NURSING PROGRAM

Urinary and Renal System worksheet (answer key)

1. The nurse is working on a medical-surgical nursing unit and is caring for several clients with
chronic kidney disease. The nurse interprets that which client is best suited for peritoneal
dialysis as a treatment option?

A. A client with severe heart failure

B. A client with a history of ruptured diverticula
C. A client with a history of herniated lumbar disk
D. A client with a history of 3 previous abdominal surgeries

2. The nurse is reviewing a client's record and notes that the health care provider has
documented that the client has chronic renal disease. On review of the laboratory results, the
nurse most likely would expect to note which finding?

A. Elevated creatinine level

B. Decreased hemoglobin level
C. Decreased red blood cell count
D. Increased number of white blood cells in the urine

3. A client with an arteriovenous fistula in the left arm who is undergoing hemodialysis is at
risk for infection. Which should the nurse formulate as the best outcome goal for this client
problem?

A. The client washes hands at least once per day.

B. The client's temperature remains lower than 101°F (38.3°C).
C. The client avoids blood pressure (BP) measurement in the left arm.
D. The client's white blood cell (WBC) count remains within normal limits.

4. The nurse is monitoring the fluid balance of an assigned client. The nurse determines that the
client has proper fluid balance if which 24-hour intake and output totals are noted?

A. Intake 1500 mL, output 800 mL

B. Intake 3000 mL, output 2000 mL
C. Intake 2400 mL, output 2900 mL
D. Intake 1800 mL, output 1750 mL
5. The nurse checks the serum myoglobin level for a client with a crush injury to the right lower
leg because the client is at risk for developing which type of acute kidney injury?

A. Prerenal
B. Intrarenal
C. Postrenal
D. Extrarenal
6. A hospitalized client is scheduled for a percutaneous kidney biopsy at 10 AM. At 8 AM, the
nurse reviews the client's vital signs and most current serum laboratory results. Which
finding is most important to report to the health care provider (HCP)?

A. Blood pressure of 180/100 mm Hg

B. Creatinine of 2 mg/dL (176.8 µmol/L)
C. Hemoglobin of 9.8 g/dL (98 g/L)
D. Platelet count of 120,000/mm3 (120 x 109/L)

7. When a client diagnosed with acute urinary retention is emergently catheterized, the nurse
should initially assess for which priority manifestation that may occur as a result of the
catheterization?

A. Dysuria
B. Hypotension
C. Infection
D. Tachycardia
8. A client with advanced kidney disease has serum potassium of 7.1 mEq/L (7.1 mmol/L) and
creatinine of 4.5 mg/dL (398 µmol/L). What is the priority prescribed intervention?
Normal potassium 3.6 to 5.2 millimoles per liter (mmol/L).
Normal creatinine 0.7 to 1.3 mg/dL
A. Administer IV 50% dextrose and regular insulin
B. Administer IV furosemide
C. Administer oral sodium polystyrene sulfonate
D. Prepare the client for hemodialysis catheter placement

9. The nurse is caring for a 78-year-old client with a urinary tract infection (UTI). Which
assessment finding would be most concerning and require immediate follow-up by the nurse?

A. Confusion
B. Presbyopia
C. Temperature 100.2 F (37.8 C)
D. White blood cell (WBC) count 12,000/mm3
10. The nurse assesses a client receiving peritoneal dialysis. Which assessment findings are most
important for the nurse to report to the health care provider? Select all that apply.

A. Cloudy outflow
B. Low-grade fever
C. Oliguria
D. Pruritus
E. Tachycardia

11. The nurse is caring for a 72-year-old client with a history of renal calculi and diabetes
mellitus who was admitted for acute pyelonephritis. The nurse assesses shaking chills,
temperature of 101.2 F (38.4 C), and flank pain. Which of the following is the priority
nursing intervention?

A. Administer intravenous antibiotics

B. Check baseline serum creatinine level
C. Have the client strain all urine
D. Obtain blood and urine cultures

12. The nurse assesses a client diagnosed with chronic kidney disease who had an internal
arteriovenous fistula performed on the left arm yesterday. Which assessment finding would
require immediate follow-up?

A. A bruit cannot be auscultated over the fistula site

B. Capillary refill of 2 seconds is assessed on the left hand
C. Client reports squeezing a rubber ball with the left hand several times daily
D. Incision is dry with no redness and has sterile skin closures in place

13. A client underwent a transurethral resection of the prostate (TURP) today and has a 3-way
Foley urinary catheter with continuous bladder irrigation (CBI). The client reports lower
abdominal pain rated as an 8 on a scale of 0-10. What action should the nurse carry out first?
 A. Administer prescribed strong analgesic suppositories prn
B. Administer prescribed morphine intravenous push prn
C. Check amount and characteristics of urine output
D. Check when the client had the last flatus or bowel movement

14. The nurse is caring for a client whose peritoneal dialysis is beginning to exhibit insufficient
outflow. What actions should the nurse perform initially? Select all that apply.

A. Assess for abdominal distention and constipation

B. Contact the client's health care provider
C. Examine the catheter for kinks and obstructions
D. Flush the tubing with 100 mL of dialysate
E. Place the client in a side-lying position
15. Which of the following assessments would be most appropriate for the nurse to make while
the dialysis solution is dwelling within the client's abdomen?

A. Assess for urticaria.

B. Observe respiratory status.
C. Check capillary refill time.
D. Monitor electrolyte status.

16. The nurse is instructing the client with chronic renal failure to maintain adequate nutritional
intake. Which of the following diets would be most appropriate?

A. High-carbohydrate, high-protein.
B. High-calcium, high-potassium, high-protein.
C. Low-protein, low-sodium, low-potassium.
D. Low-protein, high-potassium.

17. To assess the client's rental status, the nurse should monitor which of the following
laboratory tests? Select all that apply.

A. Serum sodium
B. Potassium levels.
C. Arterial blood gases.
D. Hemoglobin.
E. Serum blood urea nitrogen (BUN)
F. Creatinine levels.
G. Urinalysis

18. Which of the following is the most common initial manifestation of acute renal failure?

A. Dysuria.
B. Anuria.
C. Hematuria.
D. Oliguria.

19. The client's serum potassium level is elevated in acute renal failure, and the nurse administers
sodium polystyrene sulfonate (Kayexalate). This drug acts to:

A. Increase potassium excretion from the colon.

B. Release hydrogen ions for sodium ions.
C. Increase calcium absorption in the colon.
D. Exchange sodium for potassium ions in the colon.
20. A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. The
intended outcome of this diet is to:
A. Act as a diuretic.
B. Reduce demands on the liver.
C. Help maintain urine acidity.
D. Prevent the development of ketosis.