Question 1

A patient in the hospital has a history of urinary incontinence. Which nursing action will be included in the plan of care?

Accepted Answer

A)   Place a bedside commode near the patient's bed.
B)   Use an ultrasound scanner to check urine residual after the patient voids.
C)   Demonstrate the use of the Credé maneuver to the patient.
D)   Teach the use of Kegel exercises to strengthen the pelvic floor. A

Question 2

A 98-year-old patient with benign prostatic hyperplasia has a markedly distended bladder and is agitated and confused. All the following orders are received from the emergency department health care provider. Which order should the nurse act on first?

Accepted Answer

A)   Draw blood for blood urea nitrogen (BUN)  and creatinine.
B)   Administer lorazepam (Ativan)  0.5 mg.
C)   Insert 16 French retention catheter.
D)   Schedule for IVP. C

Question 3

The nurse instructs a patient seen in the outpatient clinic with symptoms of renal calculi to strain all urine and to

Accepted Answer

A)   report the pain level when the stone passed.
B)   collect the stone and bring it to the clinic.
C)   record the time that the stone passed.
D)   save a urine specimen to check for blood. B

Question 4

A patient who is diagnosed with nephrotic syndrome has 3+ ankle and leg edema and ascites. Which nursing diagnosis is a priority for the patient?

Accepted Answer

A)   Fluid-volume excess related to low serum protein levels
B)   Altered nutrition: less than required related to protein restriction
C)   Activity intolerance related to increased weight and fatigue
D)   Disturbed body image related to peripheral edema and ascites

Question 5

After the home health nurse teaches a patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying, which patient statement indicates that the teaching has been effective?

Accepted Answer

A)   "I will need to buy seven new catheters weekly and use a new one every day."
B)   "I will use a sterile catheter and gloves for each time I self-catheterize."
C)   "I will need to take prophylactic antibiotics to prevent any urinary tract infections."
D)   "I will wash the catheter with soap and water before and after each catheterization."

Question 6

Following an open-loop resection and fulguration of the bladder, a patient is unable to void. Which nursing action should be implemented?

Accepted Answer

A)   Assist the patient to take a 15-minute sitz bath.
B)   Encourage the patient to drink several glasses of water.
C)   Teach the patient how to do isometric perineal exercises.
D)   Insert a straight catheter and drain the bladder.

Question 7

A 78-year-old patient is admitted to the hospital with dehydration and electrolyte imbalance. The patient is confused and incontinent of urine on admission. In developing a plan of care for the patient, an appropriate nursing intervention for the patient's incontinence is to

Accepted Answer

A)   insert an indwelling catheter.
B)   apply absorbent incontinent pads.
C)   assist the patient to the bathroom q2hr.
D)   restrict fluids after the evening meal.

Question 8

A patient with a history of renal calculi is hospitalized with gross hematuria and severe colicky left flank pain that radiates to his left testicle. In planning care for the patient, the nurse gives the highest priority to the nursing diagnosis of

Accepted Answer

A)   acute pain related to irritation by the stone.
B)   deficient fluid volume related to inadequate intake.
C)   risk for infection related to urinary system damage.
D)   risk for nausea related to pain and renal colic.

Question 9

The nurse determines that instruction regarding prevention of future UTIs for a patient with cystitis has been effective when the patient states,

Accepted Answer

A)   "I will empty my bladder every 3 to 4 hours during the day."
B)   "I can use vaginal sprays to reduce bacteria."
C)   "I will wash with soap and water before sexual intercourse."
D)   "I will drink a quart of water or other fluids every day."

Question 10

A patient undergoes a nephrectomy for massive trauma to the kidney resulting from a fall from a scaffold. Which assessment data obtained postoperatively are most important to communicate to the surgeon?

Accepted Answer

A)   Blood pressure is 102/48.
B)   Urine output is 20 ml/hr for 2 hours.
C)   Crackles are heard at both lung bases.
D)   Incisional pain level is 8/10.

Question 11

When admitting a patient with acute glomerulonephritis, the nurse will ask the patient about

Accepted Answer

A)   history of high blood pressure.
B)   frequency of UTIs.
C)   recent sore throat and fever.
D)   family history of kidney disease.

Question 12

A patient with nephrotic syndrome develops flank pain. The nurse will anticipate treatment with

Accepted Answer

A)   antibiotics.
B)   antihypertensives.
C)   anticoagulants.
D)   corticosteroids.

Question 13

A 32-year-old patient is diagnosed with polycystic kidney disease. Which information is most appropriate for the nurse to include in teaching at this time?

Accepted Answer

A)   Differences between hemodialysis and peritoneal dialysis
B)   Complications of renal transplantation
C)   Methods for treating chronic and severe pain
D)   Importance of genetic counseling

Question 14

Which information noted by the nurse when caring for a patient with a bladder infection is most important to report to the health care provider?

Accepted Answer

A)   Dysuria
B)   Temperature 100.1° F
C)   Left-sided flank pain
D)   Hematuria

Question 15

Trimethoprim and sulfamethoxazole (Bactrim) BID for 7 days is ordered for a patient who has a recurrent relapse of an Escherichia coli UTI. The nurse instructs the patient to

Accepted Answer

A)   take the antibiotic for the full 7 days, even if symptoms improve in a few days.
B)   return to the clinic in 3 days so that a urine culture can be done to evaluate the effectiveness of the drug.
C)   increase the effectiveness of the drug by taking it with cranberry juice to acidify the urine.
D)   take two of the pills a day for 5 days, and reserve the rest of the pills to take if the symptoms reappear.

Question 16

In planning teaching for a patient with benign nephrosclerosis, the nurse should include instructions regarding

Accepted Answer

A)   measuring daily intake and output amounts.
B)   obtaining and documenting daily weights.
C)   monitoring and recording blood pressure.
D)   preventing bleeding caused by anticoagulants.

Question 17

A patient with a confirmed urinary stone in the proximal left ureter undergoes extracorporeal shock-wave lithotripsy. Which information is most important for the nurse to collect after lithotripsy?

Accepted Answer

A)   Urine output
B)   Pain level
C)   Appearance of the site
D)   Patient temperature

Question 18

After teaching a patient with interstitial cystitis about management of the condition, the nurse determines that further instruction is needed when the patient says,

Accepted Answer

A)   "I will have to stop having coffee and orange juice for breakfast."
B)   "I should start taking a high-potency multiple vitamin every morning."
C)   "I should call the doctor about increased bladder pain or odorous urine."
D)   "I will buy some calcium glycerophosphate (Prelief)  at the pharmacy."

Question 19

When assessing a patient who complains of a feeling of incomplete bladder emptying and a split, spraying urine stream, the nurse asks about a history of

Accepted Answer

A)   recurrent renal calculi.
B)   kidney trauma.
C)   bladder infection.
D)   gonococcal urethritis.

Question 20

A 26-year-old patient with a history of polycystic kidney disease is admitted to the surgical unit after having knee surgery. Which of the routine postoperative orders is most important for the nurse discuss with the health care provider?

Accepted Answer

A)   Give ketorolac (Toradol)  10 mg PO PRN for pain.
B)   Infuse 5% dextrose in normal saline at 75 ml/hr.
C)   Obtain BUN, creatinine, and electrolytes in 2 hours.
D)   Order regular diet after patient is awake and alert.

Exam 46: Nursing Management: Renal and Urologic Problems