NCLEX Urinary/Renal Function/Disorder and Electrolyte Imbalance

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A client with urinary incontinence asks the nurse for suggestions about managing this condition. Which suggestion would be most appropriate?

a) "Make sure to eat enough fiber to prevent constipation."
b) "Try drinking coffee throughout the day."
c) "Use scented powders to disguise any odor."
d) "Limit the number of times you urinate during the day."

a) "Make sure to eat enough fiber to prevent constipation."
Explanation: Suggestions to manage urinary incontinence include avoiding constipation such as eating adequate fiber and drinking adequate amounts of fluid. Scented powders, lotions, or sprays should be avoided because they can intensify the urine odor, irritate the skin, or cause a skin infection. Stimulants such as caffeine, alcohol, and aspartame should be avoided. The client should void regularly, approximately every 2 to 3 hours to ensure bladder emptying.

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?
a) Restricting fluid intake to reduce the need to void
b) Establishing a predetermined fluid intake pattern for the client
c) Encouraging the client to increase the time between voidings
d) Assessing present voiding patterns

D) Assessing present voiding patterns
Explanation: The guidelines for initiating bladder retraining include assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

A nursing instructor is reviewing with the class the steps in urine formation. Place in the correct order from first to last the sequence the instructor would present.
-Filtrate enters Bowman's capsule
-Plasma filtered through glomerulus
-Formed urine drains from the collecting tubules, into the renal pelvis, and down each ureter to the bladder
-Filtrate moves through tubular system of the nephron and is either reabsorped or excreted

-Plasma filtered through glomerulus
-Filtrate enters Bowman's capsule
-Filtrate moves through tubular system of the nephron and is either reabsorped or excreted
-Formed urine drains from the collecting tubules, into the renal pelvis, and down each ureter to the bladder

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
a) a decreased serum phosphate level secondary to kidney failure.
b) an increased serum calcium level secondary to kidney failure.
c) water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
d) metabolic alkalosis secondary to retention of hydrogen ions.

C) water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
Explanation: The 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.

Which is the correct term for the ability of the kidneys to clear solutes from the plasma?
a) Glomerular filtration rate (GFR)
b) Renal clearance
c) Specific gravity
d) Tubular secretion

B) Renal Clearance
Explanation: Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. GFR is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.

The client presents with nausea and vomiting, absent bowel sounds, and colicky flank pain. The nurse interprets these findings as consistent with:
a) Urethritis
b) Ureteral colic
c) Interstitial cystitis
d) Acute prostatitis

B) Ureteral colic

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?
a) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.
b) Administer furosemide (Lasix) 20 mg I.V.
c) Encourage oral fluids.
d) Start hemodialysis after a temporary access is obtained.

A) Start IV fluids with normal saline solution bolus followed by a maintenance dose.
Explanation: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.

Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure?
a) Increased red blood cell count
b) Decreased serum potassium level
c) Increased serum calcium level
d) Increased serum creatinine level

D) Increased serum creatinine level
Explanation: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?
a) Serum sodium level of 135 mEq/L
b) Serum potassium level of 4.9 mEq/L
c) Temperature of 99.2° F (37.3° C)
d) Urine output of 20 ml/hour

D) Urine output of 20 ml/hour
Explanation: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.

A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom?
a) Urinary retention
b) Painless hematuria
c) Fever
d) Frequency

A) Painless hematuria
Explanation: The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency. Later symptoms are related to metastases and include pelvic pain, urinary retention (if the tumor blocks the bladder outlet), and urinary frequency from the tumor occupying bladder space.

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?
a) "The effluent should be allowed to drain by gravity."
b) "It is important to use strict aseptic technique."
c) "The infusion clamp should be open during infusion."
d) "It is appropriate to warm the dialysate in a microwave."

D) It is appropriate to warm the dialysate in a microwave
Explanation: The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.

Which of the following is a characteristic of a normal stoma?
a) Painful
b) No bleeding when cleansing stoma
c) Dry in appearance
d) Pink color

D) Pink color
Explanation: Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned.

To assess circulating oxygen levels, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommends the use of which of the following diagnostic tests?
a) Hemoglobin
b) Hematocrit
c) Arterial blood gases
d) Serum iron levels

A) Hemoglobin
Explanation: Although hematocrit has always been the blood test of choice to assess for anemia, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines, recommend that anemia be quantified using hemoglobin rather than hematocrit measurements. Hemoglobin is recommended as it is more accurate in the assessment of circulating oxygen than hematocrit. Serum iron levels measure iron storage in the body. Arterial blood gases assess the adequacy of oxygenation, ventilation, and acid-base status.

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?
a) History of hyperparathyroidism
b) History of osteoporosis
c) Recent history of streptococcal infection
d) Previous episode of acute pyelonephritis

C) Recent hx of streptococcal infection
Explanation: Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.

A client presents at the testing center for an intravenous pyelogram. What question should the nurse ask to ensure the safety of the client?
a) "Have you any artificial joints?"
b) "Do you have a pacemaker?"
c) "Do you have any allergies?"
d) "Who has come with you today?"

C) Do you have any allergies?
Explanation: Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood.

Which type of incontinency refers to the involuntary loss of urine due to medications?
a) Overflow
b) Urge
c) Reflex
d) Iatrogenic

D) Iatrogenic
Explanation: Iatrogenic incontinence is the involuntary loss of urine due to medications. Reflex incontinence is the involuntary loss of urine due to hyperreflexia in the absence of normal sensations usually associated with voiding. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Overflow incontinence is the involuntary loss of urine associated with overdistention of the bladder.

The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important?
a) Catheterize the client immediately after the client voids.
b) Check for residual after the client reports the urge to void.
c) Set up a routine schedule of every 4 hours to check for residual urine.
d) Record the volume of urine obtained.

A) Catheterize the client immediately after the client voids
Explanation: To obtain accurate residual volumes, it is important that clients void first and that catheterization occur immediately after the attempt. The nurse should record both the volume voided (even if it is zero) and the volume obtained by catheterization. Intermittent catheterizations are performed based on a schedule, usually 3 to 4 times per day. Residual urine refers to the amount remaining in the bladder after voiding. It is essential that the client voids.

The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply.
a) Vitamin D synthesis
b) Secretion of prostaglandins
c) Vitamin B production
d) Secretion of insulin
e) Regulation of blood pressure

A) Vitamin D synthesis
B) Secretion of prostaglandins
E) Regulation of blood pressure
Explanation: Functions of the kidney include secretion of prostaglandins, regulation of blood pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body does not produce Vitamin B.

A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in:
a) 1 hour.
b) 24 hours.
c) 1 minute.
d) 30 minutes.

C) 1 minute
Explanation: The creatinine clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
a) Impaired urinary elimination
b) Toileting self-care deficit
c) Risk for infection
d) Activity intolerance

C) Risk for infection
Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?
a) Check for thrill or bruit over the access site.
b) Warm the solution to body temperature.
c) Inspect the catheter insertion site for infection.
d) Add the prescribed drug to the dialysate.

A) Check for thrill or bruit over the access site. When preparing a client for hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency. Inspecting the catheter insertion site for infection, adding the prescribed drug to the dialysate, and warming the solution to body temperature would be necessary when preparing a client for peritoneal dialysis.

A physician orders cystoscopy and random biopsies of the bladder for a client who reports painless hematuria. Test results reveal carcinoma in situ in several bladder regions. To treat bladder cancer, the client will have a series of intravesical instillations of bacillus Calmette-Guérin (BCG), administered 1 week apart. When teaching the client about BCG, the nurse should mention that this drug commonly causes:
a) delayed ejaculation.
b) hematuria.
c) impotence.
d) renal calculi.

B) hematuria
Intravesical instillation of BCG commonly causes hematuria. Other common adverse effects of BCG include urinary frequency and dysuria. Less commonly, BCG causes cystitis, urinary urgency, urinary incontinence, urinary tract infection, abdominal cramps or pain, decreased bladder capacity, tissue in urine, local infection, renal toxicity, and genital pain. BCG isn't associated with renal calculi, delayed ejaculation, or impotence.

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?
a) "Be aware that your urine will be cherry-red for 5 to 7 days."
b) "Increase your fluid intake to 2 to 3 L per day."
c) "Apply an antibacterial dressing to the incision daily."
d) "Take your temperature every 4 hours."

B) Increase your fluid intake to 2 to 3 L per day
The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?
a) Therapeutic index
b) GI absorption rate
c) Liver function studies
d) Creatinine clearance

D) Creatinine clearance
The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

A history of infection specifically caused by group A
beta-hemolytic streptococci is associated with which of the following disorders?
a) Acute glomerulonephritis
b) Acute renal failure
c) Nephrotic syndrome
d) Chronic renal failure

A) Acute glomerulonephritis
Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

The nurse is caring for the client following surgery for a urinary diversion. The client refuses to look at the stoma or participate in its care. The nurse formulates a nursing diagnosis of:

a) Disturbed body image
b) Situational low self esteem
c) Anticipatory grieving
d) Deficient knowledge: stoma care

A) Disturbed body image
The client is exhibiting defining characteristics of disturbed body image.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
a) Urine output of 250 ml/24 hours
b) Temperature of 100.2° F (37.8° C)
c) Serum creatinine level of 1.2 mg/dl
d) Blood urea nitrogen (BUN) level of 22 mg/dl

A) Urine output of 250 ml/24 hours
ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find?
a) Decreased blood urea nitrogen (BUN)
b) Decreased potassium
c) Increased serum albumin
d) Increased serum creatinine

D) Increased serum creatinine
In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.

Which type of medication may be used in the treatment of a patient with incontinence to inhibit contraction of the bladder?
a) Anticholinergic agent
b) Over-the-counter decongestant
c) Tricyclic antidepressants
d) Estrogen hormone

A) Anticholinergic agent
Anticholinergic agents are considered first-line medications for urge incontinence. Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra. Tricyclic antidepressants decrease bladder contractions as well as increase bladder neck resistance. Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.

Retention of which electrolyte is the most life-threatening effect of renal failure?
a) Potassium
b) Calcium
c) Phosphorous
d) Sodium

A) Potassium
Retention of potassium is the most life-threatening effect of renal failure.

After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the student have understood the material when they identify which of the following as a cause of stress incontinence?
a) Obstruction due to fecal impaction or enlarged prostate
b) Bladder irritation related to urinary tract infections
c) Increased urine production due to metabolic conditions
d) Decreased pelvic muscle tone due to multiple pregnancies

D) Decreased pelvic muscle tone due to multiple pregnancies
Stress incontinence is due to decreased pelvic muscle tone, which is associated with multiple pregnancies, obstetric injuries, obesity, menopause, or pelvic disease. Transient incontinence is due to increased urine production related to metabolic conditions. Urge incontinence is due to bladder irritation related to urinary tract infections, bladder tumors, radiation therapy, enlarged prostate, or neurologic dysfunction. Overflow incontinence is due to obstruction from fecal impaction or enlarged prostate.

After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an I.V. infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output?
a) It's an abnormal finding that requires further assessment.
b) It's a normal finding caused by blood loss during surgery.
c) It's an abnormal finding that will correct itself when the client ambulates.
d) It's a normal finding associated with the client's nothing-by-mouth status.

A) It's an abornmal finding that requires further assessment.
The drop in urine output to less than 30 ml/hour is abnormal and requires further assessment. The reduction in urine output may be caused by an obstruction in the urinary catheter tubing or deficient fluid volume from blood loss. The client's nothing-by-mouth status isn't the cause of the low urine output because the client is receiving I.V. fluid to compensate for the lack of oral intake. Ambulation promotes urination; however, the client should produce at least 30 ml of urine/hour.

The nurse is caring for a client who is scheduled for the creation of an ileal conduit. Which statement by the client provides evidence that client teaching was effective?
a) "My urine will be eliminated with my feces."
b) "A catheter will drain urine directly from my kidney."
c) "I will not need to worry about being incontinent of urine."
d) "My urine will be eliminated through a stoma."

D) My urine will be eliminated through a stoma
An ileal conduit is a non-continent urinary diversion whereby the ureters drain into an isolated section of ileum. A stoma is created at one end of the ileum, exiting through the abdominal wall.

Nursing management of the client with a urinary tract infection should include:
a) Teaching the client to douche daily
b) Discouraging caffeine intake
c) Administering morphine sulfate
d) Instructing the client to limit fluid intake

B) Discouraging caffeine intake
Strategies for preventing urinary tract infection include proper perineal hygiene, increased fluid intake, avoiding urinary tract irritants (including caffeine), and establishing a frequent voiding regimen.

The most common presenting objective symptoms of a urinary tract infection in older adults, especially in those with dementia, include?
a) Hematuria
b) Change in cognitive functioning
c) Back pain
d) Incontinence

B) Change in cognitive functioning
The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these patients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.

Which of the following would be included in a teaching plan for a patient diagnosed with a urinary tract infection?
a) Drink coffee or tea to increase diuresis
b) Use tub baths as opposed to showers
c) Void every 4 to 6 hours
d) Drink liberal amount of fluids

D) Drink liberal amounts of fluids
Patients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The patient should shower instead of bathe in a tub because bacteria in the bath water may enter the urethra.

The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client?
a) Clean intermittent catheterization
b) Suprapubic cystostomy tube
c) Permanent drainage with a urethral catheter
d) Credé voiding procedure

C) Permanent drainage with a urethral catheter
Permanent drainage with a urethral catheter carries the greatest risk. It may also increase the risk for bladder stones, renal diseases, bladder infections, and urosepsis, a severe systemic infection by microorganisms in the urinary tract invading the bloodstream. Clean intermittent catheterization has the fewest complications and is the preferred treatment for urinary retention. The Credé voiding procedure is used in the case of clients who have lost control over their nervous systems, secondary to injury or disease.

A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client?
a) "This medication will prevent re-infection."
b) "This medication should be taken at bedtime."
c) "This medication will relieve your pain."
d) "This will kill the organism causing the infection."

C) This medication will relieve your pain
Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.

A nurse has been asked to speak to a local women's group about preventing cystitis. Which of the following would the nurse include in the presentation?
a) Need to urinate after engaging in sexual intercourse
b) Need to wear underwear made from synthetic material
c) Importance of urinating every 4 to 6 hours while awake
d) Suggestion to take tub baths instead of showers

A) Need to urinate after engaging in sexual intercourse
Measures to prevent cystitis include voiding after sexual intercourse, wearing cotton underwear, urinating every 2 to 3 hours while awake, and taking showers instead of tub baths.

Which of the following is a factor contributing to UTI in older adults?
a) Low incidence of chronic illness
b) Sporadic use of antimicrobial agents
c) Immunocompromise
d) Active lifestyle

C) Immunocompromise
Factors that contribute to urinary tract infection in older adults include immunocompromise, high incidence of chronic illness, immobility, and frequent use of antimicrobial agents.

You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults?
a) Hypovolemia
b) Dehydration
c) Hypervolemia
d) Fluid volume excess

B) Dehydration
The most common fluid imbalance in older adults is dehydration. Because of reduced thirst sensation that often accompanies aging, older adults tend to drink less water. Use of diuretic medications, laxatives, or enemas may also deplete fluid volume in older adults. Chronic fluid volume deficit can lead to other problems such as electrolyte imbalances. Therefore, options A, C, and D are incorrect.

To evaluate a client for hypoxia, the physician is most likely to order which laboratory test?
a) Red blood cell count
b) Sputum culture
c) Total hemoglobin
d) Arterial blood gas (ABG) analysis

D) ABGs
Red blood cell count, sputum culture, total hemoglobin, and ABG analysis all help evaluate a client with respiratory problems. However, ABG analysis is the only test that evaluates gas exchange in the lungs, providing information about the client's oxygenation status.

Which of the following would be a potential cause of respiratory acidosis?
a) Vomiting
b) Hyperventilation
c) Diarrhea
d) Hypoventilation

D) Hypoventilation
Respiratory acidosis is always due to inadequate excretion of CO, with inadequate ventilation, resulting in elevated plasma CO concentration, which causes increased levels of carbonic acid. In addition to an elevated PaCO, hypoventilation usually causes a decrease in PaO.

Which of the following is the most common cause of symptomatic hypomagnesemia?
a) Alcoholism
b) IV drug use
c) Sedentary lifestyle
d) Burns

A) Alcoholism
Alcoholism is currently the most common cause of symptomatic hypomagnesemia. IV drug use, sedentary lifestyle, and burns are not the most common causes of hypomagnesemia.

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?
a) PaCO 36
b) HCO 21 mEq/L
c) O saturation 95%
d) pH 7.48

A) PaCO 36
Metabolic alkalosis is a clinical disturbance characterized by a high pH and high plasma bicarbonate concentration. The HCO value is below normal. The PaCO value and the oxygen saturation level are within a normal range

Which of the following is a correct route of administration for potassium?
a) IV (intravenous) push
b) Oral
c) Intramuscular
d) Subcutaneous

B) Oral
Potassium may be administered through the oral route. Potassium is never administered by IV push or intramuscularly to avoid replacing potassium too quickly. Potassium is not administered subcutaneously.

A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate?
a) Metabolic alkalosis
b) Metabolic acidosis
c) Respiratory alkalosis
d) Respiratory acidosis

C) Respiratory Alkalosis
A client with pneumonia may hyperventilate in an effort to increase oxygen intake. Hyperventilation leads to excess carbon dioxide (CO2) loss, which causes alkalosis — indicated by this client's elevated pH value. With respiratory alkalosis, the kidneys' bicarbonate (HCO3-) response is delayed, so the client's HCO3- level remains normal. The below-normal value for the partial pressure of arterial carbon dioxide (PaCO2) indicates CO2 loss and signals a respiratory component. Because the HCO3- level is normal, this imbalance has no metabolic component. Therefore, the client is experiencing respiratory alkalosis.

You are caring for a client with severe hypokalemia. The physician has ordered IV potassium to be administered at 10 mEq/hr. The client complains of burning along their vein. What should you do?
a) Change the electrolyte.
b) Switch to an oral formulation.
c) Increase the speed of transfusion.
d) Dilute the infusion.

D) Dilute the infusion
Treatment of severe hypokalemia requires treatment with IV infusion of potassium. Clients may experience burning along the vein with IV infusion of potassium in proportion to the infusion's concentration. If the client can tolerate the fluid, consult with the physician about diluting the potassium in a larger volume of IV solution. Oral potassium may not be enough in severe cases hypokalemia. Hypokalemia requires treatment with potassium and not any other electrolyte.

Below which serum sodium level may convulsions or coma can occur?
a) 140 mEq/L
b) 135 mEq/L
c) 142 mEq/L
d) 145 mEq/L

B) 135 mEq/L
Normal serum concentration level ranges from 135 to 145 mEq/L. When the level dips below 135 mEq/L, there is hyponatremia. Manifestations of hyponatremia include mental confusion, muscular weakness, anorexia, restlessness, elevated body temperature, tachycardia, nausea, vomiting, and personality changes. Convulsions or coma can occur if the deficit is severe. Values of 140, 142, and 145 mEq/L are within the normal range.

The calcium level of the blood is regulated by which mechanism?
a) Androgens
b) Adrenal gland
c) Parathyroid hormone (PTH)
d) Thyroid hormone (TH)

C) PTH
The serum calcium level is controlled by PTH and calcitonin. The thyroid hormone, adrenal gland, or androgens do not regulate the calcium level in the blood.

Russell Thompkins, a 77-year-old retired male, visits your general practice office twice monthly to maintain control of his congestive heart failure. He measures his weight daily and phones it to your office for his medical record. In a 24-hour period, how much fluid is Russell retaining if his weight increases by two pounds?
a) One liter
b) 1250 ml
c) 1500 ml
d) 500 ml

A) One liter
A 2-lb weight gain in 24 hours indicates that the client is retaining 1L of fluid.

A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder?
a) Metabolic alkalosis
b) Metabolic acidosis
c) Respiratory acidosis
d) Respiratory alkalosis

B) Metabolic acidosis
This client's pH value is below normal, indicating acidosis. The HCO3- value also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of base, which suggests metabolic acidosis. The PaCO2 value is normal, indicating absence of respiratory compensation. These ABG values eliminate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis.

To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body?
a) Bradycardia
b) Tachycardia
c) Increased urine output
d) Vasodilation

B) Tachycardia
Fluid volume deficit, or hypovolemia, occurs when the loss of extracellular fluid exceeds the intake of fluid. Clinical signs include oliguia, rapid heart rate, vasoconstriction, cool and clammy skin, and muscle weakness. The nurse monitors for rapid, weak pulse and orthostatic hypotension.

A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings?
a) Metabolic acidosis
b) Respiratory alkalosis
c) Metabolic alkalosis
d) Respiratory acidosis

B) Respiratory Alkalosis
Respiratory alkalosis results from alveolar hyperventilation. It's marked by a decrease in PaCO2 to less than 35 mm Hg and an increase in blood pH over 7.45. Metabolic acidosis is marked by a decrease in HCO3? to less than 22 mEq/L, and a decrease in blood pH to less than 7.35. In respiratory acidosis, the pH is less than 7.35 and the PaCO2 is greater than 45 mm Hg. In metabolic alkalosis, the HCO3? is greater than 26 mEq/L and the pH is greater than 7.45.

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?
a) Nausea or vomiting
b) Hallucinations or tinnitus
c) Light-headedness or paresthesia
d) Abdominal pain or diarrhea

C) Light-headedness or paresthesia
The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

The normal serum value for potassium is
a) 96 to 106 mEq/L.
b) 135 to 145 mEq/L.
c) 3.5 to 5.5 mEq/L.
d) 8.5 to 10.5 mg/dL.

C) 3.5-5.5 mEq/L
Serum potassium must be within normal limits to prevent cardiac dysrhythmia. Normal serum sodium is 135 to 145 mEq/L. Normal serum chloride is 96 to 106 mEq/L. Normal total serum calcium is 8.5 to 10

A client is taking spironolactone (Aldactone) to control her hypertension. Her serum potassium level is 6 mEq/L. For this client, the nurse's priority should be to assess her:
a) electrocardiogram (ECG) results.
b) neuromuscular function.
c) bowel sounds.
d) respiratory rate.

A) ECG results
Although changes in all these findings are seen in hyperkalemia, ECG results should take priority because changes can indicate potentially lethal arrhythmias such as ventricular fibrillation. It wouldn't be appropriate to assess the client's neuromuscular function, bowel sounds, or respiratory rate for effects of hyperkalemia.

A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing?
a) Hyperglycemia
b) Hypercalcemia
c) Hyperkalemia
d) Hypernatremia

C) Hyperkalemia
Administering regular insulin I.V. concomitantly with 50 ml of dextrose 50% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia. This combination doesn't help reverse the effects of hypercalcemia, hypernatremia, or hyperglycemia.

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance?
a) Respiratory acidosis
b) Respiratory alkalosis
c) Metabolic alkalosis
d) Metabolic acidosis

C) Metabolic Alkalosis
A pH over 7.45 with a HCO3- level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base HCO3-. The client isn't experiencing respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or metabolic acidosis because the pH is greater than 7.35.

Patients diagnosed with hypervolemia should avoid sweet or dry food because:
a) It obstructs water elimination.
b) It can cause dehydration.
c) It can lead to weight gain.
d) It increases the client's desire to consume fluid.

D) It increases the client's desire to consume fluid
The management goal in hypervolemia is to reduce fluid volume. For this reason, fluid is rationed, and the client is advised to take limited amount of fluid when thirsty. Sweet or dry food can increase the client's desire to consume fluid. Sweet or dry food does not obstruct water elimination nor does it cause dehydration. Weight regulation is not part of hypervolemia management except to the extent that it is achieved on account of fluid reduction.

Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate?
a) Give medications that promote fluid retention.
b) Limit sodium and water intake.
c) Teach client behaviors that decrease urination.
d) Assess for dehydration.

B) Limit sodium and water intake
Implement prescribed interventions such as limiting sodium and water intake and administering ordered medications that promote fluid elimination. Assessing for dehydration and teaching to decrease urination would not be appropriate interventions.

Which of the following solutions is hypotonic?
a) 0.45% NaCl
b) 5% NaCl
c) 0.9% NaCl
d) Lactated Ringer's solution

A) 0.45% NaCl
Half-strength saline is hypotonic. Lactated Ringer's solution is isotonic. Normal saline (0.9% NaCl) is isotonic. A solution that is 5% NaCl is hypertonic.

Which of the following are the insensible mechanisms of fluid loss?
a) Bowel elimination
b) Urination
c) Nausea
d) Breathing

D) Breathing
Loss of fluid from sweat or diaphoresis is referred to as insensible loss because it is unnoticeable and immeasurable. Losses from urination and bowel elimination are measurable.

A group of nursing students are studying for a test over acid-base imbalance. One student asks another what the major chemical regulator of plasma pH is. What should the second student respond?
a) Renin-angiotensin-aldosterone system
b) Bicarbonate-carbonic acid buffer system
c) Sodium-potassium pump
d) ADH-ANP buffer system

B) Bicarbonate-carbonic acid buffer system
The major chemical regulator of plasma pH is the bicarbonate-carbonic acid buffer system. Therefore options A and C are incorrect. Option D does not exist, it is only a distractor for this question.

Which of the following is considered an isotonic solution?
a) 3% NaCl
b) 0.9% normal saline
c) Dextran in NS
d) 0.45% normal saline

B) 0.9% Normal Saline
An isotonic solution is 0.9% normal saline (NaCl). Dextran in NS is a colloid solution, 0.45% normal saline is a hypotonic solution, and 3% NaCl is a hypertonic solution.

An elderly client takes 40 mg of Lasix twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use?
a) Hypophosphatemia
b) Hypernatremia
c) Hypokalemia
d) Hyperkalemia

C) Hypokalemia
Hypokalemia (potassium level below 3.5 mEq/L) usually indicates a defict in total potassium stores. Potassium-losing diuretics, such as loop diuretics, can induce hypokalemia.

A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?
a) pH, 7.25; PaCO2 50 mm Hg
b) pH, 7.35; PaCO2 40 mm Hg
c) pH, 7.40; PaCO2 35 mm Hg
d) pH, 7.5; PaCO2 30 mm Hg

B) oh, 7.25; PaCO2 50 mm Hg
In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. A pH value of 7.5 with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis. A ph value of 7.40 with a PaCO2 value of 35 mm Hg and a pH value of 7.35 with a PaCO2 value of 40 mm Hg represent normal ABG values, reflecting normal gas exchange in the lungs.

A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution?
a) Alkaline
b) Acidic
c) Basic
d) Neutral

B) Acidic
Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals acidic urine pH. A pH above 7.0 is considered an alkaline or basic solution. A pH of 7.0 is considered neutral.

A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess:
a) Trousseau's sign.
b) Hegar's sign.
c) Homans' sign.
d) Goodell's sign.

A) Trossaeu's sign
This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance?
a) Hypocalcemia
b) Hyperkalemia
c) Hypokalemia
d) Hypercalcemia

D) Hypercalcemia
The normal reference range for serum calcium is 9 to 11 mg/dl. A serum calcium level of 12 mg/dl clearly indicates hypercalcemia. The client's other laboratory findings are within their normal ranges, so the client doesn't have hypernatremia, hypochloremia, or hypokalemia.

Which of the following electrolytes is a major cation in body fluid?
a) Potassium
b) Bicarbonate
c) Chloride
d) Phosphate

A) Potassium
Potassium is a major cation that affects cardiac muscle functioning. Chloride is an anion. Bicarbonate is an anion. Phosphate is an anion.

Which conditions lead to chronic respiratory acidosis in older adults?
a) Thoracic skeletal change
b) Overuse of sodium bicarbonate
c) Decreased renal function
d) Erratic meal patterns

A) Thoracic skeletal change
Poor respiratory exchange as the result of chronic lung disease, inactivity, or thoracic skeletal changes may lead to chronic respiratory acidosis. Decreased renal function in older adults can cause an inability to concentrate urine and is usually associated with fluid and electrolyte imbalance. A poor appetite, erratic meal patterns, inability to prepare nutritious meals, or financial circumstances may influence nutritional status, resulting in imbalances of electrolytes. Overuse of sodium bicarbonate may lead to metabolic alkalosis.

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first?
a) Prepare for gastric lavage.
b) Monitor the client's heart rhythm.
c) Obtain a urine specimen for drug screening.
d) Prepare to assist with ventilation.

D) Prepare to assist with ventilation
Respiratory acidosis is associated with hypoventilation; in this client, hypoventilation suggests intake of a drug that has suppressed the brain's respiratory center. Therefore, the nurse should assume the client has respiratory depression and should prepare to assist with ventilation. After the client's respiratory function has been stabilized, the nurse can safely monitor the heart rhythm, prepare for gastric lavage, and obtain a urine specimen for drug screening.

A priority nursing intervention for a client with hypervolemia involves which of the following?
a) Monitoring respiratory status for signs and symptoms of pulmonary complications.
b) Establishing I.V. access with a large-bore catheter.
c) Encouraging the client to consume sodium-free fluids.
d) Drawing a blood sample for typing and crossmatching.

A) Monitoring respiratory status for signs ans symptoms of pulmonary complications
Hypervolemia, or fluid volume excess (FVE), refers to an isotonic expansion of the extracellular fluid. Nursing interventions for FVE include measuring intake and output, monitoring weight, assessing breath sounds, monitoring edema, and promoting rest. The most important intervention in the list involves monitoring the respiratory status for any signs of pulmonary congestion. Breath sounds are assessed at regular intervals.

A 57-year-old homeless female with a history of alcohol abuse has been admitted to your hospital unit. She was admitted with signs and symptoms of hypovolemia - minus the weight loss. She exhibits a localized enlargement of her abdomen. What condition could she be presenting?
a) Hypovolemia
b) Pitting edema
c) Third-spacing
d) Anasarca

C) Third spacing
Third-spacing describes the translocation of fluid from the intravascular or intercellular space to tissue compartments, where it becomes trapped and useless. The client manifests signs and symptoms of hypovolemia with the exception of weight loss. There may be signs of localized enlargement of organ cavities (such as the abdomen) if they fill with fluid, a condition referred to as ascites.

Which set of arterial blood gas (ABG) results requires further investigation?
a) pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L
b) pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L
c) pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L
d) pH 7.38, partial pressure of arterial carbon dioxide (PaCO2) 36 mm Hg, partial pressure of arterial oxygen (PaO2) 95 mm Hg, bicarbonate (HCO3-) 24 mEq/L

C)pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/LThe ABG results pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L indicate respiratory alkalosis.
The pH level is increased, and the HCO3- and PaCO2 levels are decreased. Normal values are pH 7.35 to 7.45; PaCO2 35 to 45 mm Hg; HCO3- 22 to 26 mEq/L.

The nurse is caring for a client who is exhibiting symptoms of tachypnea and circumoral paresthesias. What should be the nurse's first course of action?
a) Stop mechanical ventilation.
b) Find and correct the cause of tachypnea.
c) Administer cardiopulmonary resuscitation (CPR).
d) Give a dose of aspirin.

B) Find and correct the cause of tachypnea
Tachypnea or rapid breathing may result from various reasons including acute anxiety, high fever, thyrotoxicosis, early salicylate poisoning, hypoxemia, or mechanical ventilation. The rapid breathing expels more CO2 than necessary. This causes a deficit in carbonic acid, leading to respiratory alkalosis. Circumoral paresthesia is one of the symptoms. The first course of action is to detect and treat the cause of tachypnea. The nurse has to maintain mechanical ventilation if the client is dependent on it. CPR administration is required only if the client's condition needs it. Aspirin is not advised as early aspirin poisoning may be a cause of the tachypnea.

A 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for this client?
a) No, start with the sodium chloride IV.
b) No, sodium intake should be restricted.
c) Yes, this will correct the sodium deficit.
d) Yes, along with the hypotonic IV.

B) No, sodium intake should be restricted
The symptoms and the high level of serum sodium suggest hypernatremia, (excess of sodium). It is necessary to restrict sodium intake. Salt tablets and sodium chloride IV can only worsen this condition but may be required in hyponatremia (sodium deficit). Hypotonic solution IV may be a part of the treatment but not along with the salt tablets.

A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately?
a) Potassium
b) Sodium
c) Chloride
d) CO2

A) Potassium
The nurse should identify potassium: 2.2 mEq/L as critical because a normal potassium level is 3.8 to 5.5 mEq/L. Severe hypokalemia can cause cardiac and respiratory arrest, possibly leading to death. Hypokalemia also depresses the release of insulin and results in glucose intolerance. The glucose level is above normal (normal is 75 to 110 mg/dl) and the chloride level is a bit low (normal is 100 to 110 mEq/L). Although these levels should be reported, neither is life-threatening. The BUN (normal is 8 to 26 mg/dl) and creatinine (normal is 0.8 to 1.4 mg/dl) are within normal range.

When a client's ventilation is impaired, the body retains which substance?
a) Carbon dioxide (CO2)
b) Oxygen
c) Sodium bicarbonate
d) Nitrous oxide

A) Carbon dioxide (CO2)
When ventilation is impaired, the body retains CO2 because the carbonic acid level increases in the blood. Sodium bicarbonate is used to treat acidosis. Nitrous oxide, which has analgesic and anesthetic properties, commonly is administered before minor surgical procedures. When ventilation is impaired, the body doesn't retain oxygen. Instead, the tissues use oxygen and CO2 results.

A group of students are reviewing information about disorders of the bladder and urethra. The students demonstrate understanding of the material when they identify which of the following as a voiding dysfunction?
a) Urinary retention
b) Cystitis
c) Bladder stones
d) Urethral stricture

A) Urinary retention
Urinary retention and urinary incontinence are voiding dysfunctions, temporary or permanent alterations in the ability to urinate normally. Cystitis is an infectious disorder. Bladder stones and urethral stricture are obstructive disorders.

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?
a) Dehydration
b) Crackles
c) Hypertension
d) Hyperkalemia

A) Dehydration
The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.

A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?
a) Perform deep-breathing exercises vigorously.
b) Avoid carrying heavy items.
c) Auscultate the lungs frequently.
d) Wear a mask when performing exchanges.

D) Wear a mask when performing exchanges
The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?
a) Weight loss
b) Fever
c) Absence of pain
d) Diuresis

b) Fever
Fever is an indicator of infection or transplant rejection.

A 32-year-old flight attendant is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure. The client asks what the angiography will reveal. What is your response, as her nurse?
a) Renal circulation
b) Urine production
c) Kidney function
d) Kidney structure

A) Renal circulation
A renal angiogram (renal arteriogram) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.

The nurse observes the color of the client's urine which appears pale blue-green. The nurse obtains a drug history from the client based on the understanding that drugs used by the client may affect which of the following?
a) Size of the urinary bladder
b) Urinary tract tests
c) Urine specific gravity
d) Amount of urine produced

B) Urinary tract tests
It is important to inquire about drugs because some drugs may affect the outcome of urinary tract tests as well as the color and odor of the urine. Dietary intake may affect urine characteristics as well as urinary tract disorders and their management. Drugs do not directly affect the size of the urinary bladder or the amount of urine produced.

A nurse, when caring for a client, notes that the specific gravity of the client's urine is low. What could have lead to the low specific gravity of urine?
a) Repeated diarrhea
b) Excess fluid intake
c) Frequent vomiting
d) Urine retention

B) Excessive fluid intake
Excess fluid intake results in low specific gravity of urine. Excessive fluid intake will result in formation of dilute urine. When the urine is diluted, it results in low specific gravity of urine. Frequent vomiting, repeated diarrhea, and urine retention will result in high specific gravity of urine.

Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by:
a) diaphoresis.
b) tremors.
c) muscle weakness.
d) constipation.

C) Muscle weakness
Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and results from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

Susan Young, a 57-year-old financial officer, has been exhibiting signs and symptoms which lead her urologist to suspect the adequacy of her urinary function. Beginning with the least invasive tests, which of the following would you expect the physician to prescribe to assess kidney function? Choose all correct options.
a) Blood urea nitrogen (BUN) level
b) Creatinine clearance
c) Angiography
d) All options are correct

C) Angiography
Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the internal bladder.

The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program?
a) Pregnancy
b) Diabetes mellitus
c) Neuromuscular disorders
d) Hypotension

D) Hypotension
Hypertension, not hypotension, is a risk factor for kidney disease.

Which of the following terms is used to refer to inflammation of the renal pelvis?
a) Pyelonephritis
b) Interstitial nephritis
c) Urethritis
d) Cystitis

A) Pyleonephritis
Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic. Cystitis is inflammation of the urinary bladder. Urethritis is inflammation of the urethra. Interstitial nephritis is inflammation of the kidney.

A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact?
a) The kidneys are situated just above the adrenal glands.
b) The left kidney usually is slightly higher than the right one.
c) The kidneys lie between the 10th and 12th thoracic vertebrae.
d) The average kidney is approximately 5 cm (2?) long and 2 to 3 cm (¾? to 1??) wide.

B) The left kidney usually is slightly higher than the right one
The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4??) long, 5 to 5.8 cm (2? to 2¼?) wide, and 2.5 cm (1?) thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae.

True or False?
GFR is primarily dependent on adequate blood flow and adequate hydrostatic pressure.

True

True or False?
The primary function of the kidney is to excrete nitogeneous waste products.

False
Primary function of kidney is to regulate the volume and composition of extracellular fluids

True or False?
Water is the primary substance reabsorbed in the collecting duct?

True

True or False?
Atrial Natriuretic Factor (ANF) is secreted by the right atruim when atrial blood pressure is low, and it inhibits the action of aldosterone.

False
Atrial Natriuretic Factor (ANF) is secreted by the right atruim when atrial blood pressure is low, and it inhibits the action of high antidiuretic hormone (ADH) or renin or angiotensin II

True or False?
Increased permeability in the glomerulus causes loss of proteins into the urine.

True

True or False?
Prostaglandin synthesis by the kidneys causes vasodilation and increased renal blood flow.

True

A patient with an obstruction of the renal artery causing renal ischemia exhibits HTN. One factor that may contribute to HTN:

a) increase renin release
b) increased ADH secretion
c) decreased aldosterone secretion
d) increased synthesis and release of prostaglandins

A) Increase Renin Release
Renin is released in resonse to decreased B/P, renal ischemia, eosinophil chemotactic factor (ECF) depletion, and other factors affecting blood suppy to the kidney. It is they catalyst of the renin-angiotensin-aldosterone system, which raises B/P when stimulated. ADH is secreted by the posterior pituitary in response to serum hyperosmolality and low blood volume. Aldosterone is secreted within the renin-angiotensin II, and kidney prostaglandins lower B/P by causing vasodilation.

A clinical situation in which the increased release of erythropoietin would be expected is:

a) hypoexmia
b) hypotension
c) hyperkalemia
d) fluid overload

a) Hypoexmia
Erythropoietin is released when the oxygen tension of the renal blood supply is low and stimulates production of red blood cells in the bone marrow. Hypotension causes activation of the renin-angiotensin-aldosterone system, as well as release of ADH. Hyperkalemis stimulates release of aldosterone from the adrenal cortex, and fluid overload does not directly stimulate factors affecting the kidney.

The sites where urinary stones are most likely to obstruct the urinary system are at the __________ and the ____________.

Ureteropelvic junction and Ureterovesical junction

The volume of urine in the bladder that usually causes the urge to urinate is ____ mL.

200-250 mL

Total bladder capacity ranges from _________ mL to _________ mL.

600-1000mL

Absorption or leakage of urine wastes out of the urinary system is prevented by the cellular characteristics of the _______.

urothelium

An age related change in the kidney that leads to nocturia in an older adult is
a) decreased renal mass
b) decreased detrusor muscle tone
c) decreased ability to conserve sodium
d) decreased ability to concentrate urine

D) decreased ability to concentrate urine
The decreased ability to concentrate urine results in an increased volume of dilute urine, which does not maintain the usual diurnal elimination pattern. A decrease in bladder capacity also contributes to nocturia, but decreased bladder muscle tone results in urinary retention. Decreased renal mass decreases renal reserve, but function is generally adequate under normal circumstances.

During physical assessment of the urinary system, the nurse
a) auscultates the lower abdominal quadrants for fluid sounds
b) palpates an empty bladder at the level of the symphysis pubis
c) percusses the kidney with a firm blow at the posterior costovertebral angle
d) positions the patient prone to palpate the kidneys with a posterior approach

c) percusses the kidney with a firm blow at the posterior costovertebral angle
To assess for kidney tenderness, the nurse strikes the fist of one hand over the dorsum of the other hand at the posterior costovertebral angle. The upper abdominal quadrants and costovertebral angles are auscultated for vascular bruits in the renal vessels and aorta, and an empty bladder is not palpable. The kidneys are palpated through the abdomen, with the patient supine.

A urinalysis of a urine specimen that is not processed within 1 hour may result in erroneous measurement of
a) glucose
b) bacteria
c) specific gravity
d) white blood cells

B) bacteria
bacteria in warm urine specimens multiply rapidly, and false or unreliable bacterial counts may occur with old urine. Glucose, specific gravity, and WBCs do not change in urine specimens, but pH becomes more alkaline, RBCs are hemolyzed, and casts may disintegrate.

Which of the following urine specific gravity values would indicate to the nurse that the patient is receiving excessive IV fluid therapy?
a) 1.002
b) 1.010
c) 1.025
d) 1.030

a) 1.002
A urine specific gravity of 1.002 is low, indicating dluite urine and the excretion of excess fluid. Fluid overload, diuretics, or lack of ADH can cause dilute urine. Normal urine specific gravity indicates concentrated urine that would be seen in dehydration.

While caring for a 77-year old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. The clinical manifestations the patient is most likely to experience include:
a) cloudy urine and fever
b) urethral burning and blood urine
c) vague abdominal pain and disorientation
d) suprapubic pain and slight decline in body temperature

c) vague abdominal pain and disorientation
The usual classic symptoms of UTI are often absent in older adults, who tend to experience nonlocalized abdominal pain rather than dysuria and suprapubic pain. They may also experience cognitive impairment characterized by confusion or decreased level of consciousness.

A woman with no hx of UTIs who is experiencing urgency, frequency, and dysuria comes to the clinic, where a dipstick and microscopic urinalysis indicate bacteriuria. The nurse anticipates that the patient will
a) need to have a blood specimen drawn for a CBC and kidney function test
b) not be treated with medications unless she develops a fever, chills, or flank pain
c) be requested to obtain a clean-catch midstream urine specimen for culture and sensitivity
d) be treated empirically with TMP-SMX Bactrim for 3 days.

d) be treated empirically with TMP-SMX Bactrium for 3 days
Unless a patient has a hx of recurrent UTIs, TMP-SMX or nitrofurantoin is usually used to empirically treat an initial UTI without a culture and sensitivity test. Asymptomatic bacteriuria does not justify tc, but symptomatic UTIs should always be treated.

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