RN Alterations in Kidney Function and Elimination Assessment
Question: 1 of 30
Question: 2 of 30
Question: 3 of 30
A nurse is caring for a client with a history of benign prostatic hypertrophy who has been admitted for a
urinary tract infection. A student nurse asks what causes benign prostatic hypertrophy in men. The nurse
should respond with which of the following statements?
A. “It is an inherited disorder that causes fluid-filled cysts in the kidney that continue to grow and
multiply eventually leading to renal failure.”
B. “It is caused by smooth muscle and epithelial cells multiplying at an uncontrolled rate within the
transition zone.”
C. “It is caused by infections such as streptococcal bacteria, bacterial endocarditis, viral kidney
infections, and HIV and leads to inflammation from antibodies to the bacteria build up in the glomeruli.”
D. “It is caused by plaque made of calcium in the interstitial tissue of the renal papilla which continues
to grow, breaking through the membrane or the renal pelvis into the urine.”
Answer: B. “It is caused by smooth muscle and epithelial cells multiplying at an uncontrolled rate
within the transition zone.”
Question: 4 of 30
An occupational nurse at a candy factory is developing a plan of care for clients who are experiencing
incontinence that is affecting their job performance. Which of the following client statements would
indicate an understanding of a contributing factor to their incontinence at work?
A. “I probably have problems with incontinence due to exposure of some bacteria while packaging
candy on the line.”
B. “I probably have problems with incontinence due to our strict break policy that they monitor very
closely.”
C. “I probably have problems with incontinence because the water at work is disgusting and I don't
drink enough.”
D. “I probably have problems with incontinence because I am constantly exposed to pesticides at work.”
Answer: B. “I probably have problems with incontinence due to our strict break policy that they
monitor very closely.”
Question: 5 of 30
A nurse is admitting a client to the emergency department (ED) who reports a puffy face and malaise.
The client states, “I finished taking amoxicillin for strep throat a few days ago.” The nurse suspects the
client may have acute glomerulonephritis. If the nurse is correct, which of the following other
assessments findings should the nurse expect? (Select all that apply.)
A. Elevated systolic blood pressure
B. Fever
C. Palpable kidney masses
D. Diffuse abdominal pain
E. Dark, frothy urine
F. Decreased muscle strength
Answer: A. Elevated systolic blood pressure
B. Fever
D. Diffuse abdominal pain
E. Dark, frothy urine
F. Decreased muscle strength
Explanation:
A. Elevated systolic blood pressure is correct. The nurse should obtain a blood pressure reading to
determine if the client has hypertension. Hypertension is a clinical manifestation of glomerulonephritis.
B. Fever is correct. The nurse should check the client's temperature to determine the client has a fever.
F-ever is a clinical manifestation of glomerulonephritis.
C. Palpable kidney masses is incorrect. The nurse should not expect palpation of the kidneys in the
assessment to determine if the client has glomerulonephritis. A palpable kidney mass is a clinical
manifestation of polycystic kidney disease.
D. Diffuse abdominal pain is correct. The nurse should conduct an abdominal pain assessment to
determine if the client has pain. Abdominal pain is a clinical manifestation of glomerulonephritis.
E. Dark, frothy urine is correct. The nurse should assess the color of the of the client's urine. Dark
urine is a clinical manifestation of glomerulonephritis.
F. Decreased muscle strength is correct. The nurse should conduct a muscle strength assessment to
determine if the client has muscle weakness. Muscle weakness is a clinical manifestation of
glomerulonephritis.
Question: 6 of 30
A nurse manager on the urology unit is providing continuing education to nurses on the management of
care of a client with benign prostatic hypertrophy (BPH). TO promote an interprofessional treatment
approach related to the psychosocial impact the disease has on the client. the nurse should request a
referral for which of the following health care professionals?
A. Physical therapist
B. Psychiatrist
C. Social worker
D. Occupational therapist
Answer: B. Psychiatrist
Question: 7 of 30
A nurse is caring for a client newly diagnosed with benign prostatic hypertrophy (BPH). Which topics
are important to include in the education about this disease? (Select all that apply.)
A. Increasing exercise
B. Tamsulosin use and adverse effects
C. Urinary tract infection manifestations
D. A diet low in calcium oxalate
E. Trimethoprim/sulfamethoxazole use and adverse effects
F. Urinary retention emergency
Answer: A. Increasing exercise
B. Tamsulosin use and adverse effects
C. Urinary tract infection manifestations
F. Urinary retention emergency
Explanation:
A. Increasing exercise is correct. Education on the lifestyle modification of increasing exercise should
be included in the education to a client who has BPH as obesity is a risk factor for BPH.
B. Tamsulosin use and adverse effects is correct. Tamsulosin is used for BPH because it relaxes the
smooth muscle in the prostate and bladder neck which allows urine to pass and decreases urine
retention.
C. urinary tract infection manifestations is correct. UTIs are a common complication of BPH due to
urinary retention.
D. A diet low in calcium oxalate is incorrect. A diet high in calcium oxalate is a contributing factor to
some types of renal calculi, not BPH.
E. Trimethoprim/sulfamethoxazole use and adverse effects is incorrect.
Trimethoprim/sulfamethoxazole is a common antibiotic used for urinary tract infections.
F. Urinary retention emergency is correct. Urinary retention in clients who have BPH can lead to
kidney damage and kidney failure.
Question: 8 of 30
A nurse is conducting an admission assessment of a client with benign prostatic hypertrophy (BPH). The
client states they avoid social events due to this condition. Which of the following client findings should
the nurse expect to find in the assessment? (Select all that apply.)
A. Inability to void
B. Dysuria
C. Urinary urgency
D. Incontinence
E. Urinary frequency
F. Impotence
Answer: A. Inability to void
B. Dysuria
C. Urinary urgency
E. Urinary frequency
F. Impotence
Explanation:
A. Inability to void is correct. This is a clinical manifestation of BPH.
B. Dysuria is correct. This is a clinical manifestation of BPH.
C. Urinary urgency is correct. This is a clinical manifestation of BPH.
D. Incontinence is incorrect. This is not a clinical manifestation of BPH. Clients with BPH have
difficulty initiating and retaining a urine stream but do not have incontinence.
E. Urinary frequency is correct. This is a clinical manifestation of BPH.
F. Impotence is incorrect. This is not a clinical manifestation of BPH.
Question: 9 of 30
A nurse is planning a discharge teaching plan for a client with acute glomerulonephritis. Which of the
following actions should the nurse include in the plan to reduce the development of complications?
(Select all that apply.)
A. Salt restriction
B. Protein restriction
C. Smoking cessation
D. Regulation of hypertension
E. Increased fluid intake
F. Increased potassium intake
Answer: A. Salt restriction
B. Protein restriction
C. Smoking cessation
D. Regulation of hypertension
Explanation:
A. Salt restriction is correct. In acute disease salt should be restricted from the diet. Clients who have
acute glomerulonephritis present with signs of fluid overload.
B. Protein restriction is correct. If the disease has progressed, the client will be instructed to restrict
sodium, potassium, and protein to slow the buildup of wastes and to decrease fluid volume overload.
C. Smoking cessation is correct. Smoking cessation is necessary to reduce the aggravation of kidney
disease.
D. Regulation of hypertension is correct. Clients who have glomerulonephritis should be taught to
control hypertension as it causes scarring of the glomeruli.
E. Increased fluid intake is incorrect. Clients who have acute glomerulonephritis often present with
manifestations of fluid overload due to the glomeruli not filtering as they should.
F. Increased potassium intake is incorrect. As glomerulonephritis progresses, clients are placed on a
diet that restricts sodium, potassium, and protein. Unless the client has a decreased potassium level,
there is no reason to increase the client's intake.
Question: 10 of 30
A nurse is caring for a client diagnosed with bacterial meningitis and is receiving gentamicin. Morning
laboratory results include the following: BUN 31 mg/dL, creatinine 1.8 mg/dL, and glomerular filtration
rate 55 mL/min. Which of the following conditions does the client's laboratory results most likely
indicate?
A. A prerenal acute kidney injury
B. A chronic kidney injury
C. An intrarenal acute kidney injury
D. A postrenal acute kidney injury
Answer: C. An intrarenal acute kidney injury
Question: 11 of 30
A nurse is caring for a client in the emergency department who reports bloody urine. frequent urination,
and lower back pain rated as a 9 on a scale of 0 to 10. The provider performs a physical assessment on
the client and tells the client. "I think you have polycystic kidney disease, but we will order a CT scan to
confirm. "Which of the following physical findings did the provider most likely find during the physical
assessment that led to the possible diagnosis of polycystic kidney disease?
A. Distended bladder
B. Periorbital edema
C. Palpable kidney mass
D. Crackles in the lungs
Answer: C. Palpable kidney mass
Question: 12 of 30
A nurse is caring for four clients on a medical-surgical unit. Which of the following clients is at the
highest risk for developing acute kidney injury?
A. A client who was admitted with pneumonia receiving cefazolin IV
B. A client who was admitted with dehydration from bacterial meningitis receiving Vancomycin IV
C. A client who was admitted with uncontrolled atrial fibrillation on a diltiazem IV drip
D. A client who was admitted with an exacerbation of congestive heart failure receiving metoprolol PO
Answer: B. A client who was admitted with dehydration from bacterial meningitis receiving
Vancomycin IV
Question: 13 of 30
A nurse is caring for a client who has acute kidney injury (AKI). The nurse should expect which of the
following findings in the client's medical record? (Select all that apply.)
A. Increased BUN
B. Decreased glomerular filtration rate (GFR)
C. Decreased creatinine
D. Decreased urine output
E. Jugular venous distension
Answer: A. Increased BUN
B. Decreased glomerular filtration rate (GFR)
D. Decreased urine output
E. Jugular venous distension
Explanation:
A. Increased BUN is correct. During metabolism, proteins in foods are broken down and release urea
nitrogen into the blood. When there is an alteration in kidney function this level increases.
B. Decreased glomerular filtration rate (GFR) is correct. GFR determines how well the kidneys are
filtering excess fluids and waste products from the blood. In AKI the GFR is decreased.
C. Decreased creatinine is incorrect. Creatinine is a byproduct and levels of creatinine rise if unable to
be excreted from the body through the kidneys as in AKI.
D. Decreased urine output is correct. The underlying pathological factor of AKI is decreased renal
blood flow. Without adequate blood flow, the kidney function is affected, leading to decreased urine
output.
E. Jugular venous distention is correct. Jugular venous distention is present in AKI. The underlying
pathological factor of AKI is decreased renal blood flow. Without adequate blood flow, the kidney
function is affected and the client will have fluid and sodium retention.
Question: 14 of 30
A nurse is completing discharge teaching for a client on home intermittent peritoneal dialysis. Which of
the following statements by the client indicate an understanding of fluid balance self-management?
(Select all that apply.)
A. “I will weigh myself every other day.”
B. “I will only take my diuretic pill if my feet are puffy.
C. “I will drink only the amount of fluid in a day that my doctor told me to.”
D. “I will call my doctor if I feel short of breath all of a sudden.”
E. “I will do extra peritoneal dialysis sessions if I gain too much weight in a day.”
Answer: C. “I will drink only the amount of fluid in a day that my doctor told me to.”
D. “I will call my doctor if I feel short of breath all of a sudden.”
Explanation:
A. “I will weigh myself every other day" is incorrect. The client needs to weigh themselves daily to
monitor for fluid overload.”
B. “I will only take my diuretic pill if my feet are puffy" is incorrect. The diuretic pill needs to be
taken daily.”
C. “I will drink only the amount of fluid in a day that my doctor told me to" is correct. Fluid
restriction is an effective intervention to prevent fluid overload.”
D. “I will call my doctor if I feel short of breath all of a sudden" is correct. Shortness of breath may
indicate fluid in the lungs from fluid overload.”
E. “I will do extra peritoneal dialysis sessions if I gain too much weight in a day" is incorrect.
Peritoneal dialysis needs to be done on a schedule every day not the times per day based on the client's
weight.”
Question: 15 of 30
A nurse is caring for a client with urinary retention. The client asks what causes them to have urinary
retention. Which of the following statements should the nurse make regarding possible causes of urinary
retention? (Select all that apply.)
A. “It may be caused by a stone lodged in your urethra.”
B. “It may be caused by an underactive bladder from a neurological condition.”
C. “It may be caused by a defective gene from one of your parents.”
D. “It may be caused by a narrowing of the urethra.”
E. “It may be caused by glomeruli inflammation a week after being treated for strep throat.”
Answer: A. “It may be caused by a stone lodged in your urethra.”
B. “It may be caused by an underactive bladder from a neurological condition.”
D. “It may be caused by a narrowing of the urethra.”
Explanation:
A. “It may be caused by a stone lodged in your urethra" is correct. Stones can lead to an obstruction
of the urethra.”
B. “It may be caused by an underactive bladder from a neurological condition" is correct. Certain
neurological conditions can lead to inefficient bladder contractions that cannot fully empty the bladder.”
C. “It may be caused by a defective gene from one of your parents" is incorrect. This is related to
polycystic kidney disease.”
D. “It may be caused by a narrowing of the urethra" is correct. Urethral strictures can cause urinary
retention.”
E. “It may be caused by glomeruli inflammation a week after being treated for strep throat" is
incorrect. This is related to acute glomerulonephritis.”
Question: 16 of 30
A nurse is caring for a client in the clinic who reports an inability to drain their bladder and urgency with
urination. The client's medical history indicates they have had benign prostatic hypertrophy (BPH) for
the last 26 years. Which of the following other clinical manifestations of BPH will the client most likely
report to the nurse? (Select all that apply.)
A. Pain with urination
B. Urination at night
C. Swelling around the eyes
D. Difficulty getting the urine stream started
E. Frothy urine
F. Bloody urine
Answer: A. Pain with urination
B. Urination at night
D. Difficulty getting the urine stream started
Explanation:
A. Pain with urination is correct. Dysuria is a clinical manifestation in clients with BPH.
B. Urination at night is correct. Nocturia is a clinical manifestation in clients with BPH.
C. Swelling around the eyes is incorrect. Periorbital edema is a clinical manifestation in
glomerulonephritis caused by edema from a decreased glomerular filtration rate due to salt and water
retention from activations of the renin-angiotensin-aldosterone system.
D. Difficulty getting the urine stream started is correct. Difficulty initiating the urine stream is a
clinical manifestation of BPH.
E. Frothy urine is incorrect. Frothy urine from proteinuria is a clinical manifestation in
glomerulonephritis.
F. Bloody urine is incorrect. Hematuria is not a clinical manifestation in clients with BPH. It is a
common finding in clients who have urinary tract infections.
Question: 17 of 30
A nurse is caring for a group of clients, who all are incontinent of urine, on the medical-surgical unit.
Which comorbidities should the nurse expect to find in their medical records? (Select all that apply.)
A. Chronic obstructive pulmonary disease (COPD)
B. Heart failure
C. Diabetes mellitus
D. Multiple sclerosis
E. Lupus
Answer: A. Chronic obstructive pulmonary disease (COPD)
B. Heart failure
D. Multiple sclerosis
Explanation:
A. Chronic obstructive pulmonary disease (COPD) is correct. COPD causes a chronic cough which
is a contributing factor for incontinence.
B. Heart failure is correct. Heart failure includes fluid overload and diuresis which may be difficult to
deal with for some clients leading to incontinence.
C. Diabetes mellitus is incorrect. Diabetes mellitus is a possible comorbidity for urinary tract
infections, type 2 renal calculi, and acute and chronic kidney failure.
D. Multiple sclerosis is correct. Multiple sclerosis causes limited mobility and a physical barrier to
toileting.
E. Lupus is incorrect. Lupus is a comorbidity for glomerulonephritis, which causes inflammation in the
kidneys.
Question: 18 of 30
A nurse is caring for a group of clients on a medical-surgical unit. Which of the following clients is the
most at risk for developing acute glomerulonephritis?
A. A client who was admitted for Clostridium difficile
B. A client who was admitted for a staphylococcal skin infection
C. A client who was admitted for Haemophilus influenzae type B pneumonia
D. A client who was admitted for Escherichia coli of the intestines
Answer: B. A client who was admitted for a staphylococcal skin infection
Question: 19 of 30
A nurse is providing discharge teaching to a client with chronic kidney disease. Which of the following
client statements indicate understanding of food restrictions? (Select all that apply.)
A. “I can continue to have my frozen meats for dinner.”
B. “I need to limit my protein intake.”
C. Whole milk is a good option for a drink with my meals due to the nutrients present.”
D. “I should broil my meat and vegetables.”
E. “My lunch can contain deli meat on two slices of whole Wheat bread.”
F. “Herbs are good substitutes when I cook my meals.”
Answer: B. “I need to limit my protein intake.”
D. “I should broil my meat and vegetables.”
F. “Herbs are good substitutes when I cook my meals.”
Explanation:
A. "I can continue to have my frozen meals for dinner" is incorrect. The client should limit their
sodium intake to less than 2300 mg/day avoiding prepared or packed foods.
B. "I need to limit my protein intake" is correct. The client should eat small portions of protein
because the byproducts from protein metabolism must be filtered through the kidney.
C. "Whole milk is a good option for a drink with my meals due to the nutrients present" is
incorrect. The client should choose foods that are low-fat or fat-free products. They should also limit
their dairy intake.
D. "I should broil my meat and vegetables" is correct. Using healthy cooking methods is essential so
that the client limits saturated and trans-fat.
E. "My lunch can contain deli meat on two slices of whole wheat bread" is incorrect. Some deli
meats have added phosphorus and the client should limit their phosphorus intake. Whole wheat bread is
high in potassium and the client should limit their potassium intake.
F. "Herbs are good substitutes when I cook my meals" is correct. The client should limit their
sodium intake and should experiment with spices and herbs instead of adding salt when cooking.
Question: 20 of 30
A nurse in a clinic is collecting subjective data from a client who reports of urinary leakage. The client
states, "I have sudden urges to urinate and leak a little before getting to the bathroom." Which of the
following types of altered urinary elimination is this client most likely experiencing?
A. Stress incontinence
B. Overflow incontinence
C. Urge incontinence
D. Urinary retention
Answer: C. Urge incontinence
Question: 21 of 30
A nurse is caring for a group of clients on a medical unit. Which of the following clients is the most at
risk for an acute kidney injury? (Select all that apply.)
A. A client who is taking gentamicin for infection
B. A client who has heart failure
C. A client who is 1 day postoperative following a colon resection
D. A client who has pneumonia
E. A client who has an exacerbation of lupus
Answer: A. A client who is taking gentamicin for infection
B. A client who has heart failure
E. A client who has an exacerbation of lupus
Explanation:
A. A client who is taking gentamicin for infection is correct. Aminoglycosides are nephrotoxic
medications and can lead to intrarenal acute kidney injury.
B. A client who has heart failure is correct. Heart failure is one of the conditions that leads to prerenal
acute kidney injury due to an increase in central venous pressure, causing the ventricles to dilate
decreasing cardiac output.
C. A client who is 1 day postoperative following a colon resection is incorrect. A colon-resection
surgery itself is not a risk factor for acute kidney injury.
D. A client who has pneumonia is incorrect. Pneumonia is not a risk factor for acute kidney injury.
E. A client who has an exacerbation of lupus is correct. Lupus is a connective tissue disorder which
may lead to intrarenal acute kidney injury.
Question: 22 of 30
A nurse is performing an assessment on a client coming into the clinic with complaints of painful
urination. The client reports that they leak urine when they sneeze, cough, or lift heavy objects. Which
of the following best describes the cause of this type of urinary elimination alteration?
A. Detrusor muscle overactivity that causes bladder contraction, loss of neurological control, or
irritation of the bladder
B. Bladder obstruction that blocks urine excretion or contractility of the detrusor muscle has been
impaired
C. Weakness of the urethral sphincter or the pelvic floor muscles
D. An obstruction of the urethra due to a renal stone or a urethral stricture
Answer: C. Weakness of the urethral sphincter or the pelvic floor muscles
Question: 23 of 30
A nurse is caring for a group of clients on a urology unit. Which clients are the most at risk for benign
prostatic hypertrophy (BPH)? (Select all that apply.)
A. A client who has a body mass index of 38
B. A client whose father had BPH
C. A client who has prostate cancer
D. A client who has pyelonephritis
E. A client who has metabolic syndrome
Answer: A. A client who has a body mass index of 38
B. A client whose father had BPH
E. A client who has metabolic syndrome
Explanation:
A. A client who has a body mass index of 38 is correct. Clients with a BMI greater than 30 are at risk
for BPH.
B. A client whose father had BPH is correct. Clients with fathers diagnosed with BPH are at risk for
BPI.
C. A client who has prostate cancer is incorrect. Prostate cancer is not a risk factor for BPH.
D. A client who has pyelonephritis is incorrect. Pyelonephritis is not a risk factor for BPH.
E. A client who has metabolic syndrome is correct. Clients with a diagnosis of metabolic syndrome
are at risk for BPH.
Question: 24 of 30
A nurse is caring for a client admitted with acute glomerulonephritis. The client wants to know how this
condition occurs. Which of the following best describes the pathological process of acute
glomerulonephritis?
A. Calcium plaque formation in the renal tubules with continued growth with entry into the renal pelvis
B. Ascending bacteria from the bladder up the ureters to the kidneys and parenchymal inflammation
C. Bacterial invasion of the bladder mucosal wall and an inflammatory reaction
D. An inflammatory response and a decreased glomerular filtration rate in the kidneys
Answer: D. An inflammatory response and a decreased glomerular filtration rate in the kidneys
Question: 25 of 30
A nurse is caring for a client who has chronic glomerulonephritis. The assistive personnel (AP) brings a
snack into the client's room. Which of the following foods should the nurse stop the AP from giving to
this client?
A. Apple
B. Banana
C. Pineapple
D. Red grapes
Answer: B. Banana
Question: 26 of 30
A nurse is caring for a client admitted to the urology unit with complaints of shortness of breath and a
diagnosis of chronic kidney disease. Which of the following pathophysiological changes in the renal
system led to the admitting diagnosis of chronic kidney disease?
A. Chronic nephropathies that lead to fibrosis and destruction of normal kidney structure and function
B. Obstruction leading to the filtration system backing up and eventually shutting the kidneys down
C. Reduction of blood flow to the kidneys
D. Acute tubular necrosis caused by the damage to the cells of the renal tubules leading to cell death and
a decreased glomerular filtration rate
Answer: A. Chronic nephropathies that lead to fibrosis and destruction of normal kidney structure and
function
Question: 27 of 30
A nurse is developing a plan of care for a client in a long-term skilled facility who has urinary
incontinence. The interventions include bladder training and timed voiding. Which of the following
statements by the client best indicates how the interventions have impacted their quality of life?
A. “I don't worry so much about peeing myself and feel more confident going out of my room.”
B. “I don't have to bother the staff as much to clean me up.”
C. “I don't go through so many pads, which saves me money on my bill every month.”
D. “I take an extra set of clothes with me whenever I go out.”
Answer: A. “I don't worry so much about peeing myself and feel more confident going out of my
room.”
Question: 28 of 30
A nurse on the dialysis unit is caring for a client who has end-stage kidney disease and is getting ready
for their first hemodialysis session. Which of the following topics should the nurse include when
discussing the impact of hemodialysis treatment on the client's life? (Select all that apply.)
A. Diet restrictions
B. Home recording of the volume removed at each exchange
C. Risk for depression
D. Fluid restrictions
E. Time requirements
Answer: A. Diet restrictions
C. Risk for depression
D. Fluid restrictions
E. Time requirements
Explanation:
A. Diet restrictions is correct. Clients with end-stage kidney disease on hemodialysis must follow diet
restrictions.
B. Home recording of the volume removed at each exchange is incorrect. Home recording of the
volume removed during each exchange is performed by clients who are performing peritoneal dialysis at
home.
C. Risk for depression is correct. Clients with end-stage kidney failure on hemodialysis may
experience depression.
D. Fluid restrictions is correct. Clients with end-stage kidney failure on hemodialysis must limit their
intake of fluids to prevent fluid overload.
E. Time requirements is correct. Time restrictions, such as hours spent receiving treatment at the
dialysis center needs to be discussed as this may add to the decline of quality of life.
Question: 29 of 30
A nurse is caring for a client with a new diagnosis of acute kidney injury. The client states, "This is
really going to mess my life up." Which of the following is the best response by the nurse to assist the
client to begin to understand the impact of this disease?
A. “You have just been diagnosed so it really won't impact your life too much right away.”
B. “With all the treatments they have for this disease, you will be okay.”
C. “The biggest concern related to the disease that clients have are financial concerns.”
D. “Clients with this disease typically have concerns with finances, treatment, and adjusting to a new
normal.”
Answer: D. “Clients with this disease typically have concerns with finances, treatment, and adjusting to
a new normal.”
Question: 30 of 30
