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1. What should the nurse do to obtain an accurate urine output for a client with a continuous bladder irrigation (CBI)?

• Measure the contents of the bedside drainage bag.
• Stop the irrigation and determine the urine output.
• Subtract the volume of irrigant from the total drainage.
• Ensure the urine and irrigant drain into two separate bags.

2. A pathology report states that a client’s urinary calculus is composed of uric acid. Which should the nurse instruct the client to avoid?

• Milk
• Liver
• Cheese
• Vegetables

3. A client with cancer of the prostate requests the urinal at frequent intervals but either does not void or voids in very small amounts. What does the nurse conclude is most likely the causative factor?

• Edema
• Dysuria
• Retention
• Suppression

4. A nurse is counseling a woman who had recurrent urinary tract infections. What factor should the nurse explain is the reason why women are at a greater risk than men for contracting a urinary tract infection?

• Altered urinary pH
• Hormonal secretions
• Juxtaposition of the bladder
• Proximity of the urethra to the anus

5. A client in a nursing home is diagnosed with urethritis. What should the nurse plan to do before initiating antibiotic therapy prescribed by the health care provider?

• Prepare for urinary catheterization.
• Teach how to perform perineal care.
• Start a twenty-four-hour urine collection.
• Obtain a urine specimen for culture and sensitivity.

6. A client with a urinary retention catheter reports discomfort in the bladder and urethra. What should the nurse do first?

• Milk the tubing gently.
• Notify the health care provider.
• Check the patency of the catheter.
• Irrigate the catheter with prescribed solutions.

7. A client with rheumatoid arthritis asks the nurse why it is necessary to inject hydrocortisone into the knee joint. What reason should the nurse include in a response to this question?

• Lubricate the joint
• Reduce inflammation
• Provide physiotherapy
• Prevent ankylosis of the joint

8. What should the nurse take into consideration when planning nursing care for a client experiencing an acute episode of rheumatoid arthritis?

• Inflammation of the synovial membrane rarely occurs.
• Bony ankylosis of a joint is irreversible and causes immobility.
• Complete immobility is desired during the acute phase of inflammation.
• Redness and swelling of a joint signify irreversible damage has occurred.

9. A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy?

• “It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration.”
• “It exchanges and cleanses blood by correction of electrolytes and excretion of creatinine.”
• “It decreases the need for immobility because it clears toxins in short and intermittent periods.”
• “It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion.”

10. A nurse is assessing a client with a diagnosis of kidney failure for clinical indicators of metabolic acidosis. What should the nurse conclude is the reason why metabolic acidosis develops with kidney failure?

• Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate
• Depressed respiratory rate by metabolic wastes, causing carbon dioxide retention
• Inability of the renal tubules to reabsorb water to dilute the acid contents of blood
• Impaired glomerular filtration, causing retention of sodium and metabolic waste products

11. What is the nurse’s primary consideration when caring for a client with rheumatoid arthritis?

• Surgery
• Comfort
• Education
• Motivation

12. A nurse is caring for a client with acute kidney failure who is receiving a protein restricted diet. The client asks why this diet is necessary. What information should the nurse include in a response to the client’s questions?

• A high-protein intake ensures an adequate daily supply of amino acids to compensate for losses.
• Essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis.
• This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys.
• Urea nitrogen cannot be used to synthesize amino acids in the body, so the nitrogen for amino acid synthesis must come from the dietary protein.

13. A nurse is caring for a client with glomerulonephritis. What should the nurse instruct the client to do to prevent recurrent attacks?

• Take showers instead of tub baths.
• Continue the same restrictions on fluid intake.
• Avoid situations that involve physical activity.
• Seek early treatment for respiratory tract infections.

14. A client is admitted to the hospital with a tentative diagnosis of urinary retention related to benign prostatic hyperplasia. There is a secondary diagnosis of delirium related to urosepsis. The health care provider prescribes the insertion of an indwelling urinary retention catheter. What nursing action is most important for this client’s safety?

• Secure an order for wrist restraints.
• Orient the client to time, place, and person.
• Involve family members in the client’s care.
• Determine if any unsafe behavior patterns exist.

15. The nurse questions a client with rheumatoid arthritis about pain. When should the nurse expect the client to experience increased pain and limited movement of the joints?

• After assistive exercise
• When the room is cool
• In the morning on awakening
• When the latex fixation test is positive

16. A lithotripsy to break up renal calculi is unsuccessful, and a nephrolithotomy is performed. Which postoperative clinical indicator should the nurse report to the health care provider?

• Passage of pink-tinged urine
• Pink drainage on the dressing
• Intake of 1750 mL in 24 hours
• Urine output of 20 to 30 mL/hr

17. A nurse plans care to prevent deformities in a client with rheumatoid arthritis. Which intervention should be alternated with periods of rest?

• Active exercise
• Passive massage
• Bracing of joints
• Isometric exercises

18. A nurse is caring for a client with an undescended testicle. The nurse teaches the client that the main reason why the testicles are suspended in the scrotum is to:

• protect the sperm from the acidity of urine.
• facilitate the passage of sperm through the urethra.
• protect the sperm from high abdominal temperatures.
• facilitate their maturation during embryonic development.

19. A routine urinalysis is ordered for a client. What should the nurse do if the specimen cannot be sent immediately to the laboratory?

• Take no special action.
• Refrigerate the specimen.
• Store it in the dirty utility room and send it later.
• Discard the specimen and collect another specimen later.

20. A nurse is assessing the urine of a client with a urinary tract infection. For which characteristic should the nurse assess each specimen of urine?

• Clarity
• Viscosity
• Glucose level
• Specific gravity

21. When preparing an individualized teaching plan for a client with rheumatoid arthritis, which topic should the nurse omit from the generalized teaching plan for clients with arthritis?

• Ulnar drift
• Heberden nodes
• Swan neck deformity
• Boutonniere deformity

22. A client with arthritis reports receiving the following dietary suggestions over the years. Which recommendation for a daily diet should the nurse reinforce?

• Wheat germ and yeast
• Yogurt and blackstrap molasses
• Multiple vitamin supplements in large doses
• Adequate foods in a variety of different food groups

23. A client who has intermittently been having painful, swollen knee and wrist joints during the past 3 months is diagnosed with rheumatoid arthritis. What type of diet should the nurse expect the health care provider to order?

• Salt-free, low-fiber diet
• High-calorie, low-cholesterol diet
• High-protein diet with minimal calcium
• Regular diet with vitamins and minerals

24. A client is diagnosed with bladder cancer, and a cystectomy and an ileal conduit are scheduled. What should the nurse plan to do preoperatively?

• Limit fluid intake for twenty-four hours.
• Teach range-of-motion and Kegel exercises.
• Explain the procedure for irrigating the ileal conduit.
• Administer cleansing enemas and laxatives as ordered.

25. A nurse is caring for a client with rheumatoid arthritis. Based on the clients diagnosis, the nurse should review the result of which laboratory test?

• Pancreatic lipase
• Bence Jones protein
• Antinuclear antibody
• Alkaline phosphatase

26. A client with acute kidney failure states, “Why am I twitching and my fingers and toes tingling?” The nurse should respond, “This is caused by:

• acidosis.”
• calcium depletion.”
• potassium retention.”
• sodium chloride depletion.”

27. When caring for a male client who is to receive chemotherapy for a cancerous condition, at which time should the nurse consider that spermatogenesis occurs?

• At the time of puberty
• At any time after birth
• Immediately following birth
• During embryonic development

28. A nurse is caring for a client after surgical creation of a conduit diversion. What is the major disadvantage of a conduit diversion that the nurse should consider when caring for this client?

• Peristalsis is greatly decreased.
• Stool continuously oozes from it.
• Urine continuously drains from it.
• Absorption of nutrients is diminished.

29. A client has a heminephrectomy and returns from the postanesthesia care unit with a nephrostomy tube and an indwelling urinary catheter. The client’s urinary output is 50 mL/hr. What is the nurse’s next action?

• Record the findings.
• Irrigate the nephrostomy tube.
• Encourage the intake of oral fluids.
• Notify the health care provider immediately.

30. A nurse is caring for a client with a diagnosis of benign prostatic hyperplasia (BPH). Which information about this condition is important for the nurse to consider when caring for this client?

• It is a congenital abnormality.
• A malignancy usually results.
• It predisposes to hydronephrosis.
• An increase in the acid phosphatase level occurs.

31. A nurse is caring for a client who is admitted with ureteral colic and hematuria. The client also has stage 1 hypertension and is overweight. The decrease of which clinical indicator associated with this client’s status should the nurse be most concerned about at this time?

• Pain
• Weight
• Hematuria
• Hypertension

32. A client with rheumatoid arthritis has severe pain and swelling of the joints in both hands. Range-of-motion exercises for this client should be:

• passively performed by the nurse.
• avoided if the client reports discomfort.
• preceded by the application of heat or cold.
• gradually increased to improve mobility and independence.

33. A nurse is caring for a client with a diagnosis of chronic kidney failure who has just been told by the health care provider that hemodialysis is necessary. Which clinical manifestation indicates the need for hemodialysis?

• Ascites
• Acidosis
• Hypertension
• Hyperkalemia

34. A nurse is caring for a client with an indwelling urinary catheter. What is the most important action for the nurse to implement when irrigating the bladder?

• Use sterile equipment.
• Instill the fluid under high pressure.
• Warm the solution to body temperature.
• Aspirate immediately to ensure return flow.

35. After a nephrectomy a client arrives in the postanesthesia care unit in the supine position. Which action should be employed by the nurse to assess the client for signs of hemorrhage?

• Turn the client to observe the dressings.
• Press the client’s nail beds to assess capillary refill.
• Observe the client for hemoptysis when suctioning.
• Monitor the client’s blood pressure for a rapid increase.

36. Which medication should the nurse anticipate the health care provider will prescribe to relieve the pain experienced by a client with rheumatoid arthritis?

• Aspirin
• Codeine
• Meperidine
• Alprazolam

37. Which nursing action can best prevent infection from a urinary retention catheter?

• Cleansing the perineum
• Encouraging adequate fluids
• Irrigating the catheter once daily
• Cleansing around the meatus routinely

38. A client is ready to walk with crutches after knee surgery. Which crutch-walking technique will the nurse most likely have to reinforce after the client returns from physical therapy?

• Two-point
• Four-point
• Three-point
• Swing-through

39. A client with acute kidney failure becomes confused and irritable. Which does the nurse determine is the most likely cause of this behavior?

• Hyperkalemia
• Hypernatremia
• A limited fluid intake
• An increased blood urea nitrogen level

40. A nurse is caring for a male client who is scheduled for a dilation of the urethra. Which structure surrounding the male urethra should the nurse include in a teaching program when explaining the procedure?

• Epididymis
• Prostate gland
• Seminal vesicle
• Bulbourethral gland

41. A client who had a suprapubic prostatectomy returns from the postanesthesia care unit and accidentally pulls out the urethral catheter. What should the nurse do first?

• Reinsert a new catheter.
• Notify the health care provider.
• Check for bleeding by irrigating the suprapubic tube.
• Take no immediate action if the suprapubic tube is draining.

42. A client had a suprapubic prostatectomy. Which type of tube can the nurse expect the client to have when he returns to his room from the postanesthesia care unit?

• Cystostomy
• Nasogastric
• Nephrostomy
• Ureterostomy

43. A nurse is evaluating a client’s understanding of peritoneal dialysis. Which information in the client’s response indicates an understanding of the purpose of the procedure?

• Reestablish kidney function
• Clean the peritoneal membrane
• Provide fluid for intracellular spaces
• Remove toxins in addition to other metabolic wastes

44. A nurse is caring for a client with a continuous bladder irrigation. Which is the most important nursing action?

• Monitoring urinary specific gravity to determine hydration
• Subtracting irrigant from output to determine urine volume
• Recording urinary output every hour to determine kidney function
• Obtaining a twenty-four-hour urine specimen to determine urine concentration

45. A nurse is teaching crutch walking to a client who had arthroscopic surgery of the knee. On which part of the body should the nurse instruct the client to place weight?

• The upper arms
• The axillary region
• Palms of the hands
• Both lower extremities

46. A nurse is caring for a client with a diagnosis of renal calculi of calcium phosphate composition. Which type of diet should the nurse explore with the client when providing discharge information?

• Low purine
• Low calcium
• High phosphorus
• High alkaline ash

47. A nurse is providing client teaching to a woman who has recurrent urinary tract infections. Which information should the nurse include concerning the reason why women are more susceptible to urinary tract infections than men?

• Inadequate fluid intake
• Poor hygienic practices
• The length of the urethra
• The continuity of mucous membranes

48. A nurse is caring for a client with a diagnosis of cancer of the prostate. Which serum level should the nurse teach the client to have monitored to follow the course of the disease?

• Serum creatinine
• Blood urea nitrogen
• Nonprotein nitrogen
• Prostate-specific antigen

49. A client experiences difficulty in voiding after an indwelling urinary catheter is removed. To what does the nurse determine that this is most probably related?

• Fluid imbalance
• Sedentary lifestyle
• Interruption in previous voiding habits
• Nervous tension following the procedure

50. A regimen of rest, exercise, and physical therapy is ordered for a client with rheumatoid arthritis. What should the nurse explain is the intended purpose of this regimen?

• Prevent arthritic pain
• Halt the inflammatory process
• Help prevent the crippling effects of the disease
• Provide for the return of joint motion after prolonged loss