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 NCLEX Practice Questions

Urinary System Disorders Practice Quiz #1

(50 Questions)
By

Matt Vera, BSN, R.N.

February 15, 2014

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This is a 50-item NCLEX style exam that has questions about the diseases affecting the
Renal System. Challenging questions such as Chronic Renal Failure, Kidney Transplant,
and Renal Calculi are given in this test.

EXAM TIP: When choosing which patient to see first, choose the patient who is the most
unstable. Patient’s who are most likely to perish, most critical, or will suffer further injury
without immediate action should be prioritized first.

Tough times never last, but tough people do.

~ Robert H. Schuller

Topics

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Included topics in this practice quiz are:

 Acute Glomerulonephritis
 Chronic Renal Failure
 Diabetic Nephropathy
 Kidney Transplant
 Neurogenic Bladder
 Peritoneal Dialysis
 Prostatectomy
 Pyelonephritis
 Renal Calculi
 Urinary Tract Infection

Guidelines

Follow the guidelines below to make the most out of this exam:

 Read each question carefully and choose the best answer.

  You are given one minute per question. Spend your time wisely!
 Answers and rationales are given below. Be sure to read them.
 If you need more clarifications, please direct them to the comments section.

Questions

EXAM MODE
PRACTICE MODE
TEXT MODE

In Text Mode: All questions and answers are given for reading and answering at your own
pace. You can also copy this exam and make a print out.

1. Which of the following symptoms do you expect to see in a patient diagnosed with
acute pyelonephritis?

1. Jaundice and flank pain

2. Costovertebral angle tenderness and chills
3. Burning sensation on urination
4. Polyuria and nocturia

2. You have a patient that might have a urinary tract infection (UTI). Which statement
by the patient suggests that a UTI is likely?

1. “I pee a lot.”
2. “It burns when I pee.”
3. “I go hours without the urge to pee.”
4. “My pee smells sweet.”

3. Which instructions do you include in the teaching care plan for a patient
with cystitis receiving phenazopyridine (Pyridium).
1. If the urine turns orange-red, call the doctor.
2. Take phenazopyridine just before urination to relieve pain.
3. Once painful urination is relieved, discontinue prescribed antibiotics.
4. After painful urination is relieved, stop taking phenazopyridine.

4. Which patient is at greatest risk for developing a urinary tract infection (UTI)?

1. A 35 y.o. woman with a fractured wrist

2. A 20 y.o. woman with asthma
3. A 50 y.o. postmenopausal woman
4. A 28 y.o. with angina

5. You have a patient that is receiving peritoneal dialysis. What should you do when
you notice the return fluid is slowly draining?

1. Check for kinks in the outflow tubing.

2. Raise the drainage bag above the level of the abdomen.
3. Place the patient in a reverse Trendelenburg position.
4. Ask the patient to cough.

6. What is the appropriate infusion time for the dialysate in your 38 y.o. patient with
chronic renal failure?

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

7. A 30 y.o. female patient is undergoing hemodialysis with an internal arteriovenous

fistula in place. What do you do to prevent complications associated with this
device?
1. Insert I.V. lines above the fistula.
2. Avoid taking blood pressures in the arm with the fistula.
3. Palpate pulses above the fistula.
4. Report a bruit or thrill over the fistula to the doctor.

8. Your patient becomes restless and tells you she has a headache and feels
nauseous during hemodialysis. Which complication do you suspect?

1. Infection
2. Disequilibrium syndrome
3. Air embolus
4. Acute hemolysis

9. Your patient is complaining of musclecramps while undergoing hemodialysis.

Which intervention is effective in relieving muscle cramps?

1. Increase the rate of dialysis

2. Infuse normal saline solution
3. Administer a 5% dextrose solution
4. Encourage active ROM exercises

10. Your patient with chronic renal failure reports pruritus. Which instruction should
you include in this patient’s teaching plan?

1. Rub the skin vigorously with a towel

2. Take frequent baths
3. Apply alcohol-based emollients to the skin
4. Keep fingernails short and clean

11. Which intervention do you plan to include with a patient who has renal calculi?

1. Maintain bed rest

2. Increase dietary purines
3. Restrict fluids
4. Strain all urine

12. An 18 y.o. student is admitted with dark urine, fever, and flank pain and is
diagnosed with acute glomerulonephritis. Which would most likely be in this
student’s health history?

1. Renal calculi
2. Renal trauma
3. Recent sore throat
4. Family history of acute glomerulonephritis

13. Which drug is indicated for pain related to acute renal calculi?

1. Narcotic analgesics
2. Nonsteroidal anti-inflammatory drugs (NSAIDS)
3. Muscle relaxants
4. Salicylates

14. Which of the following causes the majority of UTI’s in hospitalized patients?

1. Lack of fluid intake

2. Inadequate perineal care
3. Invasive procedures
4. Immunosuppression

15. Clinical manifestations of acute glomerulonephritis include which of the

following?

1. Chills and flank pain

2. Oliguria and generalized edema
3. Hematuria and proteinuria
4. Dysuria and hypotension
16. You expect a patient in the oliguric phase of renal failure to have a 24 hour urine
output less than:

1. 200ml
2. 400ml
3. 800ml
4. 1000ml

17. The most common early sign of kidney disease is:

1. Sodium retention
2. Elevated BUN level
3. Development of metabolic acidosis
4. Inability to dilute or concentrate urine

18. A patient is experiencing which type of incontinence if she experiences leaking

urine when she coughs, sneezes, or lifts heavy objects?

1. Overflow
2. Reflex
3. Stress
4. Urge

19. Immediately post-op after a prostatectomy, which complications requires priority

assessment of your patient?

1. Pneumonia
2. Hemorrhage
3. Urine retention
4. Deep vein thrombosis

20. The most indicative test for prostate cancer is:

1. A thorough digital rectal examination
2. Magnetic resonance imaging (MRI)
3. Excretory urography
4. Prostate-specific antigen

21. A 22 y.o. patient with diabetic nephropathy says, “I have two kidneys and I’m still
young. If I stick to my insulinschedule, I don’t have to worry about kidney damage,
right?” Which of the following statements is the best response?

1. “You have little to worry about as long as your kidneys keep making urine.”
2. “You should talk to your doctor because statistics show that you’re being unrealistic.”
3. “You would be correct if your diabetes could be managed with insulin.”
4. “Even with insulin, kidney damage is still a concern.”

22. A patient diagnosed with sepsis from a UTI is being discharged. What do you plan
to include in her discharge teaching?

1. Take cool baths

2. Avoid tampon use
3. Avoid sexual activity
4. Drink 8 to 10 eight-oz glasses of water daily

23. You’re planning your medicationteaching for your patient with a UTI prescribed
phenazopyridine (Pyridium). What do you include?

1. “Your urine might turn bright orange.”

2. “You need to take this antibiotic for 7 days.”
3. “Take this drug between meals and at bedtime.”
4. “Don’t take this drug if you’re allergic to penicillin.”

24. Which finding leads you to suspect acute glomerulonephritis in your 32 y.o.
patient?
1. Dysuria, frequency, and urgency
2. Back pain, nausea, and vomiting
3. Hypertension, oliguria, and fatigue
4. Fever, chills, and right upper quadrant pain radiating to the back

25. What is the priority nursing diagnosiswith your patient diagnosed with end-stage
renal disease?

1. Activity intolerance
2. Fluid volume excess
3. Knowledge deficit
4. Pain

26. A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis.
Which intervention do you include in his plan of care?

1. Apply pressure to the needle site upon discontinuing hemodialysis

2. Keep the head of the bed elevated 45 degrees
3. Place the left arm on an arm board for at least 30 minutes
4. Keep the left arm dry

27. Your 60 y.o. patient with pyelonephritis and possible septicemia has had five UTIs
over the past two years. She is fatigued from lack of sleep, has lost weight, and
urinates frequently even in the night. Her labs show: sodium, 154 mEq/L; osmolarity
340 mOsm/L; glucose, 127 mg/dl; and potassium, 3.9 mEq/L. Which nursing
diagnosis is priority?

1. Fluid volume deficit related to osmotic diuresis induced by hyponatremia

2. Fluid volume deficit related to inability to conserve water
3. Altered nutrition: Less than body requirements related to hypermetabolic state
4. Altered nutrition: Less than body requirements related to catabolic effects of insulin
deficiency
28. Which sign indicated the second phase of acute renal failure?

1. Daily doubling of urine output (4 to 5 L/day)

2. Urine output less than 400 ml/day
3. Urine output less than 100 ml/day
4. Stabilization of renal function

29. Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which
information is important for providing care for the patient?

1. The patient shouldn’t feel pain during initiation of dialysis

2. The patient feels best immediately after the dialysis treatment
3. Using a stethoscope for auscultating the fistula is contraindicated
4. Taking a blood pressure reading on the affected arm can cause clotting of the fistula

30. A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet
is best on days between dialysis treatments?

1. Low-protein diet with unlimited amounts of water

2. Low-protein diet with a prescribed amount of water
3. No protein in the diet and use of a salt substitute
4. No restrictions

31. After the first hemodialysis treatment, your patient develops a

headache, hypertension, restlessness, mental confusion, nausea, and vomiting.
Which condition is indicated?

1. Disequilibrium syndrome
2. Respiratory distress
3. Hypervolemia
4. Peritonitis
32. Which action is most important during bladder training in a patient with a
neurogenic bladder?

1. Encourage the use of an indwelling urinary catheter

2. Set up specific times to empty the bladder
3. Encourage Kegel exercises
4. Force fluids

33. A patient with diabetes has had many renal calculi over the past 20 years and now
has chronic renal failure. Which substance must be reduced in this patient’s diet?

1. Carbohydrates
2. Fats
3. Protein
4. Vitamin C

34. What is the best way to check for patency of the arteriovenous fistula for
hemodialysis?

1. Pinch the fistula and note the speed of filling on release

2. Use a needle and syringe to aspirate blood from the fistula
3. Check for capillary refill of the nail beds on that extremity
4. Palpate the fistula throughout its length to assess for a thrill

35. You have a paraplegic patient with renal calculi. Which factor contributes to the
development of calculi?

1. Increased calcium loss from the bones

2. Decreased kidney function
3. Decreased calcium intake
4. High fluid intake
36. What is the most important nursing diagnosis for a patient in end-stage renal
disease?

1. Risk for injury

2. Fluid volume excess
3. Altered nutrition: less than body requirements
4. Activity intolerance

37. Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal
disease. The priority intervention is:

1. Call the doctor immediately

2. Give the patient IV lidocaine (Xylocaine)
3. Prepare to defibrillate the patient
4. Check the patient’s latest potassium level

38. A patient who received a kidney transplant returns for a follow-up visit to the
outpatient clinic and reports a lump in her breast. Transplant recipients are:

1. At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral)

2. Consumed with fear after the life-threatening experience of having a transplant
3. At increased risk for tumors because of the kidney transplant
4. At decreased risk for cancer, so the lump is most likely benign

39. You’re developing a care plan with the nursing diagnosis risk for infection for
your patient that received a kidney transplant. A goal for this patient is to:

1. Remain afebrile and have negative cultures

2. Resume normal fluid intake within 2 to 3 days
3. Resume the patient’s normal job within 2 to 3 weeks
4. Try to discontinue cyclosporine (Neoral) as quickly as possible
40. You suspect kidney transplant rejection when the patient shows which
symptoms?

1. Pain in the incision, general malaise, and hypotension

2. Pain in the incision, general malaise, and depression
3. Fever, weight gain, and diminished urine output
4. Diminished urine output and hypotension

41. Your patient returns from the operating room after abdominal aortic
aneurysm repair. Which symptom is a sign of acute renal failure?

1. Anuria
2. Diarrhea
3. Oliguria
4. Vomiting

42. Which cause of hypertension is the most common in acute renal failure?

1. Pulmonary edema
2. Hypervolemia
3. Hypovolemia
4. Anemia

43. A patient returns from surgery with an indwelling urinary catheter in place and
empty. Six hours later, the volume is 120ml. The drainage system has no
obstructions. Which intervention has priority?

1. Give a 500 ml bolus of isotonic saline

2. Evaluate the patient’s circulation and vital signs
3. Flush the urinary catheter with sterile water or saline
4. Place the patient in the shock position, and notify the surgeon
44. You’re preparing for urinary catheterization of a trauma patient and you
observe bleeding at the urethral meatus. Which action has priority?

1. Irrigate and clean the meatus before catheterization

2. Check the discharge for occult blood before catheterization
3. Heavily lubricate the catheter before insertion
4. Delay catheterization and notify the doctor

45. What change indicates recovery in a patient with nephritic syndrome?

1. Disappearance of protein from the urine

2. Decrease in blood pressure to normal
3. Increase in serum lipid levels
4. Gain in body weight

46. Which statement correctly distinguishes renal failure from prerenal failure?

1. With prerenal failure, vasoactive substances such as dopamine (Intropin) increase blood
pressure
2. With prerenal failure, there is less response to such diuretics as furosemide (Lasix)
3. With prerenal failure, an IV isotonic saline infusion increases urine output
4. With prerenal failure, hemodialysis reduces the BUN level

47. Which criterion is required before a patient can be considered for continuous
peritoneal dialysis?

1. The patient must be hemodynamically stable

2. The vascular access must have healed
3. The patient must be in a home setting
4. Hemodialysis must have failed

48. Polystyrene sulfonate (Kayexalate) is used in renal failure to:

1. Correct acidosis
2. Reduce serum phosphate levels
3. Exchange potassium for sodium
4. Prevent constipation from sorbitol use

49. Your patient has complaints of severe right-sided flank pain, nausea, vomiting
and restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP
140/90 mmHg, Pulse 118 beats/min., respirations 33 breaths/minute, and temperature,
98.0F. Which subjective data supports a diagnosis of renal calculi?

1. Pain radiating to the right upper quadrant

2. History of mild flu symptoms last week
3. Dark-colored coffee-ground emesis
4. Dark, scanty urine output

50. Immunosuppression following Kidney transplantation is continued:

1. For life
2. 24 hours after transplantation
3. A week after transplantation
4. Until the kidney is not anymore rejected

Answers and Rationale

1. Answer: 2. Costovertebral angle tenderness and chills

Costovertebral angle tenderness, flank pain, and chills are symptoms of acute
pyelonephritis.

 Option A: Jaundice indicates gallbladder or liver obstruction.

  Option C: A burning sensation on urination is a sign of lower urinary tract
infection.

2. Answer: 2. “It burns when I pee.”

A common symptom of a UTI is dysuria. A patient with a UTI often reports frequent voiding
of small amounts and the urgency to void.

 Option D: Urine that smells sweet is often associated with diabetic ketoacidosis.

3. Answer: 4. After painful urination is relieved, stop taking phenazopyridine.

Pyridium is taken to relieve dysuria because is provides an analgesic and anesthetic effect
on the urinary tract mucosa. The patient can stop taking it after the dysuria is relieved.

 Option A: The urine may temporarily turn red or orange due to the dye in the
drug.
 Option B: The drug isn’t taken before voiding, and is usually taken 3 times a day
for 2 days.

4. Answer: 3. A 50 y.o. postmenopausal woman

Women are more prone to UTI’s after menopause due to reduced estrogenlevels. Reduced
estrogen levels lead to reduced levels of vaginal Lactobacilli bacteria, which protect against
infection.

Options B, C, and D: Angina, asthma and fractures don’t increase the risk of UTI.

5. Answer: 1. Check for kinks in the outflow tubing.

Tubing problems are a common cause of outflow difficulties, check the tubing for kinks and
ensure that all clamps are open. Other measures include having the patient change
positions (moving side to side or sitting up), applying gentle pressure over the abdomen, or
having a bowel movement.
6. Answer: 1. 15 minutes

Dialysate should be infused quickly. The dialysate should be infused over 15 minutes or
less when performing peritoneal dialysis. The fluid exchange takes place over a period
ranging from 30 minutes to several hours.

7. Answer: 2. Avoid taking blood pressures in the arm with the fistula.

Don’t take blood pressure readings in the arm with the fistula because the compression
could damage the fistula.

 Option A: IV lines shouldn’t be inserted in the arm used for hemodialysis.

 Option C: Palpate pulses below the fistula.
 Option D: Lack of bruit or thrill should be reported to the doctor.

8. Answer: 2. Disequilibrium syndrome

Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes
from the blood. This can lead to cerebral edema and increased intracranial pressure (ICP).
Signs and symptoms include headache, nausea, restlessness, vomiting, confusion,
twitching, and seizures.

9. Answer: 2. Infuse normal saline solution

Treatment includes administering normal saline or hypertonic normal saline solution

because muscle cramps can occur when the sodium and water are removed to quickly
during dialysis. Reducing the rate of dialysis, not increasing it, may alleviate muscle cramps.

10. Answer: 4. Keep fingernails short and clean

Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation
and breaks in the skin that increase the patient’s risk of infection. Keeping fingernails short
and clean helps reduce the risk of infection.
11. Answer: 4. Strain all urine

All urine should be strained through gauze or a urine strainer to catch stones that are
passed. The stones are then analyzed for composition.

 Option A: Ambulation may help the movement of the stone down the urinary tract.
 Option C: Encourage fluid to help flush the stones out.

12. Answer: 3. Recent sore throat

The most common form of acute glomerulonephritis is caused by group A beta-hemolytic

streptococcal infection elsewhere in the body.

13. Answer: 1. Narcotic analgesics

Narcotic analgesics are usually needed to relieve the severe pain of renal calculi.

 Options B and D: NSAIDS and salicylates are used for their anti-inflammatory and
antipyretic properties and to treat less severe pain.
 Option C: Muscle relaxants are typically used to treat skeletal muscle spasms.

14. Answer: 3. Invasive procedures

Invasive procedures such as catheterization can introduce bacteria into the urinary tract. A
lack of fluid intake could cause concentration of urine, but wouldn’t necessarily cause
infection.

15. Answer: 3. Hematuria and proteinuria

Hematuria and proteinuria indicate acute glomerulonephritis. These finding result from
increased permeability of the glomerular membrane due to the antigen-antibody reaction.
Generalized edema is seen most often in nephrosis.
16. Answer: 2. 400ml

Oliguria is defined as urine output of less than 400ml/24hours.

17. Answer: 2. Elevated BUN level

Increased BUN is usually an early indicator of decreased renal function.

18. Answer: 3. Stress

Stress incontinence is an involuntary loss of a small amount of urine due to sudden

increased intra-abdominal pressure, such as with coughing or sneezing.

19. Answer: 2. Hemorrhage

Hemorrhage is a potential complication.

 Option A: Pneumonia may occur if the patient doesn’t cough and deep breathe.
 Option C: Urine retention isn’t a problem soon after surgery because a catheter is
in place.
 Option D: Thrombosis may occur later if the patient doesn’t ambulate.

20. Answer: 4. Prostate-specific antigen

An elevated prostate-specific antigen level indicates prostate cancer, but it can be falsely
elevated if done after the prostate gland is manipulated.

 Option A: A digital rectal examination should be done as part of the yearly

screening, and then the antigen test is done if the digital exam suggests cancer.
 Option B: MRI is used in staging the cancer.

21. Answer: 4. “Even with insulin, kidney damage is still a concern.”

Kidney damage is still a concern. Microvascular changes occur in both of the patient’s
kidneys as a complication of the diabetes. Diabetic nephropathy is the leading cause of
end-stage renal disease. The kidneys continue to produce urine until the end stage.
Nephropathy occurs even with insulin management.

22. Answer: 4. Drink 8 to 10 eight-oz glasses of water daily

Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps flush the
bacteria from the bladder. The patient should be instructed to void after sexual activity.

23. Answer: 1. “Your urine might turn bright orange.”

The drug turns the urine orange. It may be prescribed for longer than 7 days and is usually
ordered three times a day after meals. Phenazopyridine is an azo (nitrogenous) analgesic;
not an antibiotic.

24. Answer: 3. Hypertension, oliguria, and fatigue

Mild to moderate HTN may result from sodium or water retention and inappropriate renin
release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria
and azotemia.

25. Answer: 2. Fluid volume excess

Fluid volume excess because the kidneys aren’t removing fluid and wastes. The other
diagnoses may apply, but they don’t take priority.

26. Answer: 1. Apply pressure to the needle site upon discontinuing hemodialysis

Apply pressure when discontinuing hemodialysis and after removing the venipuncture
needle until all the bleedinghas stopped. Bleeding may continue for 10 minutes in some
patients.
27. Answer: 2. Fluid volume deficit related to inability to conserve water

28. Answer: 1. Daily doubling of urine output (4 to 5 L/day)

Daily doubling of the urine output indicates that the nephrons are healing. This means the
patient is passing into the second phase (dieresis) of acute renal failure.

29. Answer: 4. Taking a blood pressure reading on the affected arm can cause
clotting of the fistula

Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so
avoid taking blood pressure on the affected arm.

30. Answer: 2. Low-protein diet with a prescribed amount of water

The patient should follow a low-protein diet with a prescribed amount of water. The patient
requires some protein to meet metabolic needs.

 Option C: Salt substitutes shouldn’t be used without a doctor’s order because it

may contain potassium, which could make the patient hyperkalemic.
 Option D: Fluid and protein restrictions are needed.

31. Answer: 1. Disequilibrium syndrome

Disequilibrium occurs when excess solutes are cleared from the blood more rapidly than
they can diffuse from the body’s cells into the vascular system.

32. Answer: 2. Set up specific times to empty the bladder

Instruct the patient with neurogenic bladder to write down his voiding pattern and empty the
bladder at the same times each day.

33. Answer: 3. Protein

Because of damage to the nephrons, the kidney can’t excrete all the metabolic wastes of
protein, so this patient’s protein intake must be restricted.

 Options A, B, and D: A higher intake of carbs, fats, and vitamin supplements is

needed to ensure the growth and maintenance of the patient’s tissues.

34. Answer: 4. Palpate the fistula throughout its length to assess for a thrill

The vibration or thrill felt during palpation ensures that the fistula has the desired turbulent
blood flow. Pinching the fistula could cause damage. Aspirating blood is a needless invasive
procedure.

35. Answer: 1. Increased calcium loss from the bones

Bones lose calcium when a patient can no longer bear weight. The calcium lost from bones
form calculi, a concentration of mineral salts also known as a stone, in the renal system.

36. Answer: 2. Fluid volume excess

Kidneys are unable to rid the body of excess fluids which results in fluid volume excess
during ESRD.

37. Answer: 4. Check the patient’s latest potassium level

The patient with ESRD may develop arrhythmias caused by hypokalemia.

 Option A: Call the doctor after checking the patient’s potassium values.
 Option B: Lidocaine may be ordered if the PVCs are frequent and the patient is
symptomatic.

38. Answer: 1. At increased risk for cancer due to immunosuppression caused by

cyclosporine (Neoral)
Cyclosporine suppresses the immune response to prevent rejection of the transplanted
kidney. The use of cyclosporine places the patient at risk for tumors.

39. Answer: 1. Remain afebrile and have negative cultures

The immunosuppressive activity of cyclosporine places the patient at risk for infection, and
steroids can mask the signs of infection. The patient may not be able to resume normal fluid
intake or return to work for an extended period of time and the patient may need
cyclosporine therapy for life.

40. Answer: 3. Fever, weight gain, and diminished urine output

Symptoms of rejection include fever, rapid weight gain, hypertension, pain over the graft
site, peripheral edema, and diminished urine output.

41. Answer: 3. Oliguria

Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal failure.
Anuria is uncommon except in obstructive renal disorders.

42. Answer: 2. Hypervolemia

Acute renal failure causes hypervolemia as a result of overexpansion of extracellular

fluid and plasma volume with the hypersecretion of renin. Therefore, hypervolemia causes
hypertension.

43. Answer: 2. Evaluate the patient’s circulation and vital signs

A total UO of 120ml is too low. Assess the patient’s circulation and hemodynamic stability
for signs of hypovolemia. A fluid bolus may be required, but only after further nursing
assessment and a doctor’s order.

44. Answer: 4. Delay catheterization and notify the doctor

Bleeding at the urethral meatus is evidence that the urethra is injured. Because
catheterization can cause further harm, consult with the doctor.

45. Answer: 1. Disappearance of protein from the urine

With nephrotic syndrome, the glomerular basement membrane of the kidney becomes more
porous, leading to loss of protein in the urine. As the patient recovers, less protein is found
in the urine.

46. Answer: 3. With prerenal failure, an IV isotonic saline infusion increases urine
output

Prerenal failure is caused by such conditions as hypovolemia that impairs kidney perfusion;
giving isotonic fluids improves urine output. Vasoactive substances can increase blood
pressure in both conditions.

47. Answer: 1. The patient must be hemodynamically stable

Hemodynamic stability must be established before continuous peritoneal dialysis can be

started.

48. Answer: 3. Exchange potassium for sodium

In renal failure, patients become hyperkalemic because they can’t excrete potassium in the
urine. Polystyrene sulfonate acts to excrete potassium by pulling potassium into the bowels
and exchanging it for sodium.

49. Answer: 4. Dark, scanty urine output

Patients with renal calculi commonly have blood in the urine caused by the stone’s passage
through the urinary tract. The urine appears dark, tests positive for blood, and is typically
scant.
50. Answer: 1. For life.