(Osborn) Chapter 47: Osborn, Et Al., Test Item File For Medical-Surgical Nursing: Preparation For Practice

[Osborn] chapter 47
Learning Outcomes [Number and Title ]

Learning Outcome 1
Learning Outcome 2
Learning Outcome 3
Learning Outcome 4
Learning Outcome 5
Learning Outcome 6
Discuss the function of the kidney in relation to regulating fluid,

electrolyte, and acidbase balance.
List common diagnostic tests used to determine kidney function and
related diseases.
Identify the major diseases of the kidney.
Discuss complications of kidney-related diseases.
Recognize the signs and symptoms associated with urinary tract
disorders.
Compare and contrast the underlying principles of hemodialysis and
peritoneal dialysis.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
1. A chronic renal failure client is exhibiting signs of metabolic acidosis. Upon

assessment of the clients respiratory status, the nurse would expect:
1.
2.
3.
4.
Kussmaul respirations.
Periods of apnea.
Dyspnea.
Cheyne-Stokes respirations.
Correct Answer: Kussmaul respirations.

Rationale: Kussmaul respirations are the bodys physiologic response to acidosis. The client will
exhibit Kussmaul respirations in attempt to blow off excess CO2. Periods of apnea is incorrect
because the client will not be able to get rid of excess hydrogen ions if he or she is having
periods of apnea. The patient should exhibit rapid deep respirations, not difficulty with breathing.
Cheyne-Stokes respirations are exhibited with metabolic alkalosis.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 1
2. Which of the following nursing diagnoses would the nurse expect for a client with
a decreased erythropoietin production?
1.
2.
3.
4.
Risk for Injury

Risk for Fluid-Volume Deficit
Risk for Infection
Risk for Altered Nutrition
Correct Answer: Risk for Injury

Rationale: When the kidneys are not producing erythropoietin, the client will have a decrease in
red blood cell production. With a low red blood cell production, the client will exhibit signs of
anemia, and will therefore be at risk for injury from fatigue and weakness. Risk for Fluid-Volume
Deficit is incorrect because the client is not going to have a fluid shift with a decreased red blood
cell production. The patient would not be at increased risk for infection because the decreased
erythropoietin production indicates a decrease in red blood cell production, not white blood cell
production. Nutritional status is not directly impacted by the decreased red blood cell production.
Nursing Process: Planning
LO: 1
3. A client admitted with an infection of the urinary tract is experiencing

hypotension and shock. The nurse understands that the physiologic response of the
kidneys during this state would reveal an increase in:
Select all that apply.

1. Renin.
2. Antidiuretic hormone .
3. Aldosterone.
4. Vitamin D.
5. Chloride.
Correct Answer:
1. Renin.
2. Antidiuretic hormone .
3. Aldosterone.
Rationale: Renin. There will be an increase in the secretion of renin, which converts
angiotensinogen to angiotensin, stimulating the release of aldosterone by the adrenal cortex.
Antidiuretic hormone. There will be an increase in the antidiuretic hormone in response to an
increased serum osmolality. Aldosterone. There will be an increase in the secretion of rennin,
which converts angiotensinogen to angiotensin, stimulating the release of aldosterone by the
adrenal cortex. Vitamin D. This does not reflect hydration status, which is normally impaired in
hypotension and shock states. Chloride. This level is not increased in shock states.
Cognitive Level: Analysis
LO: 1
4. A client is admitted with acute glomerulonephritis. The nurse inspects the clients
urine and expects to find:
1.
2.
3.
4.
Tea-colored urine.
Orange-colored urine.
Clear yellow urine.
Green-colored urine.
Correct Answer: Tea-colored urine.

Rationale: The client will exhibit hematuria, or blood in the urine, and the urine will have a teacolored appearance. Orange-colored urine is associated with the use of antibiotics or
chemotherapy drugs. Clear yellow urine is a normal finding in a urinalysis. Green-colored urine
would indicate disorders associated with high calcium levels.
LO: 2
5. The nurse is preparing to administer antibiotics to a client with pyelonephritis.

The nurse understands that the implementation of this order was based on the
results of the clients:
1.
2.
3.
4.
Urine culture.
Urinalysis.
X-ray films of the kidneys.
Intravenous pyleogram.
Correct Answer: Urine culture.

Rationale: The urine culture would identify the organism causing the infection of the kidney. A
urinalysis does not identify the type of bacteria present in the kidney. X-ray films of the kidney
would not identify the type of organism causing the infection of the kidney. An intravenous
pyleogram involves the injection of a dye into the bloodstream, which concentrates in the urinary
tract to better visualize the structures of the urinary tract.
Nursing Process: Implementation
LO: 2
6. A client is diagnosed with acute tubular necrosis. The nurse understands that cardiac
monitoring would be indicated based on which laboratory findings?
Select all that apply:
1.
2.
3.
4.
5.
Hyperkalemia
Hypercalcemia
Hyperphosphatemia
Lymphocytosis
Leukocytosis
Correct Answer:
1. Hyperkalemia
2. Hypercalcemia
3. Hyperphosphatemia
Rationale: Hyperkalemia. The kidneys have lost their ability to regulate electrolyte
excretion; hyperkalcemia levels can quickly change with acute tubular necrosis and
result in cardiac complications. Therefore, it is necessary that the client have EKG
monitoring continuously to identify changes in the clients condition.
Hypercalcemia. The kidneys have lost their ability to regulate electrolyte
excretion; hypercalcemia levels can quickly change with acute tubular necrosis and
result in cardiac complications. Therefore, it is necessary that the client have EKG
monitoring continuously to identify changes in the clients condition.
Hyperphosphatemia. The kidneys have lost their ability to regulate electrolyte
excretion; hyperphosphatemia levels can quickly change with acute tubular necrosis
and result in cardiac complications. Therefore, it is necessary that the client have
EKG monitoring continuously to identify changes in the clients condition.
Lymphocytosis. Lymphocytes are not affected in acute tubular necrosis.
Leukocytosis. Leukocytosis would only be elevated if the client had an infection. In this case,
the client does not.
LO: 2
7. Which of the following nursing diagnoses would the nurse incorporate in the plan
of care of a newly diagnosed client with polycystic disease?

1.
2.
3.
4.
5.
Alteration in Comfort
Ineffective Coping
Risk for Impaired Mobility
Impaired Skin Integrity
Impaired Gas Exchange
Correct Answers:
1. Alteration in Comfort
2. Ineffective Coping
3. Risk for Impaired Mobility
Rationale: Alteration in comfort. The client with polycystic disease will experience abdominal
and lumbar pain. Ineffective coping. Half of children born to a client with polycystic disease
will have the disease, which is also progressive. Risk for impaired mobility. The pain of
polycystic disease may decrease the clients ability to ambulate. Impaired skin integrity. The
skin is not affected with this disease. Impaired gas exchange. The respiratory system is not
involved with a newly diagnosed client.
LO: 3
8. A client is concerned about the risk of developing renal carcinoma. The nurse
should respond by asking which of the following questions that would indicate the
client may be at increased risk of developing of renal carcinoma?
1.
2.
3.
4.
Do you smoke cigarettes?

Do you exercise regularly?
Are you taking any medications?
Do you take herbal supplements?
Correct Answer: Do you smoke cigarettes?

Rationale: Environmental carcinogens such as tobacco have been found to predispose a person to
transitional cell tumors such as with renal carcinoma. Exercising regularly may prevent renal
carcinoma. There are no known medications that contribute to the disease. The use of herbal
supplements has not been proven to cause renal cancer.
Client Need: Health Promotion and Maintenance
LO: 3
9. The nurse is caring for a client with an elevated serum blood urea nitrogen (BUN)
and creatinine. The client is scheduled for a CT scan with contrast. The nurse would:
1.
2.
3.
4.
Notify the health care provider to withhold contrast.

Monitor blood pressure before and after the procedure.
Hydrate well prior to the procedure.
Keep the client NPO after the procedure.
Correct Answer: Notify the health care provider to withhold contrast.

Rationale: The nurse should notify the health care provider to withhold contrast because a client
with an elevated BUN and creatinine indicates impaired renal function. With an impaired renal
function, the client would not be able to readily excrete the contrast media. This may lead to an
intrarenal cause of acute renal failure. Blood pressure would not be influenced by the
administration of the contrast media. With the renal impairment of the client, hydration would
not decrease the risk of the client developing acute renal failure.
LO: 3
10. A peritioneal dialysis client states that during the home exchanges, the return
solution is cloudy. The nurse would respond by asking the client:

1.
2.
3.
4.
5.
Do you wash your hands prior to the exchanges?

How do you change your dialysis catheter dressing?
Have you developed any recent fevers?
What color is your urine?
At what time of the day do you perform your exchanges?
Correct Answer:
1. Do you wash your hands prior to the exchanges?
2. How do you change your dialysis catheter dressing?
3. Have you developed any recent fevers?
Rationale: Do you wash your hands prior to the exchanges? The client has peritonitis, as
evidenced by the cloudy return dialysate; the questioning of aseptic techniques is necessary to
determine the cause of the peritonitis. How do you change your dialysis catheter dressing?
The client has peritonitis, as evidenced by the cloudy return dialysate; the questioning of aseptic
techniques is necessary to determine the cause of the peritonitis. Have you developed any
recent fevers? Fevers would further indicate that the client has developed peritonitis. What
color is your urine? The client is in chronic renal failure and will be anuric. At what time of
the day do you perform your exchanges? The time of the day of exchanges does not
influence the risk of peritonitis.
LO: 4
11. The nurse caring for a client with acute renal failure realizes that a complication
has occurred during the diuretic stage of the disorder when the client exhibits signs
of:

1. Hypovolemia.
2. Hypotension.
3. Infection.
4. Hyperkalemia.
5. Hypernatremia.
Correct Answer:
1. Hypovolemia.
2. Hypotension.
3. Infection.
Rationale: Hypovolemia. The client will have large amounts of urine output, as high as 1 to 2
liters/day. This places the client at risk for hypovolemia. Hypotension. The client will have large
amounts of urine output, as high as 1to 2 liters/day. This places the client at risk for hypotension.
Infection. The client can exhibit signs of infection during any phase of acute renal failure.
Hyperkalemia. The client will exhibit signs of hypokalemia with the excessive amounts of urine
output. Hypernatremia. The sodium level would decrease in this phase.
LO: 4
12. The nurse caring for a chronic renal failure client notes that the clients oral
mucosa is dry and cracked. The nurse would:

1.
2.
3.
4.
5.
Provide frequent oral care.

Offer hard candy.
Document the finding.
Encourage fluids.
Administer a fluid bolus.
Correct Answer:
1. Provide frequent oral care.
2. Offer hard candy.
3. Document the finding.
Rationale: Provide frequent oral care. Provide frequent oral care to decrease the dryness of the
oral mucosa, remove debris, and add comfort. Offer hard candy. Hard candy should be offered
because this will stimulate salivation, adding to the comfort of the client. Document the finding.
The nurse should document this finding to alert other staff of the condition of the oral mucosa
and measures implemented to increase client comfort. Encourage fluids. Chronic renal failure
clients are fluid restricted. Administer a fluid bolus. Administering a fluid bolus would not be
indicated because of the fluid restriction of chronic renal failure clients.
LO: 4
13. A client admitted with nephrolithiasis complains of flank pain. The nurse
understands that the clients stone is most likely located in the renal pelvis and
calyces because the client describes the nature of the pain as:
Select all that apply:

1.
2.
3.
4.
5.
Dull.
Constant.
Severe.
Colicky.
Intermittent.
Correct Answers:
1. Dull.
2. Constant.
Rationale: Dull. The pain would be dull and constant because the calculi are
located in the renal pelvis, which is larger anatomically than the ureter, causing
severe pain. Constant. The pain would be constant because the calculi are located
in the renal pelvis, which is a larger anatomically than the ureter, causing severe
pain. Severe. The pain would be severe and colicky as it travels from the
costovertebral angle to the flank. Colicky. The pain would be severe and colicky as
it travels from the costovertebral angle to the flank. Intermittent. The pain is
constant when the stone is in the renal pelvis.

LO: 5
14. A client with cystitis is being treated with phenazopyridine hydrochloride

(pyridium). The client notifies the nurse upon voiding because of the bright orange
color of the urine. The nurse would:
1.
2.
3.
4.
Reassure the client that this is expected.

Check the clarity of the urine.
Strain and reexamine the urine.
Encourage the client to drink fluids.
Correct Answer: Reassure the client that this is expected.

Rationale: The nurse should reassure the client that this is expected with this medication. The
color is normal with this medication. The urine may be cloudy; however, this is expected with a
diagnosis of cystitis. Straining and examining the urine would be implemented for a client with
urinary calculi. Encouraging the client to drink fluids is indicated for a client with cystitis, but
this will not change the side effect of the orange-colored urine.
LO: 5
15. A client with a nephrostomy tube complains of pain and pressure at the site. The
nurse would:
1.
2.
3.
4.
Assess for obstruction.

Irrigate the tube.
Clamp the tube.
Administer pain medication.
Correct Answer: Assess for obstruction.

Rationale: The nurse should assess for obstruction of the tube because these signs and symptoms
are related to nephrostomy tube obstruction. Irrigation of the tube is contraindicated unless
ordered by the health care provider. Clamping the tube would further cause urine backflow and
retention, which may lead to infection because of the stasis of urine. Administering pain
medication will not resolve the cause of the tube obstruction.
LO: 5
16. The nurse is caring for a client with an AV fistula. Upon assessment the nurse
notes that the extremity with the fistula is pale and cool. The nurse would initially:
1.
2.
3.
4.
Auscultate the fistula.

Notify the health care provider.
Check vital signs.
Document the finding.
Correct Answer: Auscultate the fistula.

Rationale: Auscultating the fistula would allow the nurse to determine the presence of a bruit,
which would indicate adequate blood flow through the fistula. The nurse would gather further
assessment data prior to notifying the health care provider. Checking vital signs would not
determine if the fistula was patent. Documenting the finding would not assist in determining the
patency of the fistula.
LO: 6
17. The nurse is caring for a chronic renal failure client with an AV fistula. The client
has just completed hemodialysis. Site care of the fistula would initially involve:
1.
2.
3.
4.
Application of firm pressure to the site.

Placing a sterile dressing over the site.
Checking the blood pressure in the extremity.
Applying antibiotic ointment to the site.
Correct Answer: Application of firm pressure to the site.

Rationale: After the discontinuation of the dialysis needles that were placed into the artery and
vein of the fistula, the client would be at risk for bleeding; firm pressure at the site should be
applied until bleeding has stopped. The fistula will not require a dressing after the completion of
hemodialysis. A blood pressure obtained in the extremity of the fistula could occlude the fistula.
There is no need to apply antibiotic ointment to the site unless there are signs of infection
present.
LO: 6
18. The nurse is caring for a client receiving hemodialysis. Which of the following
assessments would be necessary to detect complications of disequilibrium
syndrome?
1.
2.
3.
4.
Level of consciousness
Fluid intake
Temperature
Urine output
Correct Answer: Level of consciousness

Rationale: With the removal of solutes in the blood more rapidly than from cerebrospinal fluid
and the brain, changes in level of consciousness would be seen. Intake and output would not
reflect a sign indicating disequilibrium syndrome. Monitoring temperature would indicate the
possibility of infection, not disequilibrium syndrome. Monitoring urine output does not indicate a
sign of disequilibrium syndrome.
Nursing Process: Assessments
LO: 6

(Osborn) Chapter 47: Osborn, Et Al., Test Item File For Medical-Surgical Nursing: Preparation For Practice

Transféré par

Informations du document

Description originale:

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

(Osborn) Chapter 47: Osborn, Et Al., Test Item File For Medical-Surgical Nursing: Preparation For Practice

Transféré par

Droits d'auteur :

Formats disponibles

[Osborn] chapter 47

Learning Outcomes [Number and Title ]

Discuss the function of the kidney in relation to regulating fluid,

1. A chronic renal failure client is exhibiting signs of metabolic acidosis. Upon

Correct Answer: Kussmaul respirations.

Risk for Injury

Correct Answer: Risk for Injury

3. A client admitted with an infection of the urinary tract is experiencing

Select all that apply.

Correct Answer: Tea-colored urine.

5. The nurse is preparing to administer antibiotics to a client with pyelonephritis.

Correct Answer: Urine culture.

Select all that apply.

Do you smoke cigarettes?

Correct Answer: Do you smoke cigarettes?

Notify the health care provider to withhold contrast.

Correct Answer: Notify the health care provider to withhold contrast.

Select all that apply.

Do you wash your hands prior to the exchanges?

Select all that apply.

Select all that apply.

Provide frequent oral care.

Select all that apply:

Cognitive Level: Analysis

14. A client with cystitis is being treated with phenazopyridine hydrochloride

Reassure the client that this is expected.

Correct Answer: Reassure the client that this is expected.

Assess for obstruction.

Correct Answer: Assess for obstruction.

Auscultate the fistula.

Correct Answer: Auscultate the fistula.

Application of firm pressure to the site.

Correct Answer: Application of firm pressure to the site.

Correct Answer: Level of consciousness

Vous aimerez peut-être aussi