Chapter 20 My Nursing Test Banks

DAmico/Barbarito Health & Physical Assessment in Nursing, 2/e
Chapter 20

Question 1

Type: MCSA

The nurse is interviewing an elderly client in the clinic that reports incontinence. Numerous attempts in the recent past have been unsuccessful in helping to control the problem. A priority nursing diagnosis to consider for this client is which of the following?

1. Skin integrity impairment

2. Self-care deficit

3. Self-esteem, situational-low

4. Infection

Correct Answer: 3

Rationale 1: Skin integrity impairment is of concern, but there is no data in this scenario to indicate that it is the highest priority nursing diagnosis.

Rationale 2: There is no data in this situation to indicate any self-care deficit issues.

Rationale 3: Since the client has had no success in controlling the incontinence after repeated attempts, this client is at a high risk for situational low self-esteem.

Rationale 4: There is no data in this scenario to indicate a risk for infection.

Global Rationale: Clients suffering from incontinence are at increased risk for social isolation, self-esteem disturbance, and other psychosocial problems. There is no data to support a self-care deficit; the information available is that this client has tried to implement measures to treat the problem. The client is certainly at risk for infection and skin integrity impairment, but these two are not active at this time.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 20.7: Describe developmental, psychosocial, cultural, and environmental variations in assessment techniques and findings.

Question 2

Type: MCMA

The nurse is interviewing a client regarding urinary health. Which questions would the nurse include during the collection of subjective data?

Standard Text: Select all that apply.

1. Do you have difficulty starting your stream of urine?

2. After you urinate, does your bladder feel full or empty?

3. Do you ever have an accident or wet yourself when you sneeze?

4. Do you have to hurry to the bathroom when you have to urinate?

5. Do you know the results of your recent urine analysis tests?

Correct Answer: 1,2,3,4,5

Rationale 1: Do you have difficulty starting your stream of urine? Difficulty starting a stream usually indicates prostate disease in the male client.

Rationale 2: After you urinate, does your bladder feel full or empty? Urinary retention, or holding residual urine in the bladder after voiding, creates the sensation that the client is unable to empty the bladder and may contribute to the development of infection.

Rationale 3: Do you ever have an accident or wet yourself when you sneeze? Stress incontinence is most likely the cause of the client experiencing partial or complete incontinence when sneezing, coughing, and laughing due to loss of muscle control.

Rationale 4: Do you have to hurry to the bathroom when you have to urinate? Urge incontinence is most likely the cause of the client experiencing partial or complete incontinence if the client is consistently unable to reach the bathroom in time, and is due to loss of muscle control.

Rationale 5: Do you know the results of your recent urine analysis tests? Determining the clients knowledge of their urine health is important for ensuring client involvement in the plan of care.

Global Rationale: Urinary retention or holding residual urine in the bladder after voiding creates the sensation that the client is unable to empty the bladder and may contribute to the development of infection. Difficulty starting a stream usually indicates prostate disease in the male client. Stress incontinence and urgency occur when there is loss of muscle control over urination. Determining the clients knowledge of their urine health is important for ensuring client involvement in the plan of care.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.3: Develop questions to be used when completing the focused interview.

Question 3

Type: MCSA

The nurse is collecting a urine specimen from a client and notes the urine is foamy and amber in color. The nurse would suspect which of the following in this situation?

1. Kidney stones

2. Urinary tract infection

3. Prostate disease

4. Liver disease

Correct Answer: 4

Rationale 1: Pain is the primary symptom for the client with kidney stones. The pain may radiate and is variable in location and severity. Other symptoms include spasms, nausea, vomiting, pain on urination, frequency and urgency of urination, and gross hematuria.

Rationale 2: If a urinary tract infection is present, the client may complain of pain during urination with urgency, frequency, dribbling, pain upon urination, and suprapubic or lower back pain. Hematuria, as well as cloudy and foul-smelling urine may also accompany a urinary tract infection.

Rationale 3: Prostate disease may make it difficult for male clients to begin or maintain their urine stream.

Rationale 4: Foamy, amber-colored urine frequently is an indication of hepatic illness (liver disease).

Global Rationale: Foamy, amber-colored urine may indicate the presence of hepatic illness (liver disease). If a urinary tract infection is present, the client may complain of pain during urination with urgency, frequency, dribbling, pain upon urination, and suprapubic or lower back pain. Hematuria, as well as cloudy and foul-smelling urine may also accompany a urinary tract infection. Prostate disease may make it difficult for male clients to begin or maintain their urine stream. Pain is the primary symptom for the client with kidney stones. The pain may radiate and is variable in location and severity. Other symptoms include spasms, nausea, vomiting, pain on urination, frequency and urgency of urination, and gross hematuria.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 20.6: Differentiate normal from abnormal findings in physical assessment of the urinary system.

Question 4

Type: MCSA

The nurse is caring for a baby with newly diagnosed renal disease. The nurse would anticipate diagnostic tests to evaluate functioning of which of the following sytems to be the highest priority?

1. Ears

2. Heart

3. Lungs

4. Joints

Correct Answer: 1

Rationale 1: The ears and kidneys develop at the same time in utero. Congenital deafness is frequently associated with renal disease; therefore, the auditory function of the baby with known renal disease would be important to assess because of the embryonic development.

Rationale 2: Even though all body systems should be assessed to make sure their function is normal, the heart would not be the highest priority system since congenital deafness is frequently associated with renal disease due to the ears and kidneys developing at the same time in utero.

Rationale 3: Even though all body systems should be assessed to make sure their function is normal, the lungs would not be the highest priority system since congenital deafness is frequently associated with renal disease due to the ears and kidneys developing at the same time in utero.

Rationale 4: Even though all body systems should be assessed to make sure their function is normal, the joints would not be the highest priority system since congenital deafness is frequently associated with renal disease due to the ears and kidneys developing at the same time in utero.

Global Rationale: The ears and kidneys develop at the same time in utero. Congenital deafness is associated with renal disease. Even though all other systems would be assessed to make sure their function is normal, the auditory function of the baby with known renal disease would be important to assess because of the embryonic development.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.7: Describe developmental, psychosocial, cultural, and environmental variations in assessment techniques and findings.

Question 5

Type: MCSA

The nurse is admitting a client with constant, severe flank pain, spasms, nausea and vomiting, and oliguria. The client states that the pain was initially intermittent and radiated from the low back to the lower quadrants of the abdomen. The nurses next action is to:

1. administer pain medication.

2. notify the healthcare provider immediately.

3. obtain a urine specimen for culture.

4. complete the assessment.

Correct Answer: 2

Rationale 1: Administering pain medication would not be appropriate since the clients symptoms indicate hydroureter. Hydroureter is a complication that occurs when a renal calculus (kidney stone) moves into the ureter and blocks and dilates the ureter. Hydroureter is a medical emergency that can lead to shock, infection, and subsequent impaired renal function; therefore, the healthcare provider should be notified immediately.

Rationale 2: Hydroureter is a complication that occurs when a renal calculus (kidney stone) moves into the ureter and blocks and dilates the ureter. Symptoms include severe pain and spasms, nausea and vomiting, and diminished volume of urine (oliguria). Hydroureter is a medical emergency that can lead to shock, infection, and subsequent impaired renal function; therefore, the healthcare provider should be notified immediately.

Rationale 3: Obtaining a urine specimen for culture would not be appropriate since the clients symptoms indicate hydroureter. Hydroureter is a complication that occurs when a renal calculus (kidney stone) moves into the ureter and blocks and dilates the ureter. Hydroureter is a medical emergency that can lead to shock, infection, and subsequent impaired renal function; therefore, the healthcare provider should be notified immediately.

Rationale 4: Completing the assessment would not be appropriate since the clients symptoms indicate hydroureter. Hydroureter is a complication that occurs when a renal calculus (kidney stone) moves into the ureter and blocks and dilates the ureter. Hydroureter is a medical emergency that can lead to shock, infection, and subsequent impaired renal function; therefore, the healthcare provider should be notified immediately.

Global Rationale: Hydroureter is a complication that occurs when a renal calculus moves into the ureter and blocks and dilates the ureter. Symptoms include severe pain and spasms, nausea and vomiting, and diminished volume of urine (oliguria). Hydroureter is a medical emergency that can lead to shock, infection, and subsequent impaired renal function, and medical collaboration should be initiated immediately. All other options would not be appropriate in an emergency situation.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.6: Differentiate normal from abnormal findings in physical assessment of the urinary system.

Question 6

Type: MCSA

The nurse is palpating the left flank area and feels a sharp edge with definite delineated margins. The nurse is most likely palpating which of the following?

1. An enlarged spleen

2. An enlarged kidney

3. The colon

4. A distended bladder

Correct Answer: 1

Rationale 1: The left kidney and the spleen lie in the left upper quadrant of the abdomen and can be palpated in the flank area if enlarged. An enlarged kidney feels smooth and rounded, whereas an enlarged spleen feels sharper with a more delineated edge.

Rationale 2: The left kidney and the spleen lie in the left upper quadrant of the abdomen and can be palpated in the flank area if enlarged; however, the kidney would feel smooth and rounded if palapated.

Rationale 3: The colon normally cannot be palpated.

Rationale 4: A distended bladder would be palpated in the symphysis pubis area.

Global Rationale: An enlarged kidney feels smooth and rounded, whereas an enlarged spleen feels sharper with a more delineated edge. Both organs lie in the left upper quadrant of the abdomen. Usually the kidneys are not palpable, but may be if enlarged. The colon should not be palpable, and the bladder is in the area over the symphysis pubis.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.2: Identify landmarks that guide assessment of the urinary system.

Question 7

Type: MCMA

The nurse is assessing a client admitted for oliguria of unknown origin. During the admission, the client asks the nurse what affects urinary output. The nurse would list which of the following when responding?

Standard Text: Select all that apply.

1. Bladder size

2. Bowel patterns

3. Medications

4. Client temperature

5. Fluid intake

Correct Answer: 1,3,4,5

Rationale 1: Bladder size. Bladder size affects the amount and number of times a client voids. An adult may void five or six times per day in amounts averaging 100 to 400ml.

Rationale 2: Bowel patterns. Bowel pattern generally has no affect on urinary output.

Rationale 3: Medications. Various medications may affect the total urinary output. For example, diuretics will increase the amount urinary output.

Rationale 4: Client temperature. The clients temperature may affect the total urinary output. During times of fever the urinary output may decrease as a result of diaphoresis or dehydration.

Rationale 5: Fluid intake. The amount of fluid intake should closely correlate with the amount of fluid the client eliminates. When the amounts do not closely correlate, the reason for the difference must be investigated as it could be indicative of a potential problem.

Global Rationale: Bowel pattern does not usually affect the amount of urinary output. Factors that influence the number of times and the amount of urine that a client voids include the size of the bladder, medications, the clients temperature, and fluid intake.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.1: Describe the anatomy and physiology of the urinary system.

Question 8

Type: MCSA

Since returning from surgery the client has not voided for 8 hours; therefore, the nurse determines it is necessary to assess the client for bladder distention. The nurse would palpate for bladder distention with the client in which of the following positions?

1. Supine with only a small pillow under their head.

2. Prone position

3. Sitting in bed at a 45-degree angle

4. Lying in a left lateral position

Correct Answer: 1

Rationale 1: The bladder, when empty, is usually not palpable. As the bladder fills, the fundus can be palpated anywhere between the symphysis pubis to the level of the umbilicus When distended the bladder will feel firm, smooth, symmetric, and non-tender. Lying supine with a small pillow under the head will allow for proper palpation of a distended bladder.

Rationale 2: Supine position is lying face down so it would be impossible to palpate the bladder.

Rationale 3: Sitting at a 45-degree angle would not allow proper palpation of the bladder.

Rationale 4: Lying in a left lateral position would not allow proper palpation of the bladder.

Global Rationale: The bladder, when empty, is usually not palpable. As the bladder fills, the fundus can be palpated anywhere between the symphysis pubis to the level of the umbilicus When distended, the bladder will feel firm, smooth, symmetric, and non-tender. Lying supine with a small pillow under the head will allow for proper palpation of a distended bladder. The other positions will not allow proper palpation of the bladder.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.4: Explain client preparation for assessment of the urinary system

Question 9

Type: MCSA

The nurse is percussing over the clients symphysis pubis area and notes a dull tone. The nurse understands that this represents which of the following?

1. The right kidney

2. A full bladder

3. A bladder tumor

4. Air trapped in the intestines

Correct Answer: 2

Rationale 1: While percussion of the kidney does produce a dull tone, the right kidney would lie superior and to the right of the bladder, rather than in the symphysis pubis area.

Rationale 2: The bladder lies in the symphysis pubis area and percussion over a full bladder produces a dull tone.

Rationale 3: The nurse would be unable to determine presence of a bladder tumor by percussion.

Rationale 4: Air trapped in the intestines would produce tympany.

Global Rationale: Percussion over a full bladder produces a dull tone. An empty bladder sits low in the pelvic cavity behind the symphysis pubis, and would be difficult to percuss. Percussion over one of the kidneys would also produce a dull tone, but these organs lie lateral and superior to the bladder. Air trapped in the intestines would produce tympany.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.5: Describe the techniques required for assessment of the urinary system.

Question 10

Type: MCMA

A client presents with a medical diagnosis of uremia. The nurse expects to find which symptoms?

Standard Text: Select all that apply.

1. Itching

2. Weight loss

3. Altered mental status

4. Fluid retention

5. Insomnia

Correct Answer: 1,2,3,4

Rationale 1: Itching. Uremia is a classic sign of renal failure in which urea and other nitrogen-containing waste products are found in the blood. Common symptoms include itching, weight loss, altered mental status, and fluid retention. Fatigue rather than insomnia is another symptom.

Rationale 2: Weight loss. Uremia is a classic sign of renal failure in which urea and other nitrogen-containing waste products are found in the blood. Common symptoms include itching, weight loss, altered mental status, and fluid retention.

Rationale 3: Altered mental status. Uremia is a classic sign of renal failure in which urea and other nitrogen-containing waste products are found in the blood. Common symptoms include itching, weight loss, altered mental status, and fluid retention.

Rationale 4: Fluid retention. Uremia is a classic sign of renal failure in which urea and other nitrogen-containing waste products are found in the blood. Common symptoms include itching, weight loss, altered mental status, and fluid retention.

Rationale 5: Insomnia. Uremia is a classic sign of renal failure in which urea and other nitrogen-containing waste products are found in the blood. Common symptoms include itching, weight loss, altered mental status, and fluid retention. Fatigue rather than insomnia is another symptom.

Global Rationale: Uremia is a classic sign of renal failure in which urea and other nitrogen-containing waste products are found in the blood. Common symptoms include itching, weight loss, altered mental status, and fluid retention. Fatigue rather than insomnia is another symptom.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.6: Differentiate normal from abnormal findings in physical assessment of the urinary system.

Question 11

Type: MCSA

A client has a spinal cord injury with paralysis at C5 level. When completing discharge teaching, which of the following client statements would require further teaching?

1. I need to perform self-catheterization three times daily.

2. I know I cannot look to see if my bladder is full.

3. I need to avoid bladder distention.

4. Ill drink adequate amounts of liquids.

Correct Answer: 1

Rationale 1: I need to perform self-catheterization three times daily, would indicate the client needs further teaching since emptying the bladder only 3 times in 24 hours is insufficient. Dysreflexia occurs in clients with spinal cord injuries at level T7 or higher. Bladder distention causes a sympathetic response that can trigger a potentially life-threatening hypertensive crisis. It would be crucial for the client with this type of injury to avoid bladder distention by performing self-catheterization before this happens, most likely every 3 to 4 hrs.

Rationale 2: I know I cannot look to see if my bladder is full, would indicate the client understands his condition and care. By the time the client can see his abdomen expand or have a sense of bladder fullnessif able to have this sensationthe bladder would be overdistended and dysreflexia could occur. Dysreflexia occurs in clients with spinal cord injuries at level T7 or higher. Bladder distention causes a sympathetic response that can trigger a potentially life-threatening hypertensive crisis. It would be crucial for the client with this type of injury to avoid bladder distention.

Rationale 3: I need to avoid bladder distention, indicates that the client understands his condition and care. Bladder distention can lead to dysreflexia. Dysreflexia occurs in clients with spinal cord injuries at level T7 or higher. Bladder distention causes a sympathetic response that can trigger a potentially life-threatening hypertensive crisis.

Rationale 4: Ill drink adequate amounts of liquids, indicates that the client understands his condition and care. Adequate fluid intake is appropriate for the urinary system to function properly and to maintain homeostasis.

Global Rationale: Dysreflexia occurs in clients with spinal cord injuries at level T7 or higher. Bladder distention causes a sympathetic response that can trigger a potentially life-threatening hypertensive crisis. It would be crucial for the client with this type of injury to avoid bladder distention by performing self-catheterization before this happens, most likely every 3 to 4 hrs. By the time the client can see his abdomen expand or have a sense of bladder fullnessif able to have this sensationit may be too late to avoid dysreflexia. Liquids are important in maintaining the urinary system.

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.9: Apply critical thinking in selected simulations related to physical assessment of the urinary system.

Question 12

Type: HOTSPOT

The nurse is performing a urinary system assessment and wishes to percuss at the right costovertebral angle. Draw an arrow to the spot where the nurse would find this.

Screen Shot 2015-09-24 at 12.32.40 PM

Standard Text: Select the correct area on the image.

Correct Answer:

Rationale : The nurse places the right hand flat over the right costovertebral angle, then thumps the back of the right hand with the ulnar surface of the left fist. Pain or discomfort during and after blunt percussion suggests kidney disease. The client should feel no pain or tenderness with pressure or percussion, but findings must be correlated with other assessment data.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.2: Identify landmarks that guide assessment of the urinary system.

Question 13

Type: MCSA

The nurse is interviewing the parents of a toddler who state they are concerned about the childs bedwetting. The best response for the nurse in this situation is which of the following?

1. Be sure to limit the childs fluid intake during the evening.

2. Dont worry; all children wet the bed.

3. Well obtain a specimen to check for a urinary tract infection.

4. This problem will be gone at the age of 4.

Correct Answer: 1

Rationale 1: Most bedwetting ceases by the age of 4 or 5. If the parents are concerned enough to bring the problem to your attention, theyre interested in suggestions for help. Limiting fluid intake in the evening or waking the child to void are methods to address the problem.

Rationale 2: Dont worry; all children wet the bed, dismisses the parents concerns is not a therapeutic response.

Rationale 3: Obtaining a specimen to rule out a urinary tract infection may be appropriate but would have to be correlated with other symptomatology and assessment findings; therefore, this is not the best response by the nurse.

Rationale 4: While most bedwetting ceases by the age of 4 or 5, stating that This problem will be gone at the age of 4 is not a therapeutic response since the nurse cannot make this guarantee.

Global Rationale: Most bedwetting ceases by the age of 4 or 5. If the parents are concerned enough to bring the problem to your attention, theyre interested in suggestions for help. Limiting fluid intake before bedtime or waking the child to void are methods to address the problem. Dismissing their concerns is not therapeutic. Ruling out a urinary tract infection may be appropriate but would have to be correlated with other symptomatology and assessment findings.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.7: Describe developmental, psychosocial, cultural, and environmental variations in assessment techniques and findings.

Question 14

Type: MCSA

During the assessment of a client with multiple injuries, the nurse notices a large hematoma located at the left costovertebral angle. The nurse should suspect injury to which of the following organs?

1. Kidney

2. Ribs

3. Intestines

4. Bladder

Correct Answer: 1

Rationale 1: The two kidneys are located outside the peritoneal cavity and on either side of the vertebral column at the levels of T12 through L3, also termed the costovertebral angle; therefore, a hematoma in this area should alert the nurse to the possibility of injury to the kidney.

Rationale 2: The ribs encompass a larger area than just the costovertebral angle.

Rationale 3: The intestine does not lie at the costovertebral angle.

Rationale 4: The bladder does not lie at the costovertebral angle.

Global Rationale: The two kidneys are located outside the peritoneal cavity and on either side of the vertebral column at the levels of T12 through L3, also termed the costovertebral angle.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.2: Identify landmarks that guide assessment of the urinary system.

Question 15

Type: MCSA

The nurse is caring for a client admitted with an infection of the ureters. The nurse realizes this infection could include which of the following structures of the kidney?

1. Capsule

2. Cortex

3. Medulla

4. Pelvis

Correct Answer: 4

Rationale 1: The renal capsule is the tissue that surrounds the kidney. It is not directly connected to the ureter as the renal pelvis is, so infection would not be as likely to travel from the ureter to the capsule.

Rationale 2: The renal cortex is the outer portion of each kidney. The renal cortex is not directly connected to the ureter as the renal pelvis is, so infection would not be as likely to travel from the ureter to the cortex.

Rationale 3: The renal medulla is the inner portion of the kidney and is not continuous with the ureter as the renal pelvis is, so infection would not be as likely to travel from the ureter to the medulla.

Rationale 4: The renal pelvis is the funnel-shaped superior end of the ureter. Since it is continuous with the ureter, an infection in the ureter could easily travel to the renal pelvis.

Global Rationale: Since the renal pelvis is continuous with the ureter at the end of the ureter; therefore, an infection in the ureters could travel to the renal pelvis. The renal capsule, cortex, and medulla are not continuous with the ureters.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.1: Describe the anatomy and physiology of the urinary system;

Question 16

Type: MCSA

A clients blood pressure suddenly falls from 120/80 to 90/60. Which of the following is a major role of the kidney in this situation?

1. Increasing hydrostatic pressure

2. Release of renin

3. Increasing glomerular filtration rate

4. Dilation of renal vessels

Correct Answer: 2

Rationale 1: Increasing hydrostatic pressure is not a major role of the kidneys in response to a sudden decrease in system blood pressure.

Rationale 2: The kidneys produce and release the enzyme renin to assist in regulation of blood pressure. This is achieved by the drop in systemic blood pressure triggering the juxtaglomerular cells to release renin. Renin acts on angiotensinogen to release angiotensin I, which is in turn converted to angiotensin II. Angiotensin II activates vascular smooth muscle throughout the body, causing systemic blood pressure to rise.

Rationale 3: Glomerular filtration rate is a test used to check kidney function. It estimates how much blood passes through glomeruli each minute.

Rationale 4: Dilation of renal vessels is not a major role of the kidneys in response to a sudden decrease in system blood pressure.

Global Rationale: A drop in systemic blood pressure often triggers the juxtaglomerular cells to release renin. Renin acts on angiotensinogen to release angiotensin I, which is in turn converted to angiotensin II. Angiotensin II activates vascular smooth muscle throughout the body, causing systemic blood pressure to rise. Thus, the renin-angiotensin mechanism is a factor in renal autoregulation, even though its main purpose is the control of systemic blood pressure.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 20.1: Describe the anatomy and physiology of the urinary system.

Question 17

Type: MCMA

The nurse is preparing an educational session on kidney health for a church group. Which of the following would the nurse include as the leading cause of end-stage renal disease?

Standard Text: Select all that apply.

1. Diabetes mellitus

2. Alcoholism

3. Hypertension

4. Cardiovascular disease

5. Obesity

Correct Answer: 1,3

Rationale 1: Diabetes mellitus. Diabetes mellitus affects the blood vessels of the renal system and is a leading cause of end-stage renal disease.

Rationale 2: Alcoholism. Alcoholism is not a leading cause of end-stage renal disease.

Rationale 3: Hypertension. Hypertension affects the blood vessels of the renal system and is a leading cause of end-stage renal disease.

Rationale 4: Cardiovascular disease. Cardiovascular disease is not a leading cause of end-stage renal disease.

Rationale 5: Obesity. Obesity is not a leading cause of end-stage renal disease.

Global Rationale: Diabetes and hypertension increase the risk for end-stage renal disease. Alcoholism, cardiovascular disease, and obesity are not leading causes of end-stage renal disease.

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.8: Discuss the objectives of Healthy 2020 as they relate to the urinary system.

Question 18

Type: MCSA

The nurse is preparing an educational session on kidney health for a church group. Which of the following groups would the nurse note to have the highest incidence of end-stage renal disease?

1. Mexicans

2. Asians

3. African Americans

4. American Indians

Correct Answer: 3

Rationale 1: The Mexican population has a high rate of renal disease, but not as high as African Americans.

Rationale 2: The Asian population has a high rate of renal disease, but not as high as African Americans.

Rationale 3: African Americans have the highest rate of renal disease among culture and ethnic groups.

Rationale 4: American Indians have a high rate of renal disease, but not as high as African Americans.

Global Rationale: Although all the listed populations have higher rates of renal disease than whites, the occurrence of end-stage renal disease is highest in the African American group.

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.7: Describe developmental, psychosocial, cultural, and environmental variations in assessment techniques and findings.

Question 19

Type: MCSA

The nurse is obtaining a medication history on a newly admitted client with renal dysfunction. Which of the following medication classifications would the nurse note as significant for this client?

1. Antihypertensives

2. Analgesics

3. Antihyperlipidemics

4. Diuretics

Correct Answer: 2

Rationale 1: Antihypertensive medications have not been found to be directly linked to renal disease.

Rationale 2: The prolonged use of analgesics, especially over-the-counter drugs like ibuprofen and acetaminophen, has been linked with renal disease.

Rationale 3: Antihyperlipidemic medications have not been found to be directly linked to renal disease.

Rationale 4: Diuretic medications have not been found to be directly linked to renal disease.

Global Rationale: The prolonged use of analgesics, especially over-the-counter drugs like ibuprofen and acetaminophen, has been linked with renal disease.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.3: Develop questions to be used when completing the focused interview.

Question 20

Type: MCSA

A client experienced blood loss from surgery. What is the impact of this blood loss on the kidneys functioning?

1. Altered filtering ability of the kidneys

2. No impact on kidney function

3. Absorption of calcium and phosphate decreased

4. Stimulation of the kidneys to produce erythropoietin

Correct Answer: 4

Rationale 1: The kidneys would produce the hormone erythropoietin in response to a client experiencing blood loss during surgery. Erythropoietin then stimulates the bone marrow to produce red blood cells. The filtering ability of the kidneys would not be directly affected by blood lost during surgery.

Rationale 2: Blood loss does cause an impact on the kidneys. The kidneys would produce the hormone erythropoietin in response to a client experiencing blood loss during surgery. Erythropoietin then stimulates the bone marrow to produce red blood cells.

Rationale 3: The kidneys would produce the hormone erythropoietin in response to a client experiencing blood loss during surgery. Erythropoietin then stimulates the bone marrow to produce red blood cells. A decrease in the absorption of calcium and phosphate would not occur as a response to the blood loss.

Rationale 4: The kidneys would produce the hormone erythropoietin in response to a client experiencing blood loss during surgery. Erythropoietin then stimulates the bone marrow to produce red blood cells.

Global Rationale: The kidneys would produce the hormone erythropoietin in response to the blood lost during surgery. Erythropoietin then stimulates the bone marrow to produce red blood cells. Blood loss would not cause altered filtering ability, or decreased absorption of calcium and phosphate from the kidneys.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.1: Describe the anatomy and physiology of the urinary system.

Question 21

Type: MCSA

The nurse is teaching an adult client who is participating in rehabilitation for bladder retraining. Which of the following amounts of urine would cause the bladder to distend above the symphisis pubis?

1. 100 ml

2. 200 ml

3. 500 ml

4. 700 ml

Correct Answer: 4

Rationale 1: 100 ml is not enough urine to cause bladder distention. When more than 500 ml of urine is present, the bladder becomes distended and rises above the symphysis pubis.

Rationale 2: 200 ml is not enough urine to cause bladder distention. When more than 500 ml of urine is present, the bladder becomes distended and rises above the symphysis pubis.

Rationale 3: Greater than 500 ml of urine in the bladder causes the bladder to become distended and rise above the symphysis pubis.

Rationale 4: Since greater than 500 ml of urine in the bladder causes the bladder to become distended and rise above the symphysis pubis, 700 ml would cause bladder distention.

Global Rationale: When amounts larger than 500 ml are present in the adult bladder, it becomes distended and rises above the symphysis pubis. 700 ml is the only amount listed that is above 500 ml.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.2: Identify landmarks that guide assessment of the urinary system.

Question 22

Type: MCSA

The nurse is measuring the urinary output for a client and notes 450 ml of urine. The nurse would determine that this urine amounts is:

1. Decreased from normal.

2. Concentrated from what is normal.

3. Increased from normal.

4. Normal amount.

Correct Answer: 4

Rationale 1: While the size of the bladder varies slightly in adults, the adult bladder typically holds approximately 300 to 500 ml of urine; therefore, 450 ml would not be considered decreased from normal amounts.

Rationale 2: Concentrated urine refers to the degree of dilution of the urine rather than the amount.

Rationale 3: While the size of the bladder varies slightly in adults, the adult bladder typically holds approximately 300 to 500 ml of urine; therefore, 450 ml would not be considered increased from normal amounts.

Rationale 4: The adult bladder typically holds approximately 300 to 500 ml of urine, so 450 ml would be considered within the normal range of urine.

Global Rationale: The size of the bladder varies with the amount of urine it contains. In healthy adults, the bladder holds about 300 to 500 ml of urine; therefore, 450 ml would be considered a normal amount of urine. Concentration of the urine refers to the degree of dilution of the urine rather than the amount.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 20.6: Differentiate normal from abnormal findings in physical assessment of the urinary system.

Question 23

Type: MCSA

The nurse is preparing to catheterize a client after the client has just independently voided. The purpose of this catheterization would be to:

1. serve as a urine output baseline.

2. support the diagnosis of kidney stones.

3. evaluate the ability of the client to empty the bladder.

4. evaluate renal function.

Correct Answer: 3

Rationale 1: Catheterizing a client following independent voiding is a post-void residual urine test. This test is performed to evaluate the bladders ability to empty urine. Both the voided and catheterized amount should be recorded. This procedure would not indicate the clients urine output baseline.

Rationale 2: Catheterizing a client following independent voiding is a post-void residual urine test. This test is performed to evaluate the bladders ability to empty urine. Both the voided and catheterized amount should be recorded. This procedure would not be used to evaluate the client for kidney stones.

Rationale 3: Catheterizing a client following independent voiding is a post-void residual urine test. This test is performed to evaluate the bladders ability to empty urine. Both the voided and catheterized amount should be recorded.

Rationale 4: Catheterizing a client following independent voiding is a post-void residual urine test. This test is performed to evaluate the bladders ability to empty urine. Both the voided and catheterized amount should be recorded. This procedure would not be performed to evaluate renal function. Renal function would be evaluated through lab tests such as BUN and creatinine levels.

Global Rationale: This procedure is a post-voiding residual urine test. This test is performed to evaluate the bladders ability to empty urine. Both the voided and catheterized amount should be recorded. This procedure would not indicate urine output baseline, kidney stones, or renal function.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.4: Explain client preparation for assessment of the urinary system.

Question 24

Type: MCSA

A client is admitted with possible renal calculi. The client asks, Are there are any tests that can be performed to show the doctor if there are any kidney stones? The nurse would be correct in responding:

1. The intravenous pyelogram will allow the healthcare provider to visualize kidney stones.

2. A 24-hour urine specimen will allow the healthcare provider to visualize kidney stones.

3. A routine urinalysis will allow the healthcare provider to visualize kidney stones.

4. A kidney biopsy will allow the healthcare provider to visualize kidney stones.

Correct Answer: 1

Rationale 1: The intravenous pyelogram is a radiologic examination that allows visualization of renal calculi in the kidneys, ureters, and bladder.

Rationale 2: A 24-hour urine specimen would not aid in visualization of renal calculi. The 24-hour urine specimen could be used to evaluate such things as creatinine levels in the urine.

Rationale 3: A routine urinalysis would not aid in visualization of renal calculi. The routine urinalysis exams such things as specific gravity, pH, presence of bacteria, and several other factors.

Rationale 4: A kidney biopsy would not aid in visualization of renal calculi. A kidney biopsy would be performed to determine the presence of kidney diseases such as cancer.

Global Rationale: The intravenous pyelogram is a radiologic examination that allows visualization of renal calculi in the kidneys, ureters, and bladder. The other exams listed would not aid in visualization of renal calculi.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 20.4: Explain client preparation for assessment of the urinary system.

Question 25

Type: MCMA

A teenage girl visits the school nurse to ask why she is getting frequent urinary tract infections. Which of the following questions should the nurse ask the client during this visit?

Standard Text: Select all that apply.

1. Have you been eating foods that have high acidity?

2. Do you drink a lot of milk?

3. Do you take bubble baths frequently?

4. What direction do you wipe after a bowel movement?

5. Do you have a family history of urinary tract infections?

Correct Answer: 3,4

Rationale 1: Have you been eating foods that have high acidity? is not an appropriate response since foods high in acidity do not cause urinary tract infections.

Rationale 2: Do you drink a lot of milk? is not an appropriate response since the intake of milk does not cause urinary tract infections.

Rationale 3: Do you take bubble baths frequently? is an appropriate response. Frequent bubble baths have been found to cause urinary tract infections due to irritation and introduction of bacteria.

Rationale 4: What direction do you wipe after a bowel movement? is an appropriate response. Females should wipe the peri-anal/genital area from front to back. E-coli is the most common microorganism responsible for urinary tract infections and can easily be dragged into the urethral orifice by wiping from the anus to the urethra after defecation. Females do have a shorter urethra compared to males and are more susceptible to urinary tract infections for this reason.

Rationale 5: Do you have a family history of urinary tract infections? is not an appropriate response. A family history of urinary tract infections does increase an individuals risk for developing urinary tract infections.

Global Rationale: Females should wipe the peri-anal/genital area from front to back. E-coli is the most common microorganism responsible for urinary tract infections and can easily be dragged into the urethral orifice by wiping from the anus to the urethra after defecation. Females do have a shorter urethra compared to males and are more susceptible to urinary tract infections for this reason. Taking frequent bubble baths has also been found to lead to urinary tract infections in females. Eating foods high in acidity, drinking large amounts of milk, and family members with urinary tract infections does not increase the risk for urinary tract infections.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.7: Describe developmental, psychosocial, cultural, and environmental variations in assessment techniques and findings.

Question 26

Type: MCSA

A postpartum client with a difficult vaginal delivery 36 hours ago tells the nurse that she has not felt the need to void much since delivery. The nurse would respond with which of the following statements?

1. The inside of your bladder is most likely swollen, which makes you feel like you dont have to urinate.

2. You must be overdoing it with your activity level so soon after delivery.

3. I will need to catheterize you.

4. Your uterus must not be enlarged any longer.

Correct Answer: 1

Rationale 1: The inside of your bladder is most likely swollen, which makes you feel like you dont have to urinate, is an accurate response since during childbirth, the bladder mucosa may become edematous, causing decreased sensation and potential overdistention of the bladder. Bladder distention increases susceptibility to infection and other postpartum problems.

Rationale 2: You must be overdoing it with your activity level so soon after delivery, would not be an accurate response. An increase in activity level would not cause the client to have a lack of sensation to void.

Rationale 3: Immediate catheterization would not be necessary as long as the client is able to void in adequate amounts.

Rationale 4: Your uterus must not be enlarged any longer, is not an accurate response since a decrease in uterine size would not cause the client to have a decreased sensation for the need to void.

Global Rationale: During childbirth, the bladder mucosa may become edematous, causing decreased sensation and potential overdistention of the bladder, which increases susceptibility to infection and other postpartum problems. An increase in activity level would not cause the client to have a lack of sensation to void. Immediate catheterization would not be necessary as long as the client is able to void in adequate amounts. A decrease in uterine size would not cause the client to have a decreased sensation for the need to void.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 20.7: Describe developmental, psychosocial, cultural, and environmental variations in assessment techniques and findings.

Question 27

Type: MCSA

During the assessment of a clients urinary system, the nurse learns that the client has painful urination. The nurse would document this finding as:

1. Dysuria.

2. Hematuria.

3. Oliguria.

4. Polyuria.

Correct Answer: 1

Rationale 1: Dysuria is the term used for painful urination so the nurse would be correct in documenting this finding.

Rationale 2: Hematuria is the term used for blood in the urine; therefore, this term would not be used to describe painful urination.

Rationale 3: Oliguria is the term used for decreased urine output; therefore, this term would not be used to describe painful urination.

Rationale 4: Polyuria is the term used for increased urine output; therefore, this term would not be used to describe painful urination.

Global Rationale: Painful urination is termed dysuria. Hematuria is blood in the urine; oliguria is decreased urine output; polyuria is increased urine output.

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.6: Differentiate normal from abnormal findings in physical assessment of the urinary system.

Question 28

Type: MCSA

During the assessment of a clients renal system, the nurse is unable to palpate the kidneys. This nurse would consider this finding as:

1. An indication of an inflammatory condition of the kidneys.

2. A sign of acute or chronic renal disease.

3. Normal.

4. A sign of polycystic kidney disease.

Correct Answer: 3

Rationale 1: The kidneys are not normally palpable unless they are enlarged. Enlargement usually occurs as a result of a disease process affecting the kidneys.

Rationale 2: The kidneys are not normally palpable unless they are enlarged. Enlargement usually occurs as a result of a disease process affecting the kidneys. Acute or chronic renal failure would be diagnosed through other methods, such as diagnostic and laboratory testing.

Rationale 3: The nurse is correct in considering it to be normal to be unable to palpate the kidneys. Enlargement usually occurs as a result of a disease process affecting the kidneys.

Rationale 4: The kidneys are not normally palpable unless they are enlarged. Enlargement usually occurs as a result of a disease process affecting the kidneys, such as polycystic kidney disease.

Global Rationale: The kidneys are normally not palpable; therefore, the other options are not indicated by being unable to palpate the kidneys.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.6: Differentiate normal from abnormal findings in physical assessment of the urinary system.

Question 29

Type: MCSA

The nurse is able to percuss a dull tone over a clients bladder after the client has voided 300 ml of urine. The nurse would conclude which of the following is most likely the cause of this finding?

1. This is a normal finding

2. Possible urinary tract infection

3. This is a sign of prostate enlargement

4. Probable urinary retention

Correct Answer: 4

Rationale 1: This is not a normal finding as there should be little to no urine remaining in the bladder following urination. A dull percussion tone over the bladder of a client who has just urinated indicates urinary retention, and further evaluation is necessary.

Rationale 2: Little to no urine should remain in the bladder following urination. A dull percussion tone over the bladder of a client who has just urinated indicates urinary retention, and further evaluation is necessary. Urinary retention can lead to urinary tract infections, but this could not be concluded without additional testing.

Rationale 3: Little to no urine should remain in the bladder following urination. A dull percussion tone over the bladder of a client who has just urinated indicates urinary retention, and further evaluation is necessary Prostate enlargement usually affects the clients ability to start the urine flow and maintain a strong urine flow, so urinary retention would not indicate this condition.

Rationale 4: Little to no urine should remain in the bladder following urination. A dull percussion tone over the bladder of a client who has just urinated indicates urinary retention, and further evaluation is necessary.

Global Rationale: This is not a normal finding as there should be little to no urine remaining in the bladder following urination. A dull percussion tone over the bladder of a client who has just urinated indicates urinary retention, and further evaluation is necessary. Urinary retention can lead to urinary tract infections, but this could not be concluded without additional testing. Prostate enlargement usually affects the clients ability to start the urine flow and maintain a strong urine flow, so urinary retention would not indicate this condition.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.6: Differentiate normal from abnormal findings in physical assessment of the urinary system.

Question 30

Type: MCSA

An elderly female comes into the clinic to be seen for urinary incontinence. The nurse recognizes that this problem:

1. Is common with aging.

2. Often occurs as a secondary problem.

3. Indicates decreased renal blood flow.

4. Is related to medications.

Correct Answer: 2

Rationale 1: Aging does not necessarily cause urinary incontinence.

Rationale 2: Urinary incontinence is often secondary to another problem such as urinary tract infections or difficulty getting to the bathroom due to mobility issues.

Rationale 3: Urinary incontinence is not related to renal blood flow. Renal blood flow may affect the amount of urine produced by the kidneys.

Rationale 4: Medications do not typically cause urinary incontinence; rather, medications may be given to treat urinary some types of urinary incontinence.

Global Rationale: Urinary incontinence is not a normal sign of aging and therefore should be evaluated further for this client.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 20.6: Differentiate normal from abnormal findings in physical assessment of the urinary system.

Question 31

Type: MCMA

The nurse is preparing a client for assessment of the urinary system. The nurse would include which of the following assessment techniques in this examination?

Standard Text: Select all that apply.

1. Inspection

2. Palpation

3. Percussion

4. Auscultation

5. Client interview

Correct Answer: 1,2,3,4,5

Rationale 1: Inspection. The nurse uses each of the listed techniques in assessment of the urinary system. Inspection would be used for assessing factors such as the appearance of the urine.

Rationale 2: Palpation. The nurse uses each of the listed techniques in assessment of the urinary system. Palpation would include assessing factors such as bladder distention; percussion is used to determine factors such as the presence of urine in the bladder.

Rationale 3: Percussion. The nurse uses each of the listed techniques in assessment of the urinary system. Inspection would be used for assessing factors such as the appearance of the urine. Percussion is used to determine factors such as the presence of urine in the bladder.

Rationale 4: Auscultation. The nurse uses each of the listed techniques in assessment of the urinary system. Auscultation would be used in assessment of the renal arteries.

Rationale 5: Client interview. The nurse uses each of the listed techniques in assessment of the urinary system. The client interview provides important information regarding the overall urinary history of the client.

Global Rationale: The nurse uses each of the listed techniques in assessment of the urinary system. Inspection would be used for assessing factors such as the appearance of the urine; palpation would include assessing factors such as bladder distention; percussion is used to determine factors such as the presence of urine in the bladder; auscultation would be used in assessment of the renal arteries; and the client interview provides important information regarding the overall urinary history of the client.

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.4: Explain client preparation for assessment of the urinary system.

Question 32

Type: MCSA

The nurse is assessing a client after a motor vehicle accident and notes the presence of ecchymosis in the left flank area. The nurse would interpret this finding as which of the following?

1. Positive Grey Turners sign

2. Costovertebral angle tenderness

3. Possible clotting dysfunction

4. A precursor to hematuria

Correct Answer: 1

Rationale 1: The presence of ecchymosis in the flank area is a positive Grey Turners sign and must be correlated to signs of trauma such as blunt penetrating wounds or lacerations.

Rationale 2: Tenderness in the costovertebral angle is a symptom the client would voice if present; ecchymosis in this area does not necessarily indicate tenderness. The presence of ecchymosis in the flank area is a positive Grey Turners sign and must be correlated to signs of trauma such as blunt penetrating wounds or lacerations.

Rationale 3: A clotting problem could cause bruising, but bruising in this specific area would be more indicative of a positive Grey Turners sign.

Rationale 4: Hematuria is not necessarily going to occur as a result of the findings. The presence of ecchymosis in the flank area is a positive Grey Turners sign and must be correlated to signs of trauma such as blunt penetrating wounds or lacerations

Global Rationale: The presence of ecchymosis in the flank area is a positive Grey Turners sign and must be correlated to signs of trauma such as blunt penetrating wounds or lacerations. Tenderness in the costovertebral angle is a symptom the client would voice if present; ecchymosis in this area does not necessarily indicate tenderness. A clotting problem could cause bruising, but bruising in this specific area would be more indicative of a positive Grey Turners sign. Hematuria is not necessarily going to occur as a result of the findings.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 20.6: Differentiate normal from abnormal findings in physical assessment of the urinary system.

Question 33

Type: MCSA

The nurse is interviewing a client who states the presence of urinary incontinence with coughing and sneezing. The nurse would correctly document this type of incontinence as which of the following?

1. Functional

2. Reflex

3. Stress

4. Urge

Correct Answer: 3

Rationale 1: This documentation would be incorrect as functional incontinence results when there is an inability to reach the toilet in time. The symptoms reported indicate stress incontinence.

Rationale 2: This documentation would be incorrect as reflex incontinence occurs with spinal cord damage. The symptoms reported indicate stress incontinence.

Rationale 3: This documentation would be correct. Stress incontinence is involuntary urination occurring with coughing, sneezing, or straining. Stress incontinence and be either partial or complete leakage of urine form the bladder.

Rationale 4: This documentation would be incorrect as urge incontinence may be due to excessive intake of fluids, diminished bladder capacity, or urinary tract infection.

Global Rationale: Stress incontinence is involuntary urination occurring with coughing, sneezing, or straining. Stress incontinence and be either partial or complete leakage of urine form the bladder. Functional incontinence results when there is an inability to reach the toilet in time; reflex incontinence occurs with spinal cord damage; and urge incontinence may be due to excessive intake of fluids, diminished bladder capacity, or urinary tract infection.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.7: Describe developmental, psychosocial, cultural, and environmental variations in assessment techniques and findings.

Question 34

Type: HOTSPOT

Draw an arrow to the structure in the kidney that is made up of pyramids and calyces, whose function is to collect urine and transport it into the renal pelvis.

Standard Text: Select the correct area on the image.

Correct Answer:

Rationale : The renal medulla is composed of structures called pyramids and calyces. The pyramids are wedge like structures made up of bundles of urine-collecting tubules. At their apex, the pyramids have papillae that are enclosed by cuplike structures called calyces. The calyces collect urine and transport it into the renal pelvis, which is the funnel-shaped superior end of the ureter.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 20.1: Describe the anatomy and physiology of the urinary system.

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