Med Surg Renal, Bladder And Immune
Exam 4 Questions And Answers
/. (Ch. 46) (Evolve)
The nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based
upon this diagnosis, the nurse will expect to find which of the following as the "classic
triad" of presenting symptoms occurring in patients with renal cancer?
A. Fever, chills, flank pain
B. Hematuria, flank pain, palpable mass
C. Hematuria, proteinuria, palpable mass
D. Flank pain, palpable abdominal mass, and proteinuria - Answer-B. 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.)
/.(Ch. 46) (Evolve)
Which of the following nursing interventions is appropriate in providing care for an adult
patient with newly diagnosed adult onset polycystic kidney disease (PKD)?
A. Help the patient cope with the rapid progression of the disease.
B. Suggest genetic counseling resources for the children of the patient.
C. Expect the patient to have polyuria and poor concentration ability of the kidneys.
D. Implement appropriate measures for the patient's deafness and blindness in addition
to the renal problems. - Answer-B. 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.)
/.(Ch. 46) (Evolve)
An elderly 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 which of the following factors that may dispose him to
urinary tract infections (UTIs)?
A. High-purine diet
B. Sedentary lifestyle
C. Benign prostatic hyperplasia (BPH)
D. Recent use of broad-spectrum antibiotics - Answer-C. Benign prostatic hyperplasia
(BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary
lifestyle and recent antibiotics use are unlikely to contribute to UTIs, whereas a diet high
in purines is associated with renal calculi.)
,/.(Ch. 46) (Evolve)
The nurse is providing care for a patient who has been admitted to the hospital for the
treatment of nephrotic syndrome. Which of the following is a priority nursing assessment
in the care of this patient?
A. Assessment of pain and level of consciousness.
B. Assessment of serum calcium and phosphorus levels.
C. Blood pressure and assessment for orthostatic hypotension.
D. Daily weights and measurement of the patient's abdominal girth. - Answer-D. Daily
weight 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 blood pressure are
less important in the care of patients with nephrotic syndrome. Abnormal calcium and
phosphorus levels are not commonly associated with the etiology of nephrotic
syndrome.)
/.(Ch. 46) (Evolve)
Which of the following nursing diagnoses is a priority in the care of a patient with renal
calculi?
A. Acute pain
B. Deficient fluid volume
C. Risk for constipation
D. Risk for powerlessness - Answer-A. Acute pain
(Urinary stones are associated with severe abdominal or flank pain. Deficient fluid
volume is unlikely to results 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.)
/.(Ch. 46) (Evolve)
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 of the following measures should the nurse first recommend in an attempt to
resolve the woman's incontinence?
A. Kegel exercises
B. Use of adult incontinence pads
C. Intermittent self-catheterization
D. Dietary changes including fluid restriction. - Answer-A. 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.)
/.(Ch. 47) (Evolve)
,The nurse is preparing to administer a dose of PhosLo to a patient with chronic kidney
disease would interpret that this medication should have a beneficial effect on which of
the following laboratory values of the patient?
A. Sodium
B. Potassium
C. Magnesium
D. Phosphorus - Answer-D. Phosphorus
(Phosphorus and calcium have inverse or reciprocal relationships, meaning that when
phosphorus levels are high, calcium levels tend to be low. Therefore administration of
calcium should help to reduce a patient's abnormally high phosphorus level, as seen
with chronic kidney disease)
/.(Ch. 47) (Evolve)
When caring for a patient during the oliguric phase of acute kidney injury, which of the
following would be an appropriate nursing intervention?
A. Weigh the patient three times weekly.
B. Increase dietary sodium and potassium.
C. Provide a low-protein, high-carbohydrate diet.
D. Restrict fluids according to previous daily loss. - Answer-D. Restrict fluids according
to previous daily loss.
(Patients in the oliguric phase of acute kidney injury will have fluid volume excess with
potassium and sodium retention; hence, they will need to have dietary sodium,
potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid
loss (measured output plus 600 ml for insensible loss). The diet also needs to provide
adequate, not low, protein intake to prevent catabolism. The patient should also be
weighed daily, not just three times a week.
/.(Ch. 47) (Evolve)
Which of the following statements by the nurse regarding continuous ambulatory
peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to
this procedure?
A. "It is essential that you maintain aseptic technique to prevent peritonitis."
B. "You will be allowed a more liberal protein diet once you complete CAPD."
C. "It is important for you to maintain a daily written record of blood pressure and
weight."
D. "You will need to continue regular medical and nursing follow-up visits while
performing CAPD." - Answer-A. "It is essential that you maintain aseptic technique to
prevent peritonitis."
(Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is
imperative to teach the patient methods of preventing this from occurring. Although the
other teaching statements are accurate, they do not have the potential for mortality as
does the peritonitis, thus making that nursing action of highest priority.)
/.(Ch. 47) (Evolve)
A patient with a history of end-stage renal disease secondary to diabetes mellitus has
presented to the outpatient dialysis unit for his scheduled hemodialysis. Which of the
, following assessments should the nurse prioritize before, during, and after his
treatment?
A. Level of consciousness
B. Blood pressure and fluid balance
C. Temperature for signs and symptoms of infection
D. Assessment for signs and symptoms of infection - Answer-B. Blood pressure and
fluid balance
(Although all of the assessments are relevant to the care of a patient receiving
hemodialysis, the nature of procedure indicates a particular need to monitor patients
blood pressure and fluid balance.)
/.(Ch. 47) (Evolve)
A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant
approximately 24 hours ago. Which of the following is an expected assessment finding
for this patient during this early stage of recovery?
A. Hypokalemia
B. Hyponatremia
C. Large urine output
D. Leukocytosis with cloudy urine output - Answer-C. Large urine output
(Patients frequently experience diuresis in the hours and days immediately following a
kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings
that warrant prompt intevention.)
/.(Ch. 47) (Evolve)
Which of the following assessment findings is a consequence of the oliguric phase of
acute kidney injury (AKI)?
A. Hypovolemia
B. Hyperkalemia
C. Hypernatremia
D. Thrombocytopenia - Answer-B. Hyperkalemia
(In AKI the serum potassium levels increase because the normal ability of the kidneys to
excrete potassium is impaired. Sodium levels are typically normal or dimished, whereas
fluid volume is normally increased because of decreased urine output.
Thrombocytopenia is not a consequence of AKI, although altered platelet function may
occur in AKI.)
/.(Ch. 45) (Evolve)
In preparing a patient for an intravenous pyelogram (IVP), the nurse would expect to:
A. Administer a cathartic or enema
B. Assess patient for allergies to penicillin
C. Keep the patient NPO for 4 hours preprocedure
D. Advise the patient that a metallic taste may occur during procedure - Answer-A.
Administer a cathartic or enema
(Nursing responsibilities in caring for a patient undergoing an IVP include administration
of a cathartic or enema to empty the colon of feces and gas. The nurse will also assess
the patient for iodine sensitivity, keep the patient NPO for 8 hours preprocedure, and
Exam 4 Questions And Answers
/. (Ch. 46) (Evolve)
The nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based
upon this diagnosis, the nurse will expect to find which of the following as the "classic
triad" of presenting symptoms occurring in patients with renal cancer?
A. Fever, chills, flank pain
B. Hematuria, flank pain, palpable mass
C. Hematuria, proteinuria, palpable mass
D. Flank pain, palpable abdominal mass, and proteinuria - Answer-B. 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.)
/.(Ch. 46) (Evolve)
Which of the following nursing interventions is appropriate in providing care for an adult
patient with newly diagnosed adult onset polycystic kidney disease (PKD)?
A. Help the patient cope with the rapid progression of the disease.
B. Suggest genetic counseling resources for the children of the patient.
C. Expect the patient to have polyuria and poor concentration ability of the kidneys.
D. Implement appropriate measures for the patient's deafness and blindness in addition
to the renal problems. - Answer-B. 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.)
/.(Ch. 46) (Evolve)
An elderly 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 which of the following factors that may dispose him to
urinary tract infections (UTIs)?
A. High-purine diet
B. Sedentary lifestyle
C. Benign prostatic hyperplasia (BPH)
D. Recent use of broad-spectrum antibiotics - Answer-C. Benign prostatic hyperplasia
(BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary
lifestyle and recent antibiotics use are unlikely to contribute to UTIs, whereas a diet high
in purines is associated with renal calculi.)
,/.(Ch. 46) (Evolve)
The nurse is providing care for a patient who has been admitted to the hospital for the
treatment of nephrotic syndrome. Which of the following is a priority nursing assessment
in the care of this patient?
A. Assessment of pain and level of consciousness.
B. Assessment of serum calcium and phosphorus levels.
C. Blood pressure and assessment for orthostatic hypotension.
D. Daily weights and measurement of the patient's abdominal girth. - Answer-D. Daily
weight 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 blood pressure are
less important in the care of patients with nephrotic syndrome. Abnormal calcium and
phosphorus levels are not commonly associated with the etiology of nephrotic
syndrome.)
/.(Ch. 46) (Evolve)
Which of the following nursing diagnoses is a priority in the care of a patient with renal
calculi?
A. Acute pain
B. Deficient fluid volume
C. Risk for constipation
D. Risk for powerlessness - Answer-A. Acute pain
(Urinary stones are associated with severe abdominal or flank pain. Deficient fluid
volume is unlikely to results 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.)
/.(Ch. 46) (Evolve)
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 of the following measures should the nurse first recommend in an attempt to
resolve the woman's incontinence?
A. Kegel exercises
B. Use of adult incontinence pads
C. Intermittent self-catheterization
D. Dietary changes including fluid restriction. - Answer-A. 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.)
/.(Ch. 47) (Evolve)
,The nurse is preparing to administer a dose of PhosLo to a patient with chronic kidney
disease would interpret that this medication should have a beneficial effect on which of
the following laboratory values of the patient?
A. Sodium
B. Potassium
C. Magnesium
D. Phosphorus - Answer-D. Phosphorus
(Phosphorus and calcium have inverse or reciprocal relationships, meaning that when
phosphorus levels are high, calcium levels tend to be low. Therefore administration of
calcium should help to reduce a patient's abnormally high phosphorus level, as seen
with chronic kidney disease)
/.(Ch. 47) (Evolve)
When caring for a patient during the oliguric phase of acute kidney injury, which of the
following would be an appropriate nursing intervention?
A. Weigh the patient three times weekly.
B. Increase dietary sodium and potassium.
C. Provide a low-protein, high-carbohydrate diet.
D. Restrict fluids according to previous daily loss. - Answer-D. Restrict fluids according
to previous daily loss.
(Patients in the oliguric phase of acute kidney injury will have fluid volume excess with
potassium and sodium retention; hence, they will need to have dietary sodium,
potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid
loss (measured output plus 600 ml for insensible loss). The diet also needs to provide
adequate, not low, protein intake to prevent catabolism. The patient should also be
weighed daily, not just three times a week.
/.(Ch. 47) (Evolve)
Which of the following statements by the nurse regarding continuous ambulatory
peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to
this procedure?
A. "It is essential that you maintain aseptic technique to prevent peritonitis."
B. "You will be allowed a more liberal protein diet once you complete CAPD."
C. "It is important for you to maintain a daily written record of blood pressure and
weight."
D. "You will need to continue regular medical and nursing follow-up visits while
performing CAPD." - Answer-A. "It is essential that you maintain aseptic technique to
prevent peritonitis."
(Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is
imperative to teach the patient methods of preventing this from occurring. Although the
other teaching statements are accurate, they do not have the potential for mortality as
does the peritonitis, thus making that nursing action of highest priority.)
/.(Ch. 47) (Evolve)
A patient with a history of end-stage renal disease secondary to diabetes mellitus has
presented to the outpatient dialysis unit for his scheduled hemodialysis. Which of the
, following assessments should the nurse prioritize before, during, and after his
treatment?
A. Level of consciousness
B. Blood pressure and fluid balance
C. Temperature for signs and symptoms of infection
D. Assessment for signs and symptoms of infection - Answer-B. Blood pressure and
fluid balance
(Although all of the assessments are relevant to the care of a patient receiving
hemodialysis, the nature of procedure indicates a particular need to monitor patients
blood pressure and fluid balance.)
/.(Ch. 47) (Evolve)
A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant
approximately 24 hours ago. Which of the following is an expected assessment finding
for this patient during this early stage of recovery?
A. Hypokalemia
B. Hyponatremia
C. Large urine output
D. Leukocytosis with cloudy urine output - Answer-C. Large urine output
(Patients frequently experience diuresis in the hours and days immediately following a
kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings
that warrant prompt intevention.)
/.(Ch. 47) (Evolve)
Which of the following assessment findings is a consequence of the oliguric phase of
acute kidney injury (AKI)?
A. Hypovolemia
B. Hyperkalemia
C. Hypernatremia
D. Thrombocytopenia - Answer-B. Hyperkalemia
(In AKI the serum potassium levels increase because the normal ability of the kidneys to
excrete potassium is impaired. Sodium levels are typically normal or dimished, whereas
fluid volume is normally increased because of decreased urine output.
Thrombocytopenia is not a consequence of AKI, although altered platelet function may
occur in AKI.)
/.(Ch. 45) (Evolve)
In preparing a patient for an intravenous pyelogram (IVP), the nurse would expect to:
A. Administer a cathartic or enema
B. Assess patient for allergies to penicillin
C. Keep the patient NPO for 4 hours preprocedure
D. Advise the patient that a metallic taste may occur during procedure - Answer-A.
Administer a cathartic or enema
(Nursing responsibilities in caring for a patient undergoing an IVP include administration
of a cathartic or enema to empty the colon of feces and gas. The nurse will also assess
the patient for iodine sensitivity, keep the patient NPO for 8 hours preprocedure, and
