NCLEX RN Questions Urinary System Related

The nurse in the emergency department (ED) is caring for a 57-year-old male client.
Item 5 of 6
History and Physical
A 57-year-old male client with stage three small cell lung cancer. The client had suddenly become disoriented and did not recognize his family members and relatives. He reports severe lower extremity weakness and has had three episodes of diarrhea in the past four hours. The client is undergoing 6 cycles of chemotherapy with cisplatin and etoposide. He is currently taking a 14-day course of 15 mg of prednisone. He is on his third day of steroid treatment. He has a medical history of dyslipidemia and advanced chronic obstructive pulmonary disease.

Laboratory Results
• Hemoglobin 14 g/dL [14-18 g/dL (140–180 g/L)]
• Hematocrit 42% (0.42) [42-52% (0.42-0.52)]
• White Blood Cell 11,000 mm3 [5-10 mm3]
• Platelet Count 140,000 mm3 [150-400 mm3 (150–400 × 109/L)]
• Glucose 139 mg/dL (7.72 mmol/L) [70–110 mg/dL (4-6 mmol/L)]
• Sodium 116 mEq/L [136–145 mEq/L (mmol/L)]
• Potassium 3.3 mEq/L [3.5–5.0 mEq/L (mmol/L)]
• Creatinine 0.7 mg/dL (61.88 mmol/L) [0.6–1.2 mg/dL (53–106 mmol/L)]
• Blood Urea Nitrogen 8 mg/dL (2.86 mmol/L) [10–20 mg/dL (3.6–7.1 mmol/L)]
• Serum Osmolality 277 mOsm/kg [285-295 mOsm/kg (285–295 mmol/kg)]

Nurses' Notes
0759: Client is completely disoriented and required maximum assistance to the stretcher because of unsteady gait. Lung sounds clear bilaterally. Alopecia noted. Skin is warm and dry and normal for ethnicity. Peripheral pulses 2+. No skin tenting. Hyperactive bowel sounds in all quadrants. 20-gauge peripheral vascular access device placed in the left antecubital space. T 97.8° F (36.6° C) P 88 RR 21 BP 123/68 Pulse oximetry reading 91% on room air.
0850: Verbal order was received from physician to insert indwelling urethral catheter.
0910: Urinary catheter inserted with sterile technique. 40 mL of dark yellow urine returned.


Orders
• admit to intensive care unit
• nephrology consultation
• oncology consultation
• fluid restriction - 1 liter daily
• daily weight
• strict intake and output
• 250 mL of 3% saline at 75 mL/hr
• tolvaptan 15 mg PO daily - first dose now
• neurological assessments every two hours

The nurse reviews the orders and prepares to administer the first dose of prescribed tolvaptan. Complete the following sentences by choosing from the lists of options. Prior to administering the first dose of this medication, the nurse should obtain an order to review the client's baseline.............. as.......................... is a serious adverse effect of this medication? Osmotic demyelination syndrome is another serious adverse reaction to this medication and requires monitoring of the client's.................

• A. liver enzymes
• B. thyroid toxicity
• C. liver injury
• D. myocardial infarction
• E. urinary output.
• F. Glasgow coma scale.
• G. blood pressure.

The nurse is caring for a client with a sodium level of 130 mEq/L (mmol/L) [135-145 mEq/L, mmol/L]. Which of the following medications may cause this abnormality? Select all that apply.

• A. Spironolactone
• B. Hydrochlorothiazide
• C. Prednisone
• D. Sodium polystyrene
• E. Tolvaptan

The nurse is caring for a client with end-stage renal disease who receives prescribed sevelamer. Which of the following findings would indicate a therapeutic response?

• A. Decreased serum calcium levels
• B. Increased hemoglobin and hematocrit
• C. Decreased serum potassium levels
• D. Decreased serum phosphorus levels

The nurse is providing discharge instructions to a client prescribed phenazopyridine. Which of the following instructions should the nurse include?

• A. Discontinue this medication if urinary discoloration occurs
• B. Take this medication on an empty stomach
• C. This medication may increase the amount of urine you produce
• D. Urine may have a reddish or orange coloration after taking this medication

The following scenario applies to the next 1 items
The nurse in the emergency department (ED) is caring for a 78-year-old female client
Item 1 of 1
Nurses' Note
1355: Client was brought to the ED by the client's adult children, who reported that while she was visiting, she reported dizziness and seemed slightly confused. The adult child reports that the symptoms started one day ago. The client recently had a change in her blood pressure medication, with the physician increasing the dosage of her prescribed furosemide. Medical history of hypertension, hyperlipidemia, and osteoarthritis. Vital signs: T 100° F (37.8° C), P 104, RR 22, BP 110/66, pulse oximetry reading 95% on room air.

On assessment, the client is lethargic and oriented to person and place, but not time. The client's breathing appears unlabored with tachypnea. Clear lung sounds throughout all lung fields. Skin is warm, dry, and flaky. Peripheral pulses 1+ in all extremities. Aching pain reported in the hips and knees and rated 5 on a scale of 0 (no pain) to 10 (severe pain). Client was ambulated to the bathroom, where she urinated 300 mL of clear, yellow urine without any odor or particulates. 22-gauge peripheral venous access device (VAD) placed in right forearm.

Complete the sentence below by choosing from the list of options. Based on the client's..... and............. this client is at highest risk for........

• A. lung sounds
• B. vital signs
• C. pain level
• D. dosage increase of diuretic
• E. urinary infection.
• F. fluid volume deficit.