Question 1

A patient who is on hemodialysis for chronic kidney disease is given sevelamer hydrochloride (Renagel) with meals. What explanation should be provided to the patient as the primary reason the medication is being given?

Accepted Answer

Sevelamer hydrochloride (Renagel) is given to bind to dietary phosphorus and prevent its absorption. This helps to prevent damage to bones from high phosphorus levels commonly seen in patients with chronic kidney disease who are on hemodialysis.

Question 2

The nurse is caring for a patient who has acute kidney injury. Which diagnostic test result would most support this diagnosis?

Accepted Answer

A 24-hour creatinine clearance of 5 mL/min is significantly lower than the normal value of 100 mL/min, indicating impaired kidney function and supporting the diagnosis of acute kidney injury. Blood urea nitrogen and uric acid levels may be increased in kidney injury but can also be affected by other factors, such as diet and medications. A low hematocrit level may indicate anemia but is not specific to kidney injury.

Question 3

A patient who has diabetic nephropathy asks the nurse, "Why am I using smaller doses of insulin than I used to?" What would be the best explanation by the nurse?

Accepted Answer

Diabetic nephropathy can lead to decreased renal function. The kidneys may not break down the insulin as effectively as before, resulting in higher insulin levels in the bloodstream. This can lead to hypoglycemia if the patient continues to use the same doses of insulin as before.

Question 4

Which of these data collection techniques is the best determinant of a patient's fluid volume status that must be done on every patient with chronic kidney disease?

Accepted Answer

Daily weight is the best determinant of a patient's fluid volume status because it provides a quantitative measurement of changes in fluid balance over time. Intake and output can be useful but may not provide a complete picture of fluid status. Vital signs and skin turgor can be influenced by a variety of factors and may not be as reliable in determining fluid volume status.

Question 5

The nurse is reinforcing teaching of the most serious side effect of peritoneal dialysis. Which of these, if stated by a patient, indicates correct understanding?

Accepted Answer

Peritonitis is the most serious side effect of peritoneal dialysis, as it can lead to sepsis and death if not promptly treated. Cramps in the abdomen, paralytic ileus, and respiratory distress are potential complications but are not as serious as peritonitis.

Question 6

The nurse is collecting data for a patient who has returned from a dialysis session.After dialysis, the nurse anticipates which of these patient findings?

Accepted Answer

Dialysis may cause weight loss in patients due to the removal of excess fluid and waste products from the body. Increased energy is not a typical finding after dialysis, hypertension is possible but not anticipated, and distended neck veins are not related to dialysis.

Question 7

The nurse is caring for a patient who has a nephrostomy tube. What action should the nurse take?

Accepted Answer

The nurse should ensure that the nephrostomy tube is not kinked or clamped to allow for proper drainage of urine from the kidney to the collection bag. Limiting fluids or removal and cleaning of the tube should be done under the guidance of the healthcare provider. Keeping the collection bag taped to the abdomen is a standard practice.

Question 8

The nurse is reviewing the history and physical of a patient who has an infection. What term would the nurse understand describes an infection of the kidneys?

Accepted Answer

Pyelonephritis is the term used to describe an infection of the kidneys. Urethritis is an infection of the urethra, cystitis is an infection of the bladder, and hepatitis is an infection of the liver.

Question 9

A patient with glomerulonephritis asks, "How could I have gotten this?" How should the nurse respond?

Accepted Answer

Glomerulonephritis can be caused by a variety of factors, but one common cause is a streptococcal infection, such as a sore throat or skin infection. Asking about recent infections can help determine the cause and guide treatment. Bladder infections, unprotected sex, and family history are not typically associated with glomerulonephritis.

Question 10

A patient hourly urine output is recorded. Which of the following output rates should be brought to the attention of the registered nurse immediately?

Accepted Answer

A urine output rate of 15 mL/hr is considered low and could be a sign of dehydration or kidney dysfunction. The registered nurse should be notified immediately to assess the patient's condition and intervene if necessary. Output rates of 40, 60, or 80 mL/hr are within normal limits and do not require immediate attention.

Question 11

The nurse is reinforcing teaching on risk factors for the development of bladder cancer. Which of these, if stated by a patient, indicates a correct understanding?

Accepted Answer

Smoking is a well-known risk factor for bladder cancer, as the carcinogenic substances in tobacco can be excreted in the urine and can damage the bladder lining over time. A diet high in calcium, recurrent urinary tract infections, and hyperlipidemia are not known to be direct risk factors for bladder cancer.

Question 12

The nurse empties urine from an ileal conduit appliance. The urine has strands of mucus in it. What action should the nurse take?

Accepted Answer

Mucus in the urine from an ileal conduit is normal because the conduit is made from a piece of the intestine, and the intestines naturally produce mucus.

Question 13

The nurse is reinforcing 24-hour fluid intake teaching for a patient to prevent further urinary tract infections. Which of the following amounts if stated by the client would indicate a correct understanding of the teaching?

Accepted Answer

The recommended daily fluid intake to prevent UTIs is typically around 2-3 liters, or 2,000-3,000 mL. Option D is the closest to this range and would indicate a correct understanding of the teaching. Option C is slightly above the recommended range, but still acceptable. Option B is correct in terms of the number but may be confusing in some countries that use a period instead of a comma as a decimal separator. Option A is incorrect as it is only 1 mL, which is not enough to prevent UTIs.

Question 14

A patient with glomerulonephritis develops acute kidney injury. Which form of kidney injury has occurred?

Accepted Answer

Glomerulonephritis is a form of intrarenal (within the kidney) injury as it affects the structures inside the kidney such as glomeruli. The acute kidney injury that develops is also likely to be intrarenal. Prerenal injury is caused by decreased blood flow to the kidneys, while postrenal injury is caused by obstruction of urine flow out of the kidneys.

Question 15

The nurse is collecting data for a patient who has suspected cancer of the bladder. What finding would the nurse recognize as the most common symptom of cancer of the bladder?

Accepted Answer

Hematuria, or blood in the urine, is the most common symptom of cancer of the bladder. Pain, burning on urination, and urine retention may occur but are not as specific to bladder cancer as hematuria.

Question 16

A patient hospitalized for orthopedic surgery had a urinary catheter inserted. The patient later develops a urinary tract infection and asks the nurse what caused it. What is the appropriate response by the nurse?

Accepted Answer

The most common cause of a urinary tract infection in a patient with a urinary catheter is bacteria ascending the catheter into the bladder. This can happen when the catheter is not inserted correctly, when it is not kept clean, or when it remains in place for too long. The other options given are less likely to cause a UTI in this situation.

Question 17

The nurse is caring for a patient who has renal calculi. Which of these actions is essential for the nurse to take?

Accepted Answer

Straining all urine is essential in order to monitor for passage of the renal calculi. This can help determine the size and composition of the calculi, which can guide treatment decisions. Monitoring blood pressure may be important, but it is not directly related to the management of renal calculi. Obtaining a sterile urine specimen and limiting fluids at night may be helpful in some cases, but they are not essential for managing renal calculi.

Question 18

The nurse is caring for a patient who has chronic kidney disease and is very weak due to low hemoglobin. Which of the following does the nurse understand is the best explanation for the anemia?

Accepted Answer

Chronic kidney disease often leads to decreased secretion of erythropoietin, which is needed for the production of red blood cells. This can lead to anemia in patients with chronic kidney disease.

Question 19

The nurse is reinforcing teaching on antibiotic use for a urinary tract infection (UTI). Which of the following statements by the patient would indicate a correct understanding of the teaching?

Accepted Answer

The correct understanding of antibiotic use for UTI is to take the antibiotics until they are gone regardless of symptoms. This ensures that all bacteria causing the UTI are fully eradicated and decreases the risk of developing antibiotic resistance. Taking antibiotics until urine is no longer cloudy or until temperature is normal for 3 days does not guarantee complete eradication of bacteria, and taking antibiotics whenever discomfort is felt may lead to unnecessary antibiotic use and potential harm.

Question 20

The nurse is reinforcing teaching for a patient who has chronic kidney disease. Which patient statement indicates the need for further teaching?

Accepted Answer

The statement "As long as I don't eat protein, I'll be okay" indicates a need for further teaching. Patients with chronic kidney disease need to limit their protein intake, but they still need some protein for essential body functions. A dietitian can help the patient determine the appropriate amount of protein to consume.

Quiz 37: Nursing Care of Patients With Disorders of the Urinary System