ANSWERS AND RATIONALE

1) C
- urine specimen can be collected anytime as soon as it is available, if it is to be used to identify possible
microorganisms, it should be collected by midstream or clean catch technique.
Urine culture and sensitivity is the most accurate diagnostic test for UTI but it takes 24-72 hours to complete.
Urine culture is done to identify the infecting microorganisms and the most appropriate antibiotic to give the
patient.
Rapid tests to detect bacteria in the urine include:

nitrite dipstick - turns pink in the presence of bacteria

leukocyte esterase test - identifies lysed or intact WBC which appears in the urine when there is
infection

WBC with differential - infection causes leukocytosis (increased WBC count) and elevated neutrophils

Gram stain - to detect if infection is caused by gram positive or gram negative bacteria

Urinalysis of patient with UTI typically reveals the following findings:

bacteuria - a bacteria count greater than 100,000 is a sign of infection

pyuria

hematuria or presence of red blood cells

2) C
- Nursing Interventions when a patient is to have an IVP include:

assess patient for allergy to iodine, shellfish, or radiologic contrast dye. If allergy is present, notify
physician before the test

IVP should be performed before barium test or gall bladder test using contrast material

with hold foods for 8 hours before the test. Allow clear fluids: water, coffee and tea

perform patient bowel preparation (laxative and cathartic) a night before the test to remove feces and gas
from the intestines. Give enema or suppository on the morning of the test

check renal and fluid status. Report to physician any abnormality in the serum osmolality, creatinine,
and blood urea nitrogen levels

make sure informed consent is signed

during the test, tell patient that she will feel flushing sensation, nausea and metallic taste when contrast
media is injected

increased fluid intake after the test to promote excretion of the dye

notify physician right away if patient show reaction to the dye such as: rash, dyspnea, tachycardia,
itching or hives during or after the test.

3) C
- IVP is also known as excretory urography. It is a diagnostic test used to visualize the kidney, bladder and
ureter in which a contrast media is administered intravenously. X-ray of the said organs will show any
functional and structural abnormalities present.
4) C
- The manifestations of acute pyelonephritis are:

high fever

chills

flank pain on the affected side - may radiate to the epigastrium or towardthe ureter

headache

tenderness on palpation of costovertebral angle

muscle pain

voiding problems - dysuria, frequency and urgency

urine - cloudy or bloody, foul smelling, high WBC count and casts

5) A
- sulfamethoxazole is a sulfonamide antibiotic used to treat infection. When infection has been treated, naturally
the WBC count will go down to normal.

avoid sun exposure; use wide brimmed hat and sunscreen when under the sun

take oral form on empty stomach with 8 ounces of water

advise to report discomfort at IV insertion site if given parenterally. Do not administer IM

notify physician immediately if the following signs appear: sore throat, fever, cough, mouth sores, or iris
lesions. This may be signs of blood dyscrasias as sulfonamides may decrease hemoglobin, platelets,
granulocytes and WBC

sulfonamides are contraindicated in patients with renal impairment (don't give if creatinine clearance is
abnormal), porphyria, megaloblastic anemia, pregnant at term and breastfeeding, infants below 2 months

Phenazopyridine is used to relieve pain.

6) C
- Pyelonephritis is inflammation/infection of the kidney and renal pelvis. It is the most common upper urinary
tract infection (UTI).

Nursing Care for UTI include:

health teaching regarding antibiotic therapy

practice aseptic technique when inserting catheter. Position collection bag below the bladder

avoid irritants to the bladder such as caffeinated beverages, spicy foods, tomatoes, artificial sweeteners,
citrus juices and alcohol. These substances can irritate the bladder and increase urgency and bladder
spasms

increased fluid intake to flush out the microorganisms

practice proper perineal hygiene

provide adequate rest and sleep during the acute phase when patient experiences pain to promote healing

pain management - with medication such as phenazopyridine (pyridium) to treat pain, the patient will be
able to void without discomfort within 24 hours after initiation of treatment and normal voiding pattern
returns in three days. Hot sitz bath may also help to decrease urethral smooth muscle spasm.

emphasize the need for follow up - urine culture should be repeated after one week of completion
antibiotic therapy to ensure that the infection has been successfully eradicated

teach prevention of UTI: such as:

proper perineal hygiene

liberal fluid intake

void before and after intercourse

void frequently

7) A

8) C
- hematuria is rare in nephrotic syndrome but it is profuse is acute glomerulonephritis.
The manifestations of nephrotic syndrome are:

Proteinuria - nephrosis is believed to be due to immunologic response that results in increased

permeability of glomerular membrane to proteins resulting in massive protein losses in the urine -proteinuria and albuminuria (+3 +4), the child losses 50-100 mg/kg weight/day from proteinuria.

Hypoalbuminemia - loss of protein in blood results in hypoalbumenimia

Edema - cardinal sign and appears first in the periorbital region followed by dependent edema and
accompanied by pallor, fatigue and lethargy. Hypoalbuminemia leads to decreased oncotic pressure

resulting in fluid shift from intravascular to interstitial causing generalized edema or anasarca.The child
has lost appetite but gained weight -- puffiness of the eyes on awakening decreases during the day but
appears on the legs and abdomen. Fluid shift causes decreased blood volume that leads to decreased
blood supply to kidney. Decreased blood supply to kidney initiates release of aldosterone. Aldosterone
causes sodium retention (in interstitial spaces so child will have hyponatremia) and water retention
contributing to edema.

Hypocholesteronemia and hyperlipidemia - triglycerides and fats are released by the liver in the blood to
make up for the protein loss

9) C
- management: reduce protein excretion
Prevention of Skin Breakdown from Edema

frequent turning

keep nails short to prevent scratching

meticulous skin care to dependent and edematous areas - sacrum, scrotum, labia, abdomen, legs

loose clothing

Monitor Edema

weigh daily and monitor I and O

check for pulmonary edema manifested by crackles on auscultation

ascites - measure abdominal girth

Prevention of Infection - pulmonary edema predisposes to respiratory infection and generalized edema
predisposes to skin breakdown. Avoid contact with persons who have infection.
Diet - usually anorexic because of GI edema

high protein diet

sodium restriction if with severe edema

fluid intake equal to output and insensible loss

vitamin and iron supplements

small feedings, give favorite foods

10) B
- prednisone is prescribed for CArlo to decrease protein excretion. Proteinuria disappears in one week after
intiating treatment. The child is responding favorably to treatment if there is no proteinuria for 2 consecutive
days. Steroid therapy is continued until urine is negative for protein and gradually reduced over a period of 1 to
3 weeks

Monitor side effect of prolonged steroid therapy

Hyperglycemia - test urine

monitor growth of child by checking height because steroid has growth suppressing effect by preventing
calcium deposition in the bones

Gastric Irritation - give milk or meals, test for occult blood, administer with antacids

Avoid exposure to infection because child is immunosuppressed

11) B
- during the toddler period, the child gains 2.5 kg a year. Carlo has gained 5 kg in only 6 months. In nephrotic
syndrome, this excessive weight gain is due to edema.
12) C
- intermittent self-catheterization involves clean technique. The client should wash the catheter
with warm soapy water. This catheter can be used repeatedly.
13) C
- as sodium is released from exchange resin kayexalate, potassium ions will be excreted. This will
lower serum potassium levels.
14) A
- the damaged kidney are unable to secrete erythropoietin adequately. There is decreased
production of RBC in the bone marrow which leads to severe anemia.
15) A
- CAPD is done by the client.
16) B
- the solution used for peritoneal dialysis contains glucose, to remove edema fluids from the
body through the process of osmosis. Hyperglycemia may occur. Therefore, urine and blood
glucose levels need to be monitored.
17) A
- in renal failure, the kidneys are unable to secrete erythropoietin. This results to decreased RBC
production by the bone marrow. Severe anemia occurs.
18) D
- oliguric phase is characterized by water retention (edema) which leads to fluid volume excess.
19) C
- the kidneys are located at the costovertebral angle. Therefore the pain in pyelonephritis is
located in this area.
20) B
- disequilibrium syndrome is caused by more rapid removal of waste products from the blood

from the brain. This is due to the presence of blood-brain barrier. This causes increased
intracranial pressure.
21) A
- the diet for a client with elevated BUN and serum creatine should be low protein, to reduce urea
and nitrogenous waste products. For edema, fluid restriction should be implemented.
22) C
- kidney transplant rejection is manifested by failure of renal functions like decreased urinary
output and water retention, as manifested by weight gain.
23) C
- pyridium is a urinary analgesic. It will normally cause red-orange discoloration of the urine.
24) D
- ACE inhibitors may cause hyperkalemia. It should be used with great caution if it is prescribed
for a client with renal insufficiency.
25) A
- glomerulonephritis causes gross hematuria. The urine appears dark, smoky, cola-colored, or
red-brown.
26) A
- cloudy diasylate indicates infection (peritonitis). Culture of the fluid must be done to determine
the microorganism present.
27) D
- the client with renal failure should be given low potassium diet because of hyperkalemia. Apple
contains very little potassium. So, it can be given to the client.
28) A, B, E
- these values have normalized; therefore they indicate improvement of client's condition on
chronic hemodialysis. As edema fluids are removed from the body, there should be decrease in
weight. Hemodialysis does not affect hemoglobin levels.
29) B
- the client with ESRD should have low potassium diet to prevent hyperkalemia. Apple has very
minimal potassium. Banana, carrot, cantaloupe are rich in potassium.
30) A
- asepsis is the most effective measure to prevent infection.

31) A
- during ESRD, fluid intake of the client should be limited during anuric phase to prevent fluid overload. Fluid
overload increases renal workload, pulmonary edema, and congestive heart failure.
32) B

- the normal blood urea nitrogen level is 8 to 25 mg/dL. Values such as those in options C and D reflect
continued dehydration. Option A reflects a lower than normal value, which may occur with fluid volume
overload, among other conditions.
33) C
- the normal serum creatinine level foadults is 0.6 to 1.3 mg/dL. The client with a mild degree of renal
insufficiency would have a slight elevated level. A creatinie level of 0.2 mg/dL is low, and a level of 0.5 mg/dL
is just below normal. A creeatinie level of 3.5 mg/dL may be associated with acute or chronic renal failure.
34) A
- the diet for a client with renal failure who is receiving hemodialysis should include controlled amounts of
sodium, phosphorus, calcium, potassium, and fluids. Option B, C, and D are high in sodium, phosphorus, and
potassium.
35) B
- If the balloon is positioned in the urethra, inflating the balloon could produce trauma, and pain will occur. If
pain occurs, the fluid should be aspirated and the catheter inserted a little further into the bladder to provide
sufficient space to inflate the balloon. The balloon of the catheter is behind the opening at the insertion tip.
Inserting the catheter the extra distance will ensure that the balloon is inflated inside the bladder and not in the
urethra. There is no need to remove the catheter and insert a new one. Pain when the balloon is inflated is not
normal.
36) B
- The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this,
the client should be placed on a cardiac monitor. Fluid intake is not increased because it contributes to fluid
overload and would not affect the serum potassium level significantly. Vegetables are a natural source of
potassium in the diet, and their use would not be increased. The nurse also may assess the sodium level because
sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority
action of the nurse.
37) D
- Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents
the client from becoming hypotensive during dialysis and also from having the medication removed from the
bloodstream by dialysis. No rationale exists for waiting an entire day to resume the medication. This would lead
to ineffective control of the blood pressure.
38) A
- Clients with peritoneal dialysis catheters are at high risk for infection. A wet dressing is a conduit for bacteria
to reach the catheter insertion site. The nurse ensures that the dressing is kept dry at all times. Reinforcing the
dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated.
Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnection of peritoneal
dialysis.
39) A
- If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately,
notify the physician, and administer oxygen as needed. Options B, C, and D are incorrect.
40) C
- The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording intake
and output and measuring weight daily. Ideally, the hemodialysis client should not gain more than 0.5 kg of
weight/day.

41) D
- An arteriovenous shunt is a less common form of access site but carries a risk for bleeding when it is used
because two ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of
the cannula are joined. If accidental disconnection occurs, the client could lose blood rapidly. For this reason,
small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also
should be assessed at least every 4 hours.
42) D
- Following renal biopsy, the nurse ensures that the client remains in bed for at least 24 hours. Vital signs and
puncture site assessments are done frequently during this time. Encouraging fluids is done to reduce possible
clot formation at the biopsy site. Serial urine samples are assayed by Hematest with urine dipsticks to evaluate
bleeding. Analgesics often are needed to manage the renal colic pain that some clients feel after this procedure.
43) B
- Urolithiasis (struvite stones) can result from chronic infections. They form in urine that is alkaline and rich in
ammonia, such as with a urinary tract infection. Teaching should focus on prevention of infections and ingesting
foods to make the urine more acidic. The client should wear cotton (not synthetic) underclothing to prevent the
accumulation of moisture and to prevent irritation of the perineal area, which can lead to infection.
44) B
- The client with uric acid stones should avoid foods containing high amounts of purines. This includes limiting
or avoiding organ meats such as liver, brain, heart, kidney, and sweetbreads. Other foods to avoid include
herring, sardines, anchovies, meat extracts, consomms, and gravies. Foods that are low in purines include all
fruits, many vegetables, milk, cheese, eggs, refined cereals, sugars and sweets, coffee, tea, chocolate, and
carbonated beverages.
45) C
- Use the process of elimination. Eliminate options A and B, knowing that any inflammatory disease or infection
is accompanied by fever. Because this client is afebrile, these are not possible options. Use knowledge of
anatomy and pain assessment to select option C. Pain from renal cancer is a later finding and is localized in the
flank area. Review renal assessment techniques if you had difficulty with this question.
46) B
- Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders.
Bladder injury pain does not radiate to the umbilicus, costovertebral angle, or hip.
47) A
- The presence of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse notifies the
physician, knowing that the client should not be catheterized until the cause of the bleeding is determined by
diagnostic testing. Therefore, options B, C, and D are incorrect.
48) A
- The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit.
The presence of a thrill and bruit indicate patency of the fistula. Although the presence of a radial pulse in the
left wrist and capillary refill shorter than 3 seconds in the nail beds of the fingers on the left hand are normal
findings, they do not assess fistula patency.
49) D
- Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is
accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with gonorrhea,
diagnostic tests are done for both and include culture and rapid assays.

50) B
- Follow-up cultures are typically done in 4 to 7 days to evaluate the effectiveness of the medication. Using a
spermicide does not change the perineal pH. The infection can be prevented by the use of latex condoms.
Chlamydial infection is treated with doxycycline for 7 days or with azithromycin (Zithromax) as a single dose.
All sexual partners during the 30 days before diagnosis should be notified, examined, and treated as necessary.

51) D
- Arteriovenous fistulas are created by anastomosis of an artery and a vein within the subcutaneous tissues to
create access for hemodialysis. Fistulas should be evaluated for presence of thrills (palpate over the area) and
bruits (auscultate with a stethoscope) as an assessment of patency.
52) C
- Clinical manifestations of cystitis usually include urinary frequency, urgency, dysuria, inability to void, or
voiding only small amounts. The urine may be cloudy, with hematuria and bacteriuria. The client may complain
of pain that is suprapubic or in the lower back. Nonspecific signs include fever, chills, malaise, and nausea and
vomiting. Some clients may be asymptomatic, particularly the older client.
53) C
- ESWL is done with conscious sedation or general anesthesia. The client must sign an informed consent form
for the procedure and must be NPO for the procedure. The client needs an IV line for the procedure as well. A
Foley catheter is not needed.
54) C
- Acute rejection usually occurs within the first 3 months after transplant, although it can occur for up to 2 years
posttransplant. The client exhibits fever, hypertension, malaise, and graft tenderness. Treatment is immediately
begun with corticosteroids and possibly also with monoclonal antibodies and antilymphocyte agents.
55) D
- The client undergoing any type of diagnostic testing involving possible dye administration should be
questioned about allergy to shellfish or iodine. This is essential to identify the risk for potential allergic reaction
to contrast dye, which may be used. The other items are also useful as part of the assessment but are not as
critical as the allergy determination in the preprocedure period.
56) C
- A significant advantage of an ultrasound is that it can differentiate a solid mass from a fluid-filled cyst. It is
noninvasive and does not require any special aftercare. Other diagnostic tests, such as magnetic resonance
imaging and computed tomography scanning, are also noninvasive (unless contrast is used) and require no
special aftercare, either. However, the ultrasound can discriminate between solid and fluid masses most
optimally.
57) D
- The predominant cause of acute glomerulonephritis is infection with beta hemolytic Streptococcus 3 weeks
before the onset of symptoms. In addition to bacteria, other infectious agents that could trigger the disorder
include viruses, fungi, and parasites. Bleeding ulcer, deep vein thrombosis, and myocardial infarction are not
precipitating causes.
58) A
- The client with nephrotic syndrome typically presents with edema, hypoalbuminemia, and proteinuria. The
nurse carefully assesses the fluid balance of the client, which includes daily monitoring of weight, intake and

output, edema, and girth measurements. Albumin levels are monitored as they are prescribed, as are the BUN
and creatinine levels. The client's activity level is adjusted according to the amount of edema and water
retention. As edema increases, the client's activity level should be restricted.
59) D
- The pain of ureteral colic is caused by movement of a stone through the ureter and is sharp, excruciating, and
wavelike, radiating to the genitalia and thigh. The stone causes reduced flow of urine, and the urine also
contains blood because of its abrasive action on urinary tract mucosa. Stones in the renal pelvis cause pain that
is a deep ache in the costovertebral area. Renal colic is characterized by pain that is acute, with tenderness over
the costovertebral area.
60) A
- Iron is needed for RBC production. Otherwise, the body cannot produce sufficient erythrocytes. In either case,
the client is not receiving the full benefit of epoetin alfa therapy if iron is not taken. Options B, C, and D are not
needed for RBC production.