Lewis Med Surg - UrinaryKidney NCLEX Review Practice

Lewis Med Surg - Urinary/Kidney NCLEX Review Practice Questions 5.0 (8 reviews) Students also studied Terms in this set (31) George Brown College Nursing Save NCLEX Questions for Renal Disorder...40 terms mdunlap5920Preview NCLEX Urinary System Questions 24 terms s646680Preview Renal NCLEX Questions 30 terms lilnurseangelPreview Med Su 86 terms Jasm In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to the maintenance of homeostasis. Which physiologic processes are performed by the kidneys? Select all that apply.

• Production of renin
• Activation of vitamin D
• Carbohydrate metabolism
• Erythropoietin production
• Hemolysis of old red blood cells (RBCs)

A, B, D.

In addition to urine formation, the kidneys release renin to maintain blood pressure, activate vitamin D to maintain calcium levels, and produce erythropoietin to stimulate RBC production. Carbohydrate metabolism and hemolysis of old RBCs are not physiologic functions that are performed by the kidneys.As a component of the head-to-toe assessment of a patient who has been recently transferred to the clinical unit, the nurse is preparing to palpate the patient's kidneys. How should the nurse position the patient for this assessment?

• Prone
• Supine
• Seated at the edge of the bed
• Standing, facing away from the nurse
• Supine

To palpate the right kidney, the patient is positioned supine, and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney. The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it.

Which urinalysis result should the nurse recognize as an abnormal finding?

• pH 6.0
• Amber yellow color
• Specific gravity 1.025
• White blood cells (WBCs) 9/hpf
• White blood cells (WBCs) 9/hpf

Normal WBC levels in urine are below 5/hpf, with levels exceeding this indicative of inflammation or urinary tract infection. A urine pH of 6.0 is average; amber yellow is normal coloration, and the reference ranges for specific gravity are 1.003 to 1.030.The patient in the intensive care unit is receiving gentamicin for pneumonia from Pseudomonas. What assessment results should the nurse report to the health care provider?

• Decreased weight
• Increased appetite
• Increased urinary output
• Elevated creatinine level
• Elevated creatinine level

Gentamicin can be toxic to the kidneys and the auditory system. The elevated creatinine level must be reported to the physician as it probably indicates renal damage. Other factors that may occur with renal damage would include increased weight and decreased urinary output. Many medications have side effects of anorexia.A nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based upon this diagnosis, the nurse will expect to find what clinical manifestations as the "classic triad" occurring in patients with renal cancer?

• Fever, chills, flank pain
• Hematuria, flank pain, palpable mass
• Hematuria, proteinuria, palpable mass
• Flank pain, palpable abdominal mass, and proteinuria
• Hematuria, flank pain, palpable mass

There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease.Which nursing intervention is most appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)?

• Help the patient cope with the rapid progression of

the disease.

• Suggest genetic counseling resources for the children

of the patient.

• Expect the patient to have polyuria and poor

concentration ability of the kidneys.

• Implement appropriate measures for the patient's

deafness and blindness in addition to the renal problems.

• Suggest genetic counseling resources for the children of the patient.

PKD is one of the most common genetic diseases. The adult form of PKD may range from a relatively mild disease to one that progresses to chronic kidney disease. Polyuria, deafness, and blindness are not associated with PKD.An older male patient visits his primary care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for what factor that may put him at risk for a urinary tract infection (UTI)?

• High-purine diet
• Sedentary lifestyle
• Benign prostatic hyperplasia (BPH)
• Recent use of broad-spectrum antibiotics
• Benign prostatic hyperplasia (BPH)

BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, whereas a diet high in purines is associated with renal calculi.

The nurse is providing care for a patient who has been admitted to the hospital for the treatment of nephrotic syndrome. What are priority nursing assessments in the care of this patient?

• Assessment of pain and level of consciousness
• Assessment of serum calcium and phosphorus levels
• Blood pressure and assessment for orthostatic

hypotension

• Daily weights and measurement of the patient's

abdominal girth

• Daily weights and measurement of the patient's abdominal girth

Peripheral edema is characteristic of nephrotic syndrome, and a key nursing responsibility in the care of patients with the disease is close monitoring of abdominal girth, weights, and extremity size. Pain, level of consciousness, and orthostatic blood pressure are less important in the care of patients with nephrotic syndrome. Abnormal calcium and phosphorus levels are not commonly associated with the diagnosis of nephrotic syndrome.Which nursing diagnosis is a priority in the care of a patient with renal calculi?

• Acute pain
• Risk for constipation
• Deficient fluid volume
• Risk for powerlessness
• Acute pain

Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to result from urinary stones, whereas constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.Eight months after the delivery of her first child, a 31-year- old woman has sought care because of occasional incontinence that she experiences when sneezing or laughing. Which measure should the nurse first recommend in an attempt to resolve the woman's incontinence?

• Kegel exercises
• Use of adult incontinence pads
• Intermittent self-catheterization
• Dietary changes including fluid restriction
• Kegel exercises

Patients who experience stress incontinence frequently benefit from Kegel exercises (pelvic floor muscle exercises). The use of incontinence pads does not resolve the problem, and intermittent self-catheterization would be a premature recommendation. Dietary changes are not likely to influence the patient's urinary continence.The urinalysis of a male patient reveals a high microorganism count. What data should the nurse use to determine the area of the urinary tract that is infected (select all that apply)?

• Pain location
• Fever and chills
• Mental confusion
• Urinary hesitancy
• Urethral discharge
• Post-void dribbling

A, E.Although all the manifestations are evident with urinary tract infections (UTIs), pain location is useful in differentiating among pyelonephritis, cystitis, and urethritis because flank pain is characteristic of pyelonephritis, but dysuria is characteristic of cystitis and urethritis. Urethral discharge is indicative of urethritis, not pyelonephritis or cystitis. Fever and chills and mental confusion are nonspecific indicators of UTIs. Urinary hesitancy and postvoid dribbling may occur with a UTI but may also occur with prostate enlargement in the male patient.The patient with type 2 diabetes has a second UTI within one month of being treated for a previous UTI. Which medication should the nurse expect to teach the patient about taking for this infection?

• Ciprofloxacin (Cipro)
• Fosfomycin (Monurol)
• Nitrofurantoin (Macrodantin)
• Trimethoprim/sulfamethoxazole (Bactrim)
• Ciprofloxacin (Cipro)

This UTI is a complicated UTI because the patient has type 2 diabetes and the UTI is recurrent. Ciprofloxacin (Cipro) would be used for a complicated UTI.Fosfomycin (Monurol), nitrofurantoin (Macrodantin), and trimethoprim/sulfamethoxazole (Bactrim) should be used for uncomplicated UTIs.

The patient has scleroderma and is experiencing hypertension. The nurse should know that this could be related to which renal problem?

• Obstructive uropathy
• Goodpasture syndrome
• Chronic glomerulonephritis
• Calcium oxalate urinary calculi
• Chronic glomerulonephritis

Hypertension occurs with chronic glomerulonephritis that may be found in patients with scleroderma. Obstructive uropathy, Goodpasture syndrome, and calcium oxalate urinary calculi are not related to scleroderma and do not cause hypertension.When caring for a patient with nephrotic syndrome, the nurse should know the patient understands dietary teaching when the patient selects which food item?

• Peanut butter and crackers
• One small grilled pork chop
• Salad made of fresh vegetables
• Spaghetti with canned spaghetti sauce
• Salad made of fresh vegetables

Of the options listed, only salad made with fresh vegetables would be acceptable for the diet that limits sodium and protein as well as saturated fat if hyperlipidemia is present. Peanut butter and crackers are processed so they contain significant sodium, and peanut butter contains some protein. A pork chop is a high-protein food with saturated fat. Canned spaghetti sauce is also high in sodium.A 22-year-old patient's blood pressure at her physical done for her new job was 110/68. At the health fair two months later, her blood pressure is 154/96. What renal problem should the nurse be aware of that could contribute to this abrupt rise in blood pressure?

• Renal trauma
• Renal artery stenosis
• Renal vein thrombosis
• Benign nephrosclerosis
• Renal artery stenosis

Renal artery stenosis contributes to an abrupt rise in blood pressure, especially in people under 30 or over 50 years of age. Renal trauma usually has hematuria.Renal vein thrombosis causes flank pain, hematuria, fever, or nephrotic syndrome.Benign nephrosclerosis usually occurs in adults 30 to 50 years of age and is a result of vascular changes resulting from hypertension.Which effect of aging on the urinary system is most likely to affect the action of bumetanide (Bumex)?

• Benign enlargement of prostatic tissues
• Decreased sensation of bladder capacity
• Decreased function of the loop of Henle
• Less absorption in the Bowman's capsule
• Decreased function of the loop of Henle

Bumetanide (Bumex) is a loop diuretic that acts in the loop of Henle to decrease reabsorption of sodium and chloride. Because the loop of Henle loses function with aging, the excretion of drugs becomes less and less efficient. Thus the circulating levels of drugs are increased and their effects prolonged. The benign enlargement of prostatic tissue, decreased sensation of bladder capacity, and loss of concentrating ability do not directly affect the action of loop diuretics.Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?

• Blood pressure
• Phosphate level
• Neurologic status
• Creatinine clearance
• Phosphate level

Rationale: Normally, the kidneys control the levels of phosphate in your blood,

and the balance between phosphate and calcium in your body. When your kidneys are not working, the level of phosphate in your blood can build up. Serum phosphate level must be lowered before calcium or vitamin D is administered.