Chapter 45: Nursing Assessment: Urinary System My Nursing Test Banks

Lewis: Medical-Surgical Nursing, 8th Edition

Chapter 45: Nursing Assessment: Urinary System

Test Bank

MULTIPLE CHOICE

1. When reading a patients chart, the nurse notes that the patient has dysuria. To assess whether there is any improvement, which question will the nurse ask?

a.

Do you have any blood in your urine?

b.

Do you have to urinate very frequently?

c.

Do you have any pain when you urinate?

d.

Do you have to get up at night to urinate?

ANS: C

Dysuria is painful urination. The alternate responses are used to assess other urinary tract symptoms: hematuria, nocturia, and frequency.

DIF: Cognitive Level: Application REF: 1113

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

2. A patients urine dipstick indicates a small amount of protein in the urine. The next action by the nurse should be to

a.

check which medications the patient is currently taking.

b.

obtain a clean-catch urine for culture and sensitivity testing.

c.

ask the patient about any family history of chronic renal failure.

d.

send a urine specimen to the laboratory to test for ketones and glucose.

ANS: A

Normally the urinalysis will show zero to trace amounts of protein, but some medications may give false-positive readings. The other actions by the nurse may be appropriate, but checking for medications that may affect the dipstick accuracy should be done first.

DIF: Cognitive Level: Application REF: 1114

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

3. A creatinine clearance test is ordered for a hospitalized patient with possible renal insufficiency. Which equipment will the nurse need to obtain?

a.

Sterile specimen cup

b.

Large container for urine

c.

Foley catheter and drainage bag

d.

Towelettes for perineal cleaning

ANS: B

Since creatinine clearance testing involves a 24-hour urine specimen, the nurse should obtain a large container for the urine collection. Catheterization, cleaning of the perineum with antiseptic towelettes, and a sterile specimen cup are not needed for this test.

DIF: Cognitive Level: Application REF: 1114

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

4. A 26-year-old patient who is employed as a hairdresser and has a 10 pack-year history of cigarette smoking is scheduled for an annual physical examination. The nurse will plan to teach the patient about the increased risk for

a.

renal failure.

b.

kidney stones.

c.

pyelonephritis.

d.

bladder cancer.

ANS: D

Exposure to the chemicals involved with working as a hairdresser and in smoking both increase the risk of bladder cancer, and the nurse should assess whether the patient understands this risk. The patient is not at increased risk for renal failure, pyelonephritis, or kidney stones.

DIF: Cognitive Level: Application REF: 1110-1111 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

5. During assessment of a patient with decreased renal function, which of these medications taken by the patient at home will be of most concern to the nurse?

a.

ibuprofen (Motrin)

b.

warfarin (Coumadin)

c.

folic acid (vitamin B9)

d.

penicillin (Bicillin LA)

ANS: A

The nonsteroidal anti-inflammatory medications (NSAIDs) are nephrotoxic and should be avoided in patients with impaired renal function. The nurse also should ask about reasons the patient is taking the other medications, but the medication of most concern is the ibuprofen.

DIF: Cognitive Level: Application REF: 1109

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

6. An 82-year-old man has been admitted with benign prostatic hyperplasia. Which of the following is most appropriate to include in the nursing plan of care?

a.

Limit fluid intake to no more than 1500 mL/day.

b.

Leave a light on in the bathroom during the night.

c.

Pad the patients bed to accommodate overflow incontinence.

d.

Ask the patient to use a urinal so that all urine can be measured.

ANS: B

The patients age and diagnosis indicate a likelihood of nocturia, so leaving the light on in the bathroom is appropriate. Fluids should be encouraged because dehydration is more common in older patients. The information in the question does not indicate that measurement of the patients output is necessary or that the patient has overflow incontinence.

DIF: Cognitive Level: Application REF: 1109 | 1111-1112

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

7. While assessing a patients urinary system, the nurse cannot palpate either kidney. Which action should the nurse take next?

a.

Obtain a urine specimen to check for hematuria.

b.

Document the information on the assessment form.

c.

Ask the patient about any history of recent sore throat.

d.

Ask the health care provider about scheduling a renal ultrasound.

ANS: B

The kidneys are protected by the abdominal organs, ribs, and muscles of the back and may not be palpable under normal circumstances, so no action except to document the assessment information is needed. Asking about a recent sore throat, checking for hematuria, or obtaining a renal ultrasound may be appropriate when assessing for renal problems for some patients, but there is nothing in the question stem to indicate that they are appropriate for this patient.

DIF: Cognitive Level: Application REF: 1112

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

8. How will the nurse assess the flank area of a patient with pyelonephritis for tenderness?

a.

Push gently into the two lowest intercostal spaces.

b.

Palpate along both sides of the lumbar vertebral column.

c.

Position one hand flat at the costovertebral angle (CVA) and strike it with the other fist.

d.

Use two fingers to percuss the area between the iliac crest and ribs along the midaxillary line.

ANS: C

Checking for flank pain is best performed by percussion of the CVA and asking about pain. The other techniques would not assess for flank pain.

DIF: Cognitive Level: Comprehension REF: 1111-1112

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

9. The result of a patients creatinine clearance test is 60 mL/min. The nurse equates this finding to a glomerular filtration rate (GFR) of _____ mL/min.

a.

30

b.

60

c.

120

d.

240

ANS: B

The creatinine clearance approximates the GFR. The other responses are not accurate.

DIF: Cognitive Level: Comprehension REF: 1105-1106 | 1120

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

10. The nurse uses auscultation during assessment of the urinary system to

a.

check for ureteral peristalsis.

b.

assess for bladder distention.

c.

identify renal artery or aortic bruits.

d.

determine the position of the kidneys.

ANS: C

The presence of a bruit may indicate problems such as renal artery tortuosity or abdominal aortic aneurysm. Auscultation would not be helpful in assessing for the other listed urinary tract information.

DIF: Cognitive Level: Comprehension REF: 1112-1113

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

11. A patient who is scheduled for an intravenous pyelogram (IVP) gives the nurse the following information. Which information has the most immediate implications for the patients care?

a.

The patient describes allergies to shellfish and penicillin.

b.

The patient has not had anything to eat or drink for 8 hours.

c.

The patient complains of costovertebral angle (CVA) tenderness.

d.

The patient used a bisacodyl (Dulcolax) tablet the previous night.

ANS: A

Iodine-based contrast dye is used during IVP and for many computed tomography (CT) scans. The nurse will need to notify the health care provider before the procedures so that the patient can receive medications such as antihistamines or corticosteroids before the procedures are started. The other information also is important to note and document but does not have immediate implications for the patients care during the procedures.

DIF: Cognitive Level: Application REF: 1115-1116

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

12. When teaching a patient scheduled for a cystogram via a cystoscope about the procedure, the nurse tells the patient,

a.

Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidney.

b.

Your doctor will place a catheter into an artery in your groin and inject a dye that will visualize the blood supply to the kidneys.

c.

Your doctor will inject a radioactive solution into a vein in your arm and the distribution of the isotope in your kidneys and bladder will be checked.

d.

Your doctor will insert a lighted tube into the bladder through your urethra, inspect the bladder, and instill a dye that will outline your bladder on x-ray.

ANS: D

In a cystoscope and cystogram procedure, a cystoscope is inserted into the bladder for direct visualization, and then contrast solution is injected through the scope so that x-rays can be taken. The response beginning, Your doctor will place a catheter describes a renal arteriogram procedure. The response beginning, Your doctor will inject a radioactive solution describes a nuclear scan. The response beginning, Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted describes a retrograde pyelogram.

DIF: Cognitive Level: Application REF: 1116-1117

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

13. The nurse informs the patient undergoing cystoscopy that following the procedure, the patient

a.

will be NPO for 8 hours to prevent nausea and vomiting.

b.

is expected to be on strict bed rest for about 4 to 6 hours.

c.

should ask for the ordered narcotics as necessary for pain.

d.

may experience blood-tinged urine and urinary frequency.

ANS: D

Pink-tinged urine and urinary frequency are expected after cystoscopy. Burning on urination is common, but pain that requires opioids for relief is not expected. A good fluid intake is encouraged after this procedure. Bed rest is not required following cystoscopy.

DIF: Cognitive Level: Application REF: 1117

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

14. A patient with an elevated blood urea nitrogen (BUN) and serum creatinine is scheduled for a renal arteriogram. The nurse should question an order from radiology for bowel preparation with the use of

a.

a Fleet enema.

b.

a tap-water enema.

c.

bisacodyl (Dulcolax) tablets.

d.

senna/docusate (Sennakot-S).

ANS: A

High-phosphate enemas, such as Fleet enemas, should be avoided in patients with elevated BUN and creatinine because phosphate cannot be excreted by patients with renal failure. The other medications for bowel evacuation are more appropriate.

DIF: Cognitive Level: Application REF: 1114 | 1119

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

15. The health care provider orders a clean-catch urine specimen for culture and sensitivity testing for a patient with a suspected urinary tract infection (UTI). To obtain the specimen, the nurse will plan to

a.

teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup.

b.

have the patient empty the bladder completely, and then obtain the next urine specimen that the patient is able to void.

c.

insert a short, small mini catheter attached to a collecting container into the urethra and bladder to obtain the specimen.

d.

clean the area around the meatus with a povidone-iodine (Betadine) swab, and then have the patient void into a sterile container.

ANS: A

This answer describes the technique for obtaining a clean-catch specimen. The answer beginning, insert a short, small, mini catheter attached to a collecting container describes a technique that would result in a sterile specimen, but a health care providers order for a catheterized specimen would be required. Using Betadine before obtaining the specimen is not necessary and might result in suppressing the growth of some bacteria. And the technique described in the answer beginning have the patient empty the bladder completely would not result in a sterile specimen.

DIF: Cognitive Level: Application REF: 1114

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

16. A hospitalized patient with a decreased glomerular filtration rate is scheduled to have an intravenous pyelogram (IVP). Which action will be included in the plan of care?

a.

Monitor the urine output after the procedure.

b.

Assist with monitored anesthesia care (MAC).

c.

Give oral contrast solution before the procedure.

d.

Insert a large size urinary catheter before the IVP.

ANS: A

Patients with impaired renal function are at risk for decreased renal function after IVP because the contrast medium used is nephrotoxic, so the nurse should monitor the patients urine output. MAC sedation and retention catheterization are not required for the procedure. The contrast medium is given intravenously, not orally.

DIF: Cognitive Level: Application REF: 1115-1116 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

17. A patient with diabetic nephropathy is admitted for a right renal biopsy. Immediately after the biopsy, which of these is an essential nursing action?

a.

Monitor the blood urea nitrogen (BUN) and creatinine to assess renal function.

b.

Check blood glucose to assess for hyperglycemia or hypoglycemia.

c.

Insert a straight catheter to check for gross or microscopic hematuria.

d.

Apply a pressure dressing and keep the patient on the affected side for 30 to 60 minutes.

ANS: D

A pressure dressing is applied and the patient is kept on the affected side for 30 to 60 minutes

to put pressure on the biopsy side and decrease the risk for bleeding. The blood glucose and BUN/creatinine will not be affected by the biopsy. Although monitoring for hematuria is needed, there is no need for catheterization.

DIF: Cognitive Level: Application REF: 1118

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

18. A patient with a possible urinary tract infection (UTI) gives the nurse in the clinic a urine specimen that is a red-orange color. Which action should the nurse take first?

a.

Notify the patients health care provider.

b.

Ask the patient about use of any medications.

c.

Question the patient about any UTI risk factors.

d.

Teach about the correct procedure for midstream urine collection.

ANS: B

A red-orange color in the urine is normal with some over-the-counter (OTC) medications such as phenazopyridine (Pyridium). The color would not be expected with urinary tract infection, is not a sign that poor technique was used in obtaining the specimen, and does not need to be communicated to the health care provider until further assessment is done.

DIF: Cognitive Level: Application REF: 1119

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

19. Which of the following actions will the nurse plan to take first when admitting a patient who has a history of neurogenic bladder as a result of a spinal cord injury?

a.

Ask about the usual urinary pattern and any measures used for bladder control.

b.

Assist the patient to the toilet at scheduled times to help ensure bladder emptying.

c.

Check the patient for urinary incontinence every 2 hours to maintain skin integrity.

d.

Use intermittent catheterization on a regular schedule to avoid the risk of infection.

ANS: A

Before planning any interventions, the nurse should complete the assessment and determine the patients normal bladder pattern and the usual measures used by the patient at home. All the other responses may be appropriate, but until the assessment is complete, an individualized plan for the patient cannot be developed.

DIF: Cognitive Level: Application REF: 1109-1112

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

20. When reviewing the results of a patients urinalysis, which information indicates that the nurse should notify the health care provider?

a.

pH 6.2

b.

Trace protein

c.

WBC: 20-26/hpf

d.

Specific gravity: 1.021

ANS: C

The increased number of white blood cells (WBCs) indicates the presence of urinary tract infection or inflammation. The other findings are normal.

DIF: Cognitive Level: Application REF: 1119

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

21. A patient who had a cystoscopy the previous day calls the urology clinic and gives the nurse all the following information. Which statement by the patient should be reported immediately to the health care provider?

a.

My urine still looks pink.

b.

My IV site is still bruised.

c.

I have a temperature of 101.

d.

I did not sleep well last night.

ANS: C

The patients elevated temperature may indicate a bladder infection, a possible complication of cystoscopy. The health care provider should be notified so that antibiotic therapy can be started. Pink-tinged urine is expected after a cystoscopy. The insomnia and bruising should be discussed further with the patient but do not indicate a need to notify the health care provider.

DIF: Cognitive Level: Application REF: 1118

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

22. Following an intravenous pyelogram (IVP), all of the following assessment data are obtained. Which one requires immediate action by the nurse?

a.

The heart rate is 58 beats/minute.

b.

The respiratory rate is 38 breaths/minute.

c.

The patient complains of a dry mouth.

d.

The urine output is 400 mL in the first 2 hours.

ANS: B

The increased respiratory rate indicates that the patient may be experiencing an allergic reaction to the contrast medium used during the procedure. The nurse should immediately assess the patients oxygen saturation and breath sounds. The other data are not unusual findings following an IVP.

DIF: Cognitive Level: Application REF: 1115-1116

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

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