NCLEX 2024/2025 Exam Review (RN): Genitourinary System, Exams of Nursing

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NCLEX 2024/2025 Exam Review (RN)

Genitourinary system

abdominal x-ray? - ANSWER-a flat x-ray plate is placed over the abdomen, and an x- ray is taken. The kidneys, ureters, and bladder are visualized to assess size and portion. Calcified deposit can be identifies. This test is painless and require no preparation. Abnormal diagnostic findings with Pyelonephritis? - ANSWER-- UA is positive for red blood cells, white blood cells, casts and bacteria.

• Intravenous pyelogram reveals enlargement of the involved kidney. Active transport? - ANSWER-Requires energy. Most positive ions, glucose and amino acids are actively reabsorbed from the tubules into the surrounding capillaries. Acute renal failure? - ANSWER-The sudden and potentially reversible loss of the kidney's ability to excrete urine and nitrogenous waste products and to maintain fluid and acid-base balance. If inadequately treated, permanent damage can occur and cause chronic renal failure. ADH? - ANSWER-either stimulated or inhabited according to these serum levels to regulate the fluid balance. Afferent arterioles? - ANSWER-Blood enters the glomerulus under high pressure via the afferent arteriole. Benign Prostatic Hypertrophy? - ANSWER-Common in men over the age of 50. It is an enlargement of the prostate gland that causes partial or complete obstruction of the urethra. Signs and symptoms include urgency, frequency with alternating hesitancy during urination, nocturia, hematuria, retention, voiding small amounts, enlarged prostate gland upon palpitation. Blood urea nitrogen (BUN)? - ANSWER-Is a measure of the nitrogen fraction of urea, the end product of protein metabolism. An elevated level results from insufficient secretion and an increase in nitrogenous waste products in the blood. This condition is called azotemia. Normal values 10-20 mg/dL. Calcium stone diet? - ANSWER-Reduced dairy products with acid ash foods such as meat, whole grains, cranberry juice and prunes. Causes of chronic renal failure? - ANSWER-- acute renal failure
• nephrotoxic agents
• metabolic disease
• destruction of renal blood vessels due to hypertension or diabetes

• recurrent infections of the urinary tract. Causes of renal failure? - ANSWER-Pre-renal causes: are outside of the kidney and affects structures that supply the kidney. Renal causes: are structural to the kidney itself. Post-renal causes: mainly due to obstruction within the urinary tract (beyond the kidney). Chronic Renal Failure? - ANSWER-progressive, irreversible deterioration of renal function that can end in fatal uremia unless dialysis or kidney transplantation is performed. Collecting duct? - ANSWER-Primary location for water reabsorption (increases urine concentration). cortex of kidney? - ANSWER-outer layer of kidney contains glomeruli, proximal tubules, and distal tubules. Creatine clearance test? - ANSWER-the best indicator of the kidney's filtration function. It measures the amount of creatine filtered by glomeruli over a 24-hour period. Creatine? - ANSWER-Is a specific indicator of renal function, because renal impairment or failure is virtually the only cause for its elevation. Usually viewed with the BUN serum level to obtain a broad view of kidney function. Normal value is 0.7-1.6 mg/dL. Cystoscopy? - ANSWER-A lighted scope is inserted through the urethra for direct visualization of the bladder. The scope may be used to resect tumors, biopsy the bladder, remove stones, cauterize bleeding areas, or implant radium seeds. Cystourethrogram? - ANSWER-A catheter is inserted via the urethra and radiopaque dye is injected. While the client voids, x-rays are taken. The bladder and urethra are visualized. Decreased hematocrit levels are because? - ANSWER-seen in clients with renal failure because low erythropoietin secretion. Normal values range from 40-47%. Desired outcomes of patients with glomerulonephritis? - ANSWER--Client drinks 8 glasses of water every day.
• Client complies with the prescribed high-calorie, high carbohydrate, low-protein, and low-sodium diet.
• Edema is reduced, correlating with daily intake and output and weights.
• Blood pressure is controlled with antihypertensive such as clonidine, hydralazine, methyldopa, and with diuretics like furosemide
• Bed rest is maintained until hematuria, proteinuria, and hypertension subside.
• Client discusses the importance of prompt treatment for signs and symptoms of glomerulonephritis, sore throats, and respiratory infections.

Dialysis? - ANSWER-The passage of particles from an area of high concentration to an area of low concentration across a semipermeable membrane.

• peritoneal dialysis
• hemodialysis Different types of peritoneal dialysis include? - ANSWER-- intermittent manual
• intermittent automatic
• continuous ambulatory Distal tubules? - ANSWER-Secretion of hydrogen ions (H+) to maintain the acid-base balance. Diuretic phase of renal failure? - ANSWER-Urine output is greater than 3?/day, BUN and creatine slowly rise, and hypovolemia and weight loss result. The diuretic phase lasts several days to one week. Effects of Pyridium? - ANSWER-- stains urine a reddish orang color.
• is a urinary analgesic and antiseptic.
• Causes gastrointestinal upset. Functions of the kidneys? - ANSWER-- maintain homeostasis of the blood by forming urine.
• arterial blood pressure regulation.
• water regulation.
• acid-base balance.
• electrolyte regulation.
• excretion of waste products.
• vitamin D and calcium regulation.
• erythropoietin regulation.
• excretion and detoxification of drugs. Genitourinary tract? - ANSWER- glomerular filtration rate? (GFR) - ANSWER-125cc/min and is dependent upon capillary wall permeability, blood pressure, and effective filtration pressures. Glomeruli? - ANSWER-Clumps of capillaries surrounded by Bowman's capsule glomeruli? - ANSWER-Filtration of water, sodium, potassium, calcium, magnesium, chloride, phosphate, urea, creatine, glucose, and amino acids occur here. Glomerulonephritis? - ANSWER-A non-bacterial inflammation of the glomeruli in both kidneys that involves an antigen-antibody reaction and causes increased membrane permeability, glomerular cell hyperplasia, and scarring with loss of renal function. It frequently follows staphylococcus aureus, group A B-hemolytic streptococcus, or

respiratory infection. Signs and symptoms include headache, fever, chills, nausea, vomiting, back pain, oliguria, hematuria, proteinuria, hypertension, edema, azotemia, increased urine specific gravity and elevated BUN and creatine. Hemodialysis? - ANSWER-Involves passage of blood from the client through a semipermeable membrane immersed in dialysate. Diffusion and ultrafiltration occur between blood and dialysate.

• An arteriovenous fistula (or graft) is an internal anastomosis of an artery and a neighboring vein that can be easily accessed for HD. Hypercalcemia? - ANSWER-elevated calcium level. >10.5 mEq/L. Due to immobility, bone metastasis, excess vitamin D intake, osteoporosis, decreased renal excretion, and parathyroid tumors. Signs and symptoms include skeletal muscle weakness, bone pain, renal calculi, pathological fractures, altered LOC, constipation, nausea, vomiting, anorexia, polyuria, and decreased serum phosphorous levels. Hyperkalemia? - ANSWER-elevated potassium. >5.5 mEq/L. can be caused by burns, renal failure acidosis, or excessive intake. Signs and symptoms include skeletal muscle cramps, weakness, bradycardia, arrhythmias, oliguria, diarrhea, and cardiac arrest. Hypermagnesemia? - ANSWER->2.5 mEq/L. is caused by renal insufficiency, diabetic ketoacidosis, and excessive intake (usually via antacids). Signs and symptoms include central nervous system and neuromuscular depression, hypotension, sedation, and cardiac arrest. Hypernatremia? - ANSWER-elevated level of sodium. > 146mEq/L. is caused by steroid therapy, renal disease, aldosterone excess, or gain of total body water. Signs and symptoms include water retention, edema, weight gain and hypertension. Hypocalcemia? - ANSWER-Decreased calcium level. <8.5mEq/L. Caused by hypoparathyroidism, low vitamin D intake, pregnancy, rickets, and renal disease. Signs and symptoms include tetany, paresthesia of fingers and around the mouth, muscle twitching, cramps, laryngospasms, and elevated phosphorous levels. Hypokalemia? - ANSWER-<3.5 mEq/l. decreased potassium. Is caused by diuretic therapy, poor nutritional intake, GI loss, ulcerative colitis, Cushing's syndrome, and alkalosis. Signs and symptoms include muscle weakness, decreased reflexes, flaccid paralysis, CNS depression, lethargy, hypotension, anorexia and ECG changes. Hypomagnesemia? - ANSWER-<1.5 mEq/L. is caused by alcoholism, malnutrition, and decreased oral intake. Signs and symptoms include tremors, neuromuscular irritability, disorientation, and convulsions. Hyponatremia? - ANSWER-decreased sodium level. <135mEq/L. Caused by diuretic therapy, burns, gastrointestinal loss, or excess body fluid reducing the ration of sodium

to water. Signs and symptoms include decreased blood pressure, poor skin turgor, dehydration, shock, oliguria and seizures. Intravenous pyelogram? - ANSWER-A contrast material is injected intravenously. As the kidneys filter and excrete the dye, x-rays are taken a specific time intervals over 1 hour. the kidneys, ureter, and bladder are visualized to evaluate function and identify obstructions present. Left and right renal arteries? - ANSWER-Branch from the abdominal aorta to supply the kidneys with 20% of the body's total blood volume. Loop of Henle? - ANSWER-Reabsorption of water and sodium to concentrate the urine and some electrolytes. Medications often prescribed for treatment of acute renal failure? - ANSWER-anti- infectives to treat the organisms, antacids such as aluminum hydroxide (Amphogel) to bind with phosphates, sodium bicarbonate to treat acidosis, antihypertensive, diuretics for fluid overload, such as mannitol, and potassium-lowering agents(insulin and glucose, sodium polystyrene sulfonate). Sometimes a dopamine drip is initiated to increase renal perfusion by activating dopaminergic receptors within the sympathetic nervous system. Medulla of the kidney? - ANSWER-the middle layer of the kidney. nephrectomy? - ANSWER-Removal of a kidney is required if extensive damage has occurred to the parenchyma. A Penrose drain is placed in the renal bed. nephrolithotomy? - ANSWER-Parenchyma of the kidney is cut through a flank incision to extract a stone. A nephrostomy tube is placed to divert the urine away from the kidney. Nephrons? - ANSWER-Functional units of the kidneys that use three processes: filtration, reabsorption, and secretions. Normal findings of urine? - ANSWER-- pale to deep amber in color

• aromatic
• more than 30 cc/hr Nursing goals and interventions for acute renal failure? - ANSWER-- Determining the underlying causes of renal failure and preventing them from happening in the future.
• encouraging a diet low in protein, sodium, and potassium; and a low in fat, and high carbohydrates and calories.
• obtaining daily weights, restricting fluid intake, monitoring the client's intake and output, and assessing for edema in legs, feet and sacral area.
• Instituting bed rest to conserve energy.
• Monitoring neurological status and reporting any changes.
• Monitoring electrolytes and providing supplements as ordered.

• protecting against infection.
• assessing skin for breakdown, rash, or uremic frost.
• educating client concerning medications, diet, prevention and safety. nursing goals and interventions of chronic renal failure? - ANSWER-- similar to those in acute renal failure.
• irreversible damage to the renal parenchyma.
• dialysis is often used to substitute for lost kidney function.
• if severe damage occurs, a kidney transplant is indicated. Oliguric Phase of renal failure? - ANSWER-urine output is less than 400cc/day and BUN and creatine rise, decreasing the normal ratio of BUN; creatine from 20:1 to 10:1. Hypervolemia, edema, weight gain, and hypertension result. Lasts up to 1-2 weeks. Osmolality? - ANSWER-An indicator of the body's water balance. High serum levels indicate dehydration; low serum levels indicate hypervolemia. Passive transport (diffusion)? - ANSWER-does not require energy, as it takes advantage of established concentration gradients. Water, urea, and most negative ions are passively reabsorbed. Percutaneous lithotripsy? - ANSWER-an endoscope is passed through a small incision made over the kidney to remove the calculi or disintegrate it with ultrasonic waves. Peritoneal dialysis? - ANSWER-a catheter is placed through the abdominal wall into the peritoneal space. Dialysate flows into the abdominal cavity by gravity, dwells in the abdomen for a specific amount of time, and is then drained into a bag by gravity. Continuous ambulatory peritoneal dialysis requires that dialysate remain in the peritoneum 24 hours per day with several dialysate exchanges each day. Phases of acute renal failure? - ANSWER-1. Oliguric

2. Diuretic
3. Recovery Phosphorus? - ANSWER-Is inversely proportional to serum calcium levels. Altered levels occur in renal disease, as the kidneys regulate the calcium and phosphorus balance by activating vitamin D. Normal values 3-4.5mg/dL. Procedures to remove renal calculi? - ANSWER-- pyelolithotomy

• percutaneous lithotripsy
• nephrectomy
• ureterolithotomy
• nephrolithotomy
• transcutaneous shock wave lithotripsy

Proximal Tubules? - ANSWER-Primary location for reabsorption and secretion of glucose, amino acids, and electrolytes. Pyelolithotomy? - ANSWER-Removal of a stone from the renal pelvis through a flank incision; urethral catheter and penrose drain are inserted. Pyelonephritis? - ANSWER-Inflammation of the kidney tissues. Signs and symptoms include those of cystitis, fever, chills, malaise, flank pain and costovertebral tenderness. Interventions include antibiotic therapy, increased fluid intake, urine inspection, daily weights, frequent temperature monitoring, and client teaching to prevent reinfection and to increase compliance. Recovery phase of renal failure? - ANSWER-BUN and creatine are normal and urine output is between 4 and 5L/day as renal function gradually returns. renal arteriogram? - ANSWER-A radioactive isotope is injected via translumbar or femoral catheter, and x-rays are taken. Renal circulation is visualized, and perfusion insufficiencies can be identified. The kidneys, uterus, and bladder are visualized to assess size and portion. Calcified deposits can be identified. This test is painless and requires no preparation. Renal biopsy? - ANSWER-An intestinal x-ray is taken to mark the lower pole of the kidney. The client is positioned prone and bent at the diaphragm. As the client inhales, a needle is inserted into the kidney, and a sample is aspirated. The sample is sent to pathology to determine histology. Renal calculi? - ANSWER-often form within the urinary tract, causing pain and damage to surrounding tissues. Stones can consist of calcium, cystine oxalates, and uric acid. Causes of renal calculi include urinary stasis, hypercalcemia, alkaline urine, gout (elevated uric acid levels), and increased dietary vitamin D, causing increased calcium absorption. Signs and symptoms of renal calculi include: pain radiating from the flank to the abdomen; alternating retention and diuresis; nausea; vomiting; hematuria; diaphoresis; restlessness; low-grade fever; urgency; UTI and pallor. renal capsule of the kidney? - ANSWER-a tightly adhering, fibrous capsule surrounding each kidney. Renal pelvis? - ANSWER-The innermost layer of the kidney; a hollow collection area made up of calyces (cut shaped containers) that hold urine to be delivered to the ureters. renal pyramids of the kidney? - ANSWER-In the middle layer of the kidney; hold collecting ducts and loops of henle. Renal ultrasound? - ANSWER-Sound waves are passed over the abdomen, and a computer interprets the tissue density, creating images in print form. The kidneys,

ureters, bladder, and renal vessels are visualized to evaluate size, position, and patency. This procedure is not painful or invasive and requires no preparation. Signs and symptoms of chronic renal failure? - ANSWER-- oliguria/ anuria

• electrolyte imbalances
• hypertension
• CHF
• anorexia
• nausea/vomiting
• hiccups
• ammonia on the breath
• mild alteration in sensorium
• slurred speech
• encephalopathy
• potential seizures or coma
• peripheral neuropathy
• bone pain
• brittle hair and dry nails and skin
• infertility
• pathological fractures The Bladder? - ANSWER-Is a hollow, muscular organ that stores urine until it is eliminated. Its holding capacity is approximately 300-500 cc of urine. Therapeutic medications for patients with urinary stones? - ANSWER-- aluminum hydroxide
• analgesics like morphine sulfate
• allopurinol
• antispasmodics such as atropine to relax smooth muscle Transcutaneous shock wave lithotripsy? - ANSWER-The client is submerged in a large bath of warm water as ultrasonic waves are delivered to the area near the stone to crush or disintegrate it. treatment of benign prostatic hypertrophy - ANSWER-Surgical intervention. The four most common procedures to correct BPH are: transurethral resection of the prostate (TURP), suprapubic resection, retropubic resection and perineal (radical) resection. Tubular reabsorption? - ANSWER-Substances filtered out in the glomerulus are useful to the body and would be lost in the urine if not for selective tubular reabsorption through active transport or passive diffusion. Upper urinary tract infections? - ANSWER-include pyelonephritis and glomerulonephritis.

ureterolithotomy? - ANSWER-An incision is made into the ureter through an abdominal or flank excision to extract a stone. A Penrose drain is inserted around the ureter to collect extra drainage, and a urethral catheter is inserted to act as a splint that should never be irrigated. Ureters? - ANSWER-are hollow tubes that propel urine through peristaltic action from the renal pelvis to the bladder. Urethra? - ANSWER-the distal portion of the urinary tract for eliminating urine from the body. It is surrounded by the prostate gland in men and is the terminal portion of the reproductive tract serving as a passage for semen. Uric acid stones diet? - ANSWER-low purine diet with alkaline ash foods such as milk, fruits, rhubarb, and vegetables urinalysis? - ANSWER-tests for several disorders, diabetes mellitus, dehydration, UTI, kidney trauma and glomerulonephritis. Urinary Tract Infections? - ANSWER-infectious disorders causing inflammation of the urethra or of the bladder wall. Half of the cases are asymptomatic and the remaining half present with urgency, burning upon urination (dysuria), bladder spasms, frequency of urination during the day and night, and foul smelling urine. Urine culture and sensitivity? - ANSWER-can be collected by a voided specimen (clear catch) or a sterile catheterized specimen. The results identify bacterial count, as well as the infectious agent and its antibiotic sensitivity. UTI Treatment? - ANSWER-- Single dose antibiotics (ciproflaxin, Bactrim, trimethoprim) are given for 10-14 days. Phenazopyridine HCL (pyridium) is often ordered to UTIs.

• drinks lots of fluids.
• client identifies signs and symptoms (chills, fever, dysuria, frequency, urgency and itching. What must you do when caring for a client with renal calculi? - ANSWER-- monitor intake and output.
• strain all urine through gauze to check for passage of stones.
• take frequent vital signs.
• prevent infection.
• monitor electrolytes as well as uric acid and calcium levels. Which diagnostic tests would be utilized to confirm renal stones? - ANSWER-- urinalysis
• intravenous pyelogram
• x-ray
• cystoscopy
• ultrasound

Which of the following particles are filtered through the membranes in dialysis? - ANSWER-- urea

• creatine
• sodium
• potassium