Urinary System Disorders | NCLEX Quiz 121

1. A female client is admitted for treatment of chronic renal failure (CRF). Nurse Julian knows that this disorder increases the client's risk of:

Water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

A decreased serum phosphate level secondary to kidney failure.

An increased serum calcium level secondary to kidney failure.

Metabolic alkalosis secondary to retention of hydrogen ions.

A 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 the inability of the kidneys to excrete hydrogen ions.Options B and C: Electrolyte imbalances associated with this disorder result from the kidneys’ inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia.Option D: CRF may cause metabolic acidosis. not metabolic alkalosis. secondary to the inability of the kidneys to excrete hydrogen ions.

Explanation

A 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 the inability of the kidneys to excrete hydrogen ions.Options B and C: Electrolyte imbalances associated with this disorder result from the kidneys’ inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia.Option D: CRF may cause metabolic acidosis. not metabolic alkalosis. secondary to the inability of the kidneys to excrete hydrogen ions.

2. For a male client in the oliguric phase of acute renal failure (ARF). which nursing intervention is most important?

Encouraging coughing and deep breathing

Promoting carbohydrate intake

Limiting fluid intake

Providing pain-relief measures

During the oliguric phase of ARF. urine output decreases markedly. possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications. such as heart failure and pulmonary edema.Option A: Encouraging coughing and deep breathing is important for clients with various respiratory disorders.Option B: Promoting carbohydrate intake may be helpful in ARF but doesn’t take precedence over fluid limitation.Option D: Controlling pain isn’t important because ARF rarely causes pain.

Explanation

During the oliguric phase of ARF. urine output decreases markedly. possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications. such as heart failure and pulmonary edema.Option A: Encouraging coughing and deep breathing is important for clients with various respiratory disorders.Option B: Promoting carbohydrate intake may be helpful in ARF but doesn’t take precedence over fluid limitation.Option D: Controlling pain isn’t important because ARF rarely causes pain.

3. Nurse Pippy is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way?

Fluid intake should be double the urine output.

Fluid intake should be approximately equal to the urine output.

Fluid intake should be half the urine output.

Fluid intake should be inversely proportional to the urine output.

Normally. fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. For example. fluid intake that is double the urine output indicates fluid retention; fluid intake that is half the urine output indicates dehydration. Normally. fluid intake isn’t inversely proportional to the urine output.

Explanation

Normally. fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. For example. fluid intake that is double the urine output indicates fluid retention; fluid intake that is half the urine output indicates dehydration. Normally. fluid intake isn’t inversely proportional to the urine output.

4. A male client with acute pyelonephritis receives a prescription for co-trimoxazole (Septra) P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the prescribed regimen?

Urine output increases to 2.000 ml/day.

Flank and abdominal discomfort decrease.

Bacteria are absent on urine culture.

The red blood cell (RBC) count is normal.

Co-trimoxazole is a sulfonamide antibiotic used to treat urinary tract infections. Therefore. the absence of bacteria on urine culture indicates that the drug has achieved its desired effect.Options A and D: Co-trimoxazole doesn’t affect urine output or the RBC count.Option B: Although flank pain may decrease as the infection resolves. this isn’t a reliable indicator of the drug’s effectiveness.

Explanation

Co-trimoxazole is a sulfonamide antibiotic used to treat urinary tract infections. Therefore. the absence of bacteria on urine culture indicates that the drug has achieved its desired effect.Options A and D: Co-trimoxazole doesn’t affect urine output or the RBC count.Option B: Although flank pain may decrease as the infection resolves. this isn’t a reliable indicator of the drug’s effectiveness.

5. Because of difficulties with hemodialysis. peritoneal dialysis is initiated to treat a female client's uremia. Which finding signals a significant problem during this procedure?

Potassium level of 3.5 mEq/L

Hematocrit (HCT) of 35%

Blood glucose level of 200 mg/dl

White blood cell (WBC) count of 20.000/mm3

An increased WBC count indicates infection. probably resulting from peritonitis. which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore. peritoneal dialysis would no longer be a treatment option for this client.Option A: A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution.Option B: An HCT of 35% is lower than normal. However. in this client. the value isn’t abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.Option D: Hyperglycemia occurs during peritoneal dialysis because of the high glucose content of the dialysate; it’s readily treatable with sliding-scale insulin.

Explanation

An increased WBC count indicates infection. probably resulting from peritonitis. which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore. peritoneal dialysis would no longer be a treatment option for this client.Option A: A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution.Option B: An HCT of 35% is lower than normal. However. in this client. the value isn’t abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.Option D: Hyperglycemia occurs during peritoneal dialysis because of the high glucose content of the dialysate; it’s readily treatable with sliding-scale insulin.

6. A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation. the nurse is aware that the functions of the three lumens include:

Continuous inflow and outflow of irrigation solution.

Intermittent inflow and continuous outflow of irrigation solution.

Continuous inflow and intermittent outflow of irrigation solution.

Intermittent flow of irrigation solution and prevention of hemorrhage.

When preparing for continuous bladder irrigation. a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

Explanation

When preparing for continuous bladder irrigation. a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

7. A client comes to the outpatient department complaining of vaginal discharge. dysuria. and genital irritation. Suspecting a sexually transmitted disease (STD). Dr. Smith orders diagnostic tests of the vaginal discharge. Which STD must be reported to the public health department?

Chlamydia

Gonorrhea

Genital herpes

Human papillomavirus infection

Gonorrhea must be reported to the public health department.Options A. C. and D: Chlamydia. genital herpes. and human papillomavirus infection aren’t reportable diseases.

Explanation

Gonorrhea must be reported to the public health department.Options A. C. and D: Chlamydia. genital herpes. and human papillomavirus infection aren’t reportable diseases.

8. After trying to conceive for a year. a couple consults an infertility specialist. When obtaining a history from the husband. Nurse Jessica inquires about childhood infectious diseases. Which childhood infectious disease most significantly affects male fertility?

Chickenpox

Measles

Mumps

Scarlet fever

Mumps is the most significant childhood infectious disease affecting male fertility. Chickenpox. measles. and scarlet fever don’t affect male fertility.

Explanation

Mumps is the most significant childhood infectious disease affecting male fertility. Chickenpox. measles. and scarlet fever don’t affect male fertility.

9. A female client requires hemodialysis. Which of the following drugs should be withheld before this procedure?

Phosphate binders

Insulin

Antibiotics

Cardiac glycosides

Cardiac glycosides such as digoxin should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis. and a hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity.Option A: Phosphate binders and insulin can be administered because they aren’t removed from the blood by dialysis.Option C: Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.

Explanation

Cardiac glycosides such as digoxin should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis. and a hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity.Option A: Phosphate binders and insulin can be administered because they aren’t removed from the blood by dialysis.Option C: Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.

10. A 26-year-old female client seeks care for a possible infection. Her symptoms include burning on urination and frequent. urgent voiding of small amounts of urine. She's placed on trimethoprim-sulfamethoxazole (Bactrim) to treat possible infection. Another medication is prescribed to decrease the pain and frequency. Which of the following is the most likely medication prescribed?

Nitrofurantoin (Macrodantin)

Ibuprofen (Motrin)

Acetaminophen with codeine

Phenazopyridine (Pyridium)

Phenazopyridine may be prescribed in conjunction with an antibiotic for painful bladder infections to promote comfort. Because of its local anesthetic action on the urinary mucosa. phenazopyridine specifically relieves bladder pain.Option A: Nitrofurantoin is a urinary antiseptic with no analgesic properties.Options B and C: While ibuprofen and acetaminophen with codeine are analgesics. they don’t exert a direct effect on the urinary mucosa.

Explanation

Phenazopyridine may be prescribed in conjunction with an antibiotic for painful bladder infections to promote comfort. Because of its local anesthetic action on the urinary mucosa. phenazopyridine specifically relieves bladder pain.Option A: Nitrofurantoin is a urinary antiseptic with no analgesic properties.Options B and C: While ibuprofen and acetaminophen with codeine are analgesics. they don’t exert a direct effect on the urinary mucosa.