Chapter 34: The Urinary System My Nursing Test Banks

Chapter 34: The Urinary System

MULTIPLE CHOICE

1. An 85-year-old patient was held NPO since midnight last night for diagnostic testing. The procedure is now complete at 10:00 AM. The nurse should:

a.

check urine for concentration every hour.

b.

measure urine output every 2 hours.

c.

assess urine for the presence of glucose.

d.

offer 4 ounces of water or juice every hour.

ANS: D

Offering small amounts of fluid every hour will rehydrate the older adult without resorting to IV fluids. The older adult has very little fluid reserve and has lost the ability to concentrate the urine; consequently, a long period without fluid intake can cause dehydration.

DIF: Cognitive Level: Application REF: 768 OBJ: 1 (clinical)

TOP: Dehydration in the Older Adult KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. The nurse cautions the diabetic patient that ultimately the disease will affect the blood flow through the kidney due to:

a.

long-term high glucose levels.

b.

scleroses of renal vessels.

c.

arterial spasm.

d.

long-term insulin use.

ANS: B

The long-term effect of diabetes is generalized vasoconstriction, which leads many diabetic patients to renal insufficiency and renal failure.

DIF: Cognitive Level: Application REF: 782 OBJ: 2 (theory)

TOP: Renal Insufficiency Related to Diabetes Mellitus

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse explains that when the kidney suffers an autoimmune inflammatory reaction, the glomeruli lose their ability to function effectively, which leads to:

a.

glomerulonephritis.

b.

reduced urinary output.

c.

nephrosis.

d.

nephrotoxicity.

ANS: A

Glomerulonephritis occurs when the inflammatory process alters the effectiveness of the semipermeable membrane in the glomeruli.

DIF: Cognitive Level: Comprehension REF: 766 OBJ: 2 (theory)

TOP: Glomerulonephritis: Etiology KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. The nurse understands that most often tumors occur in the bladder because the bladder wall is exposed most frequently to:

a.

retained carcinogens.

b.

concentrated urine.

c.

acidic fluids.

d.

strong metabolic wastes.

ANS: A

Retained carcinogenic agents stay in intimate contact with the bladder wall until excreted in the urine.

DIF: Cognitive Level: Comprehension REF: 767 OBJ: 2 (theory)

TOP: Bladder Cancer Related to Retained Carcinogens

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. When the patient asks why he has so many urinary tract infections (UTIs), the nurse points out that UTIs can result from:

a.

bacteria that have colonized in the kidney.

b.

viral infections generating debris in the bladder.

c.

carelessness in handwashing.

d.

spicy foods irritating the bladder wall.

ANS: A

The urinary tract is very vulnerable to bacterial infection. In the high volume of blood that is filtered by the kidney, there are some bacteria. These bacteria can colonize the kidney, causing an infection. Also, bacteria can easily enter the urinary tract through the urethra, and then the infection may spread up into the kidneys.

DIF: Cognitive Level: Comprehension REF: 766 OBJ: 2 (theory)

TOP: UTI: Etiology KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

6. The nurse clarifies that nephrotoxic drugs such as doxycycline and rifampin can cause kidney damage by:

a.

bacterial destruction of the nephrons.

b.

chemical alterations of glomeruli.

c.

necrosis of tubules from reduction of oxygenation.

d.

clumping of cellular debris from killed bacteria.

ANS: B

Nephrotoxic drugs may chemically alter the glomeruli, which make them ineffective.

DIF: Cognitive Level: Application REF: 767 OBJ: 2 (theory)

TOP: Nephrotoxicity KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

7. The nurse recommends that, in order to keep optimum flow through the urinary system, a person should have a minimum intake of _____ mL/day.

a.

1000 to 1500

b.

2000 to 2500

c.

3000 to 3500

d.

4000 to 4500

ANS: B

Intake of a minimum of 2000 mL/day is adequate to maintain optimal flow through the urinary system.

DIF: Cognitive Level: Comprehension REF: 767 OBJ: 3 (theory)

TOP: Optimum Fluid Intake KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. When a patient is put on a sulfa drug, the nurse adds interventions to the nursing care plan to increase the daily fluid intake to a minimum of _____ mL/day.

a.

1500

b.

2000

c.

2500

d.

3000

ANS: D

While on nephrotoxic drugs, a fluid intake of 3000 to 3500 mL/day is recommended.

DIF: Cognitive Level: Comprehension REF: 767 OBJ: 3 (theory)

TOP: Sulfa Drugs: Increased Fluid Intake

KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

9. The nurse reviewing laboratory reports on kidney function identifies a result that suggests decreased renal function, which is:

a.

blood urea nitrogen (BUN), 10.5 mg/dL.

b.

creatinine, 0.6 mg/dL.

c.

BUN, 15 mg/dL.

d.

creatinine, 2.0 mg/dL.

ANS: D

The normal for BUN is 10 to 20 mg/dL. The normal for creatinine is 0.6 to 1.2 mg/dL. The creatinine is elevated.

DIF: Cognitive Level: Application REF: 767 | 769 OBJ: 3 (theory)

TOP: Serum Reports: BUN and Creatinine

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. A patient is scheduled to have a cystometrography performed. Which statement by the patient indicates an understanding of the planned test?

a.

The test will measure my urine flow volume and muscle function.

b.

The test will measure my renal clearance and urinary volume.

c.

The test will evaluate the amount of particulate matter in my urine.

d.

The test will monitor the time it takes for an injected dye to appear in my urine.

ANS: A

Cystometrography measures the urine flow and the muscles that control the flow.

DIF: Cognitive Level: Application REF: 772 OBJ: 1 (clinical)

TOP: Cystometrography: Purpose KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

11. The nurse is caring for a woman suspected of having a vaginal fistula. Which finding will support the proposed diagnosis?

a.

Pneumaturia

b.

Hematuria

c.

Oliguria

d.

Dysuria

ANS: A

Gas in the urine (pneumaturia) is a cardinal sign of a vaginal fistula.

DIF: Cognitive Level: Comprehension REF: 773 OBJ: 2 (clinical)

TOP: Vaginal Fistula: Pneumaturia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

12. When the patient reports he has blood in his urine the moment he starts to void that disappears until the next time he voids, the nurse is aware that the source of the bleeding is most probably:

a.

in the kidney.

b.

above the neck of the bladder.

c.

in the neck of the bladder.

d.

in the urethra.

ANS: D

Hematuria that begins at the initiation of the stream, then abates, is usually in the urethra. Bleeding from the neck of the bladder will appear at the end of the voiding. Bleeding from above the neck of the bladder will be present all the time.

DIF: Cognitive Level: Application REF: 773 OBJ: 3 (clinical)

TOP: Hematuria: Location KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

13. The nurse is collecting data from a patient who complains of having urinary frequency. When reviewing the patients health history, the nurse would be prompted to inquire about the patients intake of:

a.

red meat.

b.

caffeine.

c.

over-the-counter cold remedies.

d.

tomato juice.

ANS: B

Excitement, anxiety, and fear can produce increased frequency of urination. Caffeine and other diuretics found in foods and drinks and an increased intake of fluid can increase the number of times a person must urinate.

DIF: Cognitive Level: Application REF: 774 OBJ: 2 (theory)

TOP: Urinary Frequency: Cause KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

14. The student nurse is attempting to irrigate an indwelling catheter. Which action by the student nurse best indicates an understanding of the correct procedure to employ?

a.

The student nurse uses steady gentle pressure.

b.

The student nurse forces solution into the catheter to remove the obstruction.

c.

The student nurse pulls back on the plunger if fluid will not enter the catheter.

d.

The student nurse counts the amount of irrigation fluid as output.

ANS: A

When irrigating, use the correct amount of sterile solution (according to agency policy, or the amount of solution that may be determined by physicians order for nephrostomy tubes, ureteral tubes, or catheters). When irrigating, use a steady, gentle stream to irrigate. Avoid exerting pressure that may traumatize or cause discomfort. Do not pull back forcefully on an irrigating syringe attached to a urinary catheter or tube as this creates negative pressure that may damage delicate tissues. The amount of irrigation fluid is counted as intake, not output.

DIF: Cognitive Level: Application REF: 776 OBJ: 3 (clinical)

TOP: Irrigation of Indwelling Catheter KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

15. The patient confides that sneezing makes her wet her pants. The nurse recognizes that this is a cardinal sign of ______ incontinence.

a.

urge

b.

stress

c.

functional

d.

overflow

ANS: B

Stress incontinence occurs when the urethral sphincter fails and there is an increase in intra-abdominal pressure, caused by such things as sneezing, laughing, coughing, or aerobic exercise. Urge incontinence is the involuntary loss of urine when there is a strong urge to urinate (urinary urgency). Functional incontinence is caused by cognitive inability to recognize the urge to urinate or self-care deficit caused by extreme depression. Inability to reach the bathroom due to restraints, side rails, or an out-of-reach walker can also result in functional incontinence. Overflow incontinence occurs when there is poor contractility of the detrusor muscle or obstruction of the urethra, as in prostate hypertrophy in the male or genital prolapse or abnormality in the female.

DIF: Cognitive Level: Comprehension REF: 777 OBJ: 4 (theory)

TOP: Incontinence: Stress KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

16. A frustrated patient reports that, after two surgeries to correct incontinence, she is still involuntarily voiding. Which suggestion by the nurse would be most helpful to the patient at this time?

a.

Wear heavy pads.

b.

Keep a voiding diary.

c.

Acquire an indwelling catheter.

d.

Attempt to void every hour.

ANS: B

Keeping a voiding diary identifies involuntary voiding times that can be averted by using the toilet just before the identified times and using the diary to set up a voiding schedule.

DIF: Cognitive Level: Application REF: 777 OBJ: 4 (clinical)

TOP: Incontinence: Voiding Diary KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

17. In instructing the patient in the use of vaginal weight training, the nurse coaches the patient to insert the smallest of the cones in the vagina and:

a.

wear it all day.

b.

perform 10 Kegel exercises and remove it, repeating this exercise three times a day.

c.

hold it in place with muscle tightening for 15 minutes and remove it.

d.

attempt to expel it with vaginal muscle tightening.

ANS: C

Vaginal weight training is done with a set of five small, cone-shaped weights that are used along with pelvic muscle exercise as a therapeutic option for incontinence. The lightest cone, which has a string attached, is inserted into the vagina and held in place by muscle tightening for 15 minutes twice a day. When there is no problem holding this cone in place, the next heaviest cone is used. This continues until the heaviest cone can be held in place for the 15-minute period.

DIF: Cognitive Level: Comprehension REF: 779 OBJ: 4 (clinical)

TOP: Incontinence: Vaginal Weight Training

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

18. A patient has just returned to the nursing unit after having a renal biopsy. When planning the patients care, which instruction will most likely be included?

a.

The patient will remain NPO for the first 4 hours after the procedure.

b.

Any postprocedure hematuria should be reported to the primary care provider.

c.

Hematuria in the days following the procedure is expected.

d.

The patient should remain flat in bed for at least 6 hours after the procedure.

ANS: D

Postprocedure care for the patient who has undergone a renal biopsy will include activity limitations. The patient must lie on the back for 6 to 24 hours (time varies according to facility protocols and physician orders), avoid activities that increase abdominal pressure (e.g., sneezing, laughing), and expect that urine will have blood for the first 24 hours. Oral intake is encouraged. The patient should drink 3000 mL of fluid to flush the urinary system (unless otherwise contraindicated). Once home, the patient should report fever, dysuria, and malaise.

DIF: Cognitive Level: Application REF: 768 OBJ: 1 (clinical)

TOP: Patient Teaching: Renal Biopsy KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

19. The nurse is caring for a patient who recently had abdominal surgery. When evaluating the patients output, the nurse correctly recognizes that urinary output less than ________ mL/hr is considered inadequate.

a.

15

b.

20

c.

25

d.

30

ANS: D

An important nursing intervention is to assess for decreasing urinary function. Urine output should be at least 30 mL/hr.

DIF: Cognitive Level: Comprehension REF: 777 OBJ: 2 (clinical)

TOP: Measuring Intake and Output KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

20. A patient has had diagnostic tests to assess uric acid levels. The tests reveal that levels are elevated. The nurse should consider the patients intake of what to potentially explain excessive levels?

a.

Protein

b.

Calcium

c.

Leafy green vegetables

d.

Glucose

ANS: A

Uric acid elevations are associated with increased dietary intake of purine-containing foods. Sources of purines include beef and liver.

DIF: Cognitive Level: Application REF: 769 OBJ: 1 (clinical)

TOP: Diagnostic Tests for Urologic Disorders

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

MULTIPLE RESPONSE

21. The nurse lists the functions of the kidney, which include: (Select all that apply.)

a.

regulation of electrolytes.

b.

elimination of metabolic waste.

c.

regulation of fluid volume.

d.

regulation of blood pressure.

e.

secretion of erythropoietin.

ANS: A, B, C, D, E

All the options listed are functions of the kidney.

DIF: Cognitive Level: Comprehension REF: 765 OBJ: 1 (theory)

TOP: Kidney Function KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. The nurse outlines the age-related changes that occur in the urinary system, which include: (Select all that apply.)

a.

hypertrophy of the prostate.

b.

decrease in secretion of renin.

c.

decrease in muscle tone of bladder.

d.

enlargement of bladder.

e.

increase in ability to concentrate urine.

ANS: A, B, C

As the urinary system ages, the bladder size shrinks and the kidney loses its ability to concentrate urine.

DIF: Cognitive Level: Comprehension REF: 766 OBJ: 2 (theory)

TOP: Age-Related Changes in the Urinary System

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. The nurse is discussing bladder health with a patient. During the discussion, the nurse has emphasized the need to void in a timely manner. Which statement by a patient indicates understanding of the rationale behind the recommendations? (Select all that apply.)

a.

Urinating regularly will prevent prolonged exposure of the bladder wall to harmful wastes.

b.

Allowing my bladder to overfill causes the walls to overstretch.

c.

A full bladder can cause undue strain on the urinary sphincters.

d.

The characteristics of urine can change after being in the bladder for overly extended periods.

e.

Pressure from a distended bladder can cause excessive pressure on my colon.

ANS: A, B, C

Urine does not change character in the bladder and does not press on the colon.

DIF: Cognitive Level: Comprehension REF: 767 OBJ: 2 (theory)

TOP: Encouraging Voiding Frequency KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

24. While caring for a patient with an indwelling catheter, the nurse will include in the daily care the interventions of: (Select all that apply.)

a.

observing tube placement and level of urine in collection bag.

b.

keeping the drainage bag below the level of the bed.

c.

avoiding patient ambulating with the catheter collection bag.

d.

cutting off the balloon arm when discontinuing the catheter.

e.

cleaning the meatus and catheter with soap and water.

ANS: A, B, E

The balloon arm should not be cut off, but emptied by the use of a syringe. Patients with indwelling catheters can be ambulated as long as the bag is below the insertion site of the catheter.

DIF: Cognitive Level: Application REF: 776 OBJ: 3 (clinical)

TOP: Catheter Care KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

25. When the patient complains of urinary retention, the nurse can help the patient to void by: (Select all that apply.)

a.

accompanying the patient to the toilet.

b.

offering caffeine or carbonated drinks.

c.

providing a warm bath.

d.

instructing in the double void technique.

e.

running water in the lavatory to stimulate urination.

ANS: B, C, D, E

All options except accompanying the patient to the toilet are acceptable interventions to assist a patient to void. The patient should be given privacy and adequate time to void.

DIF: Cognitive Level: Application REF: 782 OBJ: 3 (theory)

TOP: Urine Retention: Techniques to Relieve

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

COMPLETION

26. The basic functional unit of the kidney is the ________.

ANS:

nephron

The nephron is the functional unit of the kidney, housing the glomerulus and the collecting tubules. Each kidney has approximately 1 million nephrons.

DIF: Cognitive Level: Knowledge REF: 765 OBJ: 1 (theory)

TOP: Nephron: Definition KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

27. The nurse explains that the urge to void occurs when the bladder contain as little as ______ mL of urine.

ANS:

150

The bladder will transmit the urge to void with a bladder content as little as 150 mL of urine.

DIF: Cognitive Level: Knowledge REF: 766 OBJ: 3 (theory)

TOP: Voiding: Urge KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MATCHING

In order to communicate with the patient more effectively, the nurse clarifies the meanings of some urological terms. Match these terms with their correct definitions.

a.

Anuria

b.

Oliguria

c.

Polyuria

d.

Nocturia

e.

Hematuria

28. Diminished urine

29. Blood in the urine

30. Urination at night

31. High urinary output

32. Absence of urine

28. ANS: B DIF: Cognitive Level: Knowledge REF: 775

OBJ: 1 (theory) TOP: Definitions of Terms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

29. ANS: E DIF: Cognitive Level: Knowledge REF: 773

OBJ: 1 (theory) TOP: Definitions of Terms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

30. ANS: D DIF: Cognitive Level: Knowledge REF: 775

OBJ: 1 (theory) TOP: Definitions of Terms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

31. ANS: C DIF: Cognitive Level: Knowledge REF: 775

OBJ: 1 (theory) TOP: Definitions of Terms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

32. ANS: A DIF: Cognitive Level: Knowledge REF: 775

OBJ: 1 (theory) TOP: Definitions of Terms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

Leave a Reply