(Answers and Rationale) NCLEX Questions for Kidney Stones, Bladder Cancer, Prostate Issues

1. A. Urine should be strained for calculi and sent to the lab for analysis. Fluid intake of 3 to 4 L is encouraged to flush the urinary tract and prevent further calculi formation. A low-calcium diet is recommended to help prevent the formation of calcium calculi. Ambulation is encouraged to help pass the calculi through gravity.

2. D. Cystitis is the most common adverse reaction of clients undergoing radiation therapy; symptoms include dysuria, frequency, urgency, and nocturia. Clients with radiation implants require a private room. Urine of clients with radiation implants for bladder cancer should be sent to the radioisotopes lab for monitoring. It is recommended that fluid intake be increased.

3. C. Infections is the major complication to watch for in clients on cyclosporine therapy because it’s an immunosuppressive drug. Depression may occur posttransplantation but not because of cyclosporine. Hemorrhage is a complication associated with anticoagulant therapy. Peptic ulcer disease is a complication of steroid therapy.

4. D. In a client with acute renal graft rejection, evidence of deteriorating renal function is expected. The nurse would see elevated WBC counts and fever because the body is recognizing the graft as foreign and is attempting to fight it. The client would most likely have acute hypertension.

5. D. The client undergoing a renal transplantation will need vigilant follow-up care and must adhere to the medical regimen. The client is most likely anuric or oliguric preoperatively, but postoperatively will require close monitoring of urine output to make sure the transplanted kidney is functioning optimally. While the client will always need to be monitored for signs and symptoms of infection, it’s most important post-op will require close monitoring of urine output to make sure the transplanted kidney is functioning optimally. While the client will always need to be monitored for signs and symptoms of infection, it’s most important postoperatively due to the immunosuppressant therapy. Rejection can occur postoperatively.

6. D. Blood clots and blocked outflow if the urine can increase spasms. The irrigation shouldn’t be stopped as long as the catheter is draining because clots will form. A belladonna and opium suppository should be given to relieve spasms but only after assessment of the drainage. Oral analgesics should be given if the spasms are unrelieved by the belladonna and opium suppository.

7. D. Postobstructive diuresis seen in hydronephrosis can cause electrolyte imbalances; lab values must be checked so electrolytes can be replaced as needed. VS should initially be taken every 30 minutes for the first 4 hours and then every 2 hours. Urine output needs to be assessed hourly. The client’s weight should be taken daily to assess fluid status more closely.

8. C. The calculus should be analyzed for composition to determine appropriate interventions such as dietary restrictions. Calculi don’t result in infections. The size and number of calculi aren’t relevant, and they don’t contain antibodies.

9. C. Pain at the graft site and weight gain indicates the transplanted kidney isn’t functioning and possibly is being rejected. Transplant clients usually have edema, anorexia, fever, and nausea before transplantation, so those symptoms may not indicate rejection.

10. D. Steroid use tends to increase blood glucose levels, particularly in clients with diabetes and borderline diabetes. Steroids also contribute to poor wound healing and may cause acne, mood swings, and sodium and water retention. Steroids don’t affect thermoregulation, bleeding tendencies, or constipation.

11. C. Water diuresis causes low urine specific gravity, low urine osmolarity, and a normal to elevated serum sodium level. High specific gravity indicates dehydration. Hypernatremia signals acidosis and shock. Elevated urine pH can result from potassium deficiency, a high-protein diet, or uncontrolled diabetes.

12. C. The PSA test is used to monitor prostate cancer progression; higher PSA levels indicate a greater tumor burden. Serum creatinine levels may suggest blockage from an enlarged prostate. CBC is used to diagnose anemia and polycythemia. Serum potassium levels identify hypokalemia and hyperkalemia.

13. C. Autonomic dysreflexia is a potentially life-threatening complication of spinal cord injury, occurring from obstruction of the urinary system or bowel. Incontinence and diarrhea don’t result in obstruction of the urinary system or bowel, respectively. An URI could obstruct the respiratory system, but not the urinary or bowel system.

14. D. To control uric acid calculi, the client should follow a low-purine diet, which excludes high-purine foods such as organ meats. A low-calcium diet decreases the risk for oxalate renal calculi. Oxalate is an essential amino acid and must be included in the diet. A low-oxalate diet is used to control calcium or oxalate calculi.

15. C. Struvite stones commonly are referred to as infection stones because they form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Calcium oxalate stones result from increased calcium intake or conditions that raise serum calcium concentrations. Uric acid stones occur in clients with gout. Cystine stones are rare and occur in clients with a genetic defect that results in decreased renal absorption of the amino acid cystine.

16. C. A nephrostomy tube is put in place after a percutaneous ultrasonic lithotripsy to treat calculuses in the renal pelvis. The client may also have a foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect elimination of the calculus fragments.

17. A. 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, CV angle, or hip.

18. A. The client with prostatitis has a prostate gland that is swollen and tender but that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection (which often accompany the disorder).

19. C. Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur.

20. D. In the client with BPH, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about the use of these medications if the client has urinary retention. Retention can also be precipitated by other factors, such as alcoholic beverages, infection, bedrest, and becoming chilled.

21. D. No specific precautions are necessary following a renal scan. Urination into a commode is acceptable without risk from the small amount of radioactive material to be excreted. The nurse wears gloves to maintain body secretion precautions.

22. C. Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.

23. B. Frequent dressing changes around the Penrose drain is required to protect the skin against breakdown from urinary drainage. If urinary drainage is excessive, an ostomy pouch may be placed over the drain to protect the skin. A Penrose drain is not irrigated. Weighing the dressings is not necessary. Placing the client on the affected side will prevent a free flow of urine through the drain.

24. B. To increase urinary output, diuretics and osmotic agents are considered. The client should be monitored closely because fluid overload can cause hypertension, congestive heart failure, and pulmonary edema. Fluid intake would not be encouraged or restricted. Irrigation of the foley catheter will not assist in allievating this oliguria.

25. A. Acute rejection most often occurs in the first 2 weeks after transplant. Clinical manifestations include fever, malaise, elevated WBC count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Chronic rejection occurs gradually during a period of months to years. Although kidney infection or obstruction can occur, the symptoms presented in the question do not relate specifically to these disorders.

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