A client with severe Crohn disease develops a small bowel obstruction. Which clinical finding should the nurse expect the client to report?

1. Bloody vomitus
2. Projectile vomiting
3. Bleeding with defecation
4. Pain in the left lower quadrant

B. Projectile vomiting

A client with a history of Crohn disease develops an intestinal obstruction. A nasogastric tube is inserted and connected to low continuous suction. The nurse monitors the client for fluid volume deficit. What clinical finding does the nurse expect if the client becomes dehydrated?

1. Restlessness
2. Constipation
3. Inelastic skin turgor
4. Increased blood pressure

C. Inelastic skin turgor

A client is diagnosed with a peptic ulcer. When teaching about peptic ulcers, the nurse instructs the client to report what kind of stools?

1. Frothy
2. Ribbon shaped
3. Pale or clay colored
4. Dark brown or black

D. Dark brown or black

A client with irritable bowel syndrome has instructions to take psyllium 2 rounded teaspoons full twice a day for constipation. What is most important for the nurse to include in the teaching plan?

1. Urine may be discolored.
2. Stop taking the laxative once a bowel movement occurs.
3. Each dose should be taken with a full glass of water or juice.
4. Daily use may inhibit the absorption of some fat-oluble vitamins.

C. Each dose should be taken with a full glass of water or juice.

A 9-year-old child with chronic kidney disease is undergoing peritoneal dialysis. For which associated complication should the nurse monitor the child?

1. Petechiae
2. Abdominal bruit
3. Cloudy return dialysate
4. Increased blood glucose level

C. Cloudy return dialysate

Four days after abdominal surgery a client has not passed flatus and there are no bowel sounds. Paralytic ileus is suspected. What does the nurse conclude is the most likely cause of the ileus?

1. Decreased blood supply
2. Impaired neural functioning
3. Perforation of the bowel wall
4. Obstruction of the bowel lumen

B. Impaired neural functioning

A client is admitted to the hospital in the oliguric phase of acute kidney injury. The nurse estimates that the urine output for the last 12 hours is about 200 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. What does the nurse conclude about the amount of fluid prescribed?

1. It equals the expected urinary output for the next 24 hours.
2. It will prevent the development of pneumonia and a high fever.
3. It will compensate for both insensible and expected output over the next 24 hours.
4. It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias.

C. It will compensate for both insensible and expected output over the next 24 hours.

A healthcare provider prescribes furosemide for a client with hypervolemia. The nurse recalls that furosemide exerts its effects in what part of the renal system?

1. Distal tubule
2. Collecting duct
3. Glomerulus of the nephron
4. Loop of Henle

D. Loop of Henle

A nurse is caring for a client with chronic kidney failure. What should the nurse teach the client to limit the intake of to help control uremia associated with end-stage renal disease (ESRD)?

1. Fluid
2. Protein
3. Sodium
4. Potassium

B. Protein

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

1. A high-protein intake ensures an adequate daily supply of amino acids to compensate for losses.
2. Essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis.
3. This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys.
4. 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.

C. This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys.

A nurse is caring for a client receiving hemodialysis for chronic kidney disease. The nurse should monitor the client for which complication?

1. Peritonitis
2. Hepatitis B
3. Renal calculi
4. Bladder infection

B. Hepatitis B

A nurse is caring for a client with end-stage renal disease. For which clinical indicator should the nurse monitor the client?

1. Polyuria
2. Jaundice
3. Azotemia
4. Hypotension

C. Azotemia

A nurse is caring for a client with acute kidney injury. Which findings should the nurse anticipate when reviewing the laboratory report of the client’s blood level of calcium, potassium, and creatinine? Select all that apply.

1. Calcium: 7.6 mg/dL (1.9 mmol/L)
2. Calcium: 10.5 mg/dL (2.6 mmol/L)
3. Potassium 6.0 mEq/L (6.0 mmol/L)
4. Potassium 3.5 mEq/L (3.5 mmol/L)
5. Creatinine: 3.2 mg/dL (194 mcmol/L)
6. Creatinine: 1.1 mg/dL (90 mcmol/L)

A. Calcium: 7.6 mg/dL (1.9 mmol/L)

C. Potassium 6.0 mEq/L (6.0 mmol/L)

E. Creatinine: 3.2 mg/dL (194 mcmol/L)

A client with end-stage kidney disease is receiving continuous ambulatory peritoneal dialysis. The nurse should monitor the client for which peritoneal dialysis complications? Select all that apply.

1. Pruritus
2. Oliguria
3. Tachycardia
4. Cloudy outflow
5. Abdominal pain
   

C. Tachycardia

D. Cloudy outflow

E. Abdominal pain

A nurse is caring for a client with end-stage renal disease. Which clinical indicators of end-stage renal disease should the nurse expect? Select all that apply.

1. Polyuria
2. Jaundice
3. Azotemia
4. Hypertension
5. Polycythemia

C. Azotemia

D. Hypertension

When assessing a client during peritoneal dialysis, a nurse observes that drainage of the dialysate from the peritoneal cavity has ceased before the required volume has returned. What should the nurse instruct the client to do?

1. Drink a glass of water
2. Turn from side to side
3. Deep breathe and cough
4. Rotate the catheter periodically

B. Turn from side to side

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?

1. Reestablishing kidney function
2. Cleaning the peritoneal membrane
3. Providing fluid for intracellular spaces
4. Removing toxins in addition to other metabolic wastes

D. Removing toxins in addition to other metabolic wastes

A client with a history of chronic kidney disease is hospitalized. Which assessment findings will alert the nurse to kidney insufficiency?

1. Facial flushing
2. Edema and pruritus
3. Dribbling after voiding and dysuria
4. Diminished force and caliber of stream

B. Edema and pruritus

A client who has been on hemodialysis for several weeks asks the nurse what substances are being removed by the dialysis. Which substance removal should the nurse share with the client?

1. Blood
2. Sodium
3. Glucose
4. Bacteria

B. Sodium

A client is to have hemodialysis. What must the nurse do before this treatment?

1. Obtain a urine specimen to evaluate kidney function.
2. Weigh the client to establish a baseline for later comparison.
3. Administer medications that are scheduled to be given within the next hour.
4. Explain that the peritoneum serves as a semipermeable membrane to remove wastes.

B. Weigh the client to establish a baseline for later comparison.

A client with end-stage renal disease is hospitalized. For which complications should the nurse monitor the client? Select all that apply.

1. Anemia
2. Dyspnea
3. Jaundice
4. Hyperexcitability
5. Hypophosphatemia

A. Anemia

B. Dyspnea

A nurse is caring for a client who had a kidney transplant. Which test is most important for the nurse to monitor to determine whether a client’s newly transplanted kidney is working effectively?

1. Renal scan
2. Serum creatinine
3. 24-hour urine output
4. White blood cell (WBC) count

B. Serum creatinine

A nurse is caring for a client with end-stage kidney disease who is about to receive a transplant. When the client returns from the postanesthesia care unit after a kidney transplant, how often should the nurse measure the client’s urinary output?

1. 1 hour
2. 2 hours
3. 15 minutes
4. 30 minutes

A. 1 hour

The primary healthcare provider prescribed a diagnostic study with contrast medium for an older adult who has an endocrine disorder. Which assessment result should the nurse check before the study?

1. Urinary pH
2. Serum creatinine
3. Urinary creatinine
4. Creatinine clearance

B. Serum creatinine

Which diagnostic tests are used to measure the kidney size of a client with kidney dysfunction? Select all that apply.

1. Cystoscopy
2. Cystography
3. Radiography
4. Cystourethrography
5. Computed tomography (CT)

C. Radiography

E. Computed tomography (CT)

The registered nurse is instructing the student nurse regarding the gross anatomy and physiology of the kidneys prior to client examination. Which statement made by the student nurse indicates the nurse needs to intervene?

1. "The right kidney is a little longer and narrower than the left kidney."
2. "The existence of three kidneys with normal kidney function is normal."
3. "The presence of a single kidney with normal kidney function is normal."
4. "The urinary bladder lies directly behind the pubic bone."

A. "The right kidney is a little longer and narrower than the left kidney."

The nurse is preparing a blood transfusion for a client with renal failure. Why does anemia often complicate renal failure?

1. Increase in blood pressure
2. Decrease in erythropoietin
3. Increase in serum phosphate levels
4. Decrease in serum sodium concentration

B. Decrease in erythropoietin

The registered nurse is preparing to assess a client’s renal system. Which statement by the nurse indicates effective technique?

1. "I must first palpate the client if a tumor is suspected."
2. "I must first listen for normal pulse at the client’s wrist region."
3. "I must first auscultate the client and then proceed to percussion and palpation."
4. "I must first examine tender abdominal areas and then proceed to nontender areas."

C. "I must first auscultate the client and then proceed to percussion and palpation."

The nurse is preparing a client who is on metformin therapy and is scheduled to undergo renal computed tomography with contrast dye. What does the nurse anticipate the primary healthcare provider to inform the client regarding the procedure?

1. "Discontinue metformin 1 day prior to procedure."
2. "Discontinue metformin a half-day prior to procedure."
3. "Discontinue metformin 3 days following the procedure."
4. "Discontinue metformin 7 days following the procedure."

A. "Discontinue metformin 1 day prior to procedure."

What should the nurse monitor for when caring for a postoperative client who presents with 180 mL of urine in the urinary drainage bag from the past 8 hours?

1. Renal failure
2. Liver cirrhosis
3. Diabetes mellitus
4. Rheumatoid arthritis

A. Renal failure