.
Potassium 4.9 mEq/L (4.9 mmol/L)
33- The nurse has assessed 4 children. Which finding requires immediate follow-up with the health care provider?
1.
Child who had a surgical repair of hypospadias earlier today with no urinary output in the
past hour
2.
Child who is awaiting a neurological consult for suspected absence seizures and is sleeping
soundly
3.
Child who returned from a bronchoscopy an hour ago and coughed up blood-tinged sputum
4.
Child with gastroenteritis, serum sodium of 131 mEq/L (131 mmol/L), and temperature of
100 F (37.7 C)
34- A client with chronic kidney disease has received a continuous intravenous infusion of heparin for 5 days. The nurse reviews the coagulation studies and the medication administration record. Which prescription would the nurse question?
1.
Epoetin
2.
Sodium polystyrene sulfonate
3.
Vitamin K
4.
Warfarin
35- The nurse is admitting a 4-year-old diagnosed with Wilms tumor. The child is scheduled for a right nephrectomy in the morning. Which action is a priority in the preoperative care plan?
1.
Assessment of the child's emotional maturity level
2.
Auscultating for adventitious breath sounds
3.
Instructions not to palpate the abdomen
4.
Monitoring blood pressure closely
