ch. 46 MJ

Question 0

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

a. “I can use vaginal sprays to reduce bacteria.”
b. “I will drink a quart of water or other fluids every day.”
c. “I will wash with soap and water before sexual intercourse.”
d. “I will empty my bladder every 3 to 4 hours during the day.”

Answer 0

d. “I will empty my bladder every 3 to 4 hours during the day.”

Question 1

A patient returns to the clinic with recurrent dysuria after being treated with trimethoprim and sulfamethoxazole (Bactrim) for 3 days. Which action will the nurse plan to take?

a. mRemind the patient about the need to drink 1000 mL of fluids daily.
b. Obtain a midstream urine specimen for culture and sensitivity testing.
c. Teach the patient to take the prescribed Bactrim for at least 3 more days.
d. Suggest that the patient use acetaminophen (Tylenol) to treat the sympto

Answer 1

b. Obtain a midstream urine specimen for culture and sensitivity testing.

Question 2

hich information will the nurse include when teaching the patient with a urinary tract infection (UTI) about the use of phenazopyridine (Pyridium)?

a. Take the medication for at least 7 days.
b. Use sunscreen while taking the Pyridium.
c. The urine may turn a reddish-orange color.
d. Use the Pyridium before sexual intercourse.

Answer 2

c. The urine may turn a reddish-orange color.

Question 3

A 72-year-old who has benign prostatic hyperplasia is admitted to the hospital with chills, fever, and vomiting. Which finding by the nurse will be most helpful in determining whether the patient has an upper urinary tract infection (UTI)?

a. Suprapubic pain
b. Bladder distention
c. Foul-smelling urine
d. Costovertebral tenderness

Answer 3

d. Costovertebral tenderness

Question 4

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

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 will buy some calcium glycerophosphate (Prelief) at the pharmacy.”
d. “I should call the doctor about increased bladder pain or odorous urine.”

Answer 4

b. “I should start taking a high potency multiple vitamin every morning.”

Question 5

When admitting a patient with acute glomerulonephritis, it is most important that the nurse ask the patient about

a. recent sore throat and fever.
b. history of high blood pressure.
c. frequency of bladder infections.
d. family history of kidney stones.

Answer 5

a. recent sore throat and fever.

Question 6

Which finding by the nurse for a patient admitted with glomerulonephritis indicates that treatment has been effective?

a. The patient denies pain with voiding.
b. The urine dipstick is negative for nitrites.
c. Peripheral and periorbital edema is resolved.
d. The antistreptolysin-O (ASO) titer is decreased.

Answer 6

c. Peripheral and periorbital edema is resolved.

Question 7

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

a. antibiotics.
b. anticoagulants.
c. corticosteroids.
d. antihypertensives.

Answer 7

b. anticoagulants

Question 8

A patient is admitted to the hospital with new onset nephrotic syndrome. Which assessment data will the nurse expect to find related to this illness?

a. Poor skin turgor
b. High urine ketones
c. Recent weight gain
d. Low blood pressure

Answer 8

c. Recent weight gain

Question 9

A patient’s renal calculus is analyzed as being very high in uric acid. To prevent recurrence of stones, the nurse teaches the patient to avoid eating

a. milk and dairy products.
b. legumes and dried fruits.
c. organ meats and sardines.
d. spinach, chocolate, and tea.

Answer 9

c. organ meats and sardines.

Question 10

To prevent the recurrence of renal calculi, the nurse teaches the patient to

a. use a filter to strain all urine.
b. avoid dietary sources of calcium.
c. drink diuretic fluids such as coffee.
d. have 2000 to 3000 mL of fluid a day.

Answer 10

d. have 2000 to 3000 mL of fluid a day.

Question 11

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

a. monitoring and recording blood pressure.
b. obtaining and documenting daily weights.
c. measuring daily intake and output amounts.
d. preventing bleeding caused by anticoagulants.

Answer 11

a. monitoring and recording blood pressure.

Question 12

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?

a. Importance of genetic counseling
b. Complications of renal transplantation
c. Methods for treating chronic and severe pain
d. Differences between hemodialysis and peritoneal dialysis

Answer 12

a. Importance of genetic counseling

Question 13

When assessing a 30-year-old man who complains of a feeling of incomplete bladder emptying and a split, spraying urine stream, the nurse asks about a history of

a. bladder infection.
b. recent kidney trauma.
c. gonococcal urethritis.
d. benign prostatic hyperplasia.

Answer 13

c. gonococcal urethritis.

Question 14

After obtaining the health history for a 25-year-old who smokes two packs of cigarettes daily, the nurse will plan to do teaching about the increased risk for

a. kidney stones.
b. bladder cancer.
c. bladder infection.
d. interstitial cystitis.

Answer 14

b. bladder cancer.

Question 15

A 78-year-old who has been admitted to the hospital with dehydration is confused and incontinent of urine. Which nursing action will be best to include in the plan of care?

a. Apply absorbent incontinent pads.
b. Restrict fluids after the evening meal.
c. Insert an indwelling catheter until the symptoms have resolved.
d. Assist the patient to the bathroom every 2 hours during the day.

Answer 15

d. Assist the patient to the bathroom every 2 hours during the day.

Question 16

A 62-year-old asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which intervention is most appropriate to include in the care plan?

a. Assist the patient to the bathroom q3hr.
b. Place a commode at the patient’s bedside.
c. Demonstrate how to perform the Credé maneuver.
d. Teach the patient how to perform Kegel exercises.

Answer 16

d. Teach the patient how to perform Kegel exercises.

Question 17

Following rectal surgery, a patient voids about 50 mL of urine every 30 to 60 minutes. Which nursing action is most appropriate?

a. Use an ultrasound scanner to check the postvoiding residual.
b. Monitor the patient’s intake and output over the next few hours.
c. Have the patient take small amounts of fluid frequently throughout the day.
d. Reassure the patient that this is normal after rectal surgery because of anesthesia.

Answer 17

a. Use an ultrasound scanner to check the postvoiding residual.

Question 18

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

a. Place a bedside commode near the patient’s bed.
b. Demonstrate the use of the Credé maneuver to the patient.
c. Use an ultrasound scanner to check postvoiding residuals.
d. Teach the use of Kegel exercises to strengthen the pelvic floor.

Answer 18

a. Place a bedside commode near the patient’s bed.

Question 19

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?

a. “I will use a sterile catheter and gloves for each time I self-catheterize.”
b. “I will clean the catheter carefully before and after each catheterization.”
c. “I will need to buy seven new catheters weekly and use a new one every day.”
d. “I will need to take prophylactic antibiotics to prevent any urinary tract infections.”

Answer 19

b. “I will clean the catheter carefully before and after each catheterization.”

Question 20

Which action will the nurse include in the plan of care for a patient who has had a ureterolithotomy and has a left ureteral catheter and a urethral catheter in place?

a. Provide education about home care for both catheters.
b. Apply continuous steady tension to the ureteral catheter.
c. Clamp the ureteral catheter unless output from the urethral catheter stops.
d. Call the health care provider if the ureteral catheter output drops suddenly.

Answer 20

d. Call the health care provider if the ureteral catheter output drops suddenly.

Question 21

A patient who has bladder cancer had a cystectomy with creation of an Indiana pouch. Which topic will be included in patient teaching?

a. Application of ostomy appliances
b. Catheterization technique and schedule
c. Analgesic use before emptying the pouch
d. Use of barrier products for skin protection

Answer 21

b. Catheterization technique and schedule

Question 22

Two days after surgery for an ileal conduit, the patient will not look at the stoma or participate in care. The patient insists that no one but the ostomy nurse specialist care for the stoma. The nurse identifies a nursing diagnosis of
a.
anxiety related to effects of procedure on lifestyle.
b.
disturbed body image related to change in body function.
c.
readiness for enhanced coping related to need for information.
d.
self-care deficit, toileting, related to denial of altered body function.

Answer 22

b.

disturbed body image related to change in body function.

Question 23

A patient who has had a transurethral resection with fulguration for bladder cancer 3 days previously calls the nurse at the urology clinic. Which information given by the patient is most important to report to the health care provider?
a.
The patient is using opioids for pain.
b.
The patient has noticed clots in the urine.
c.
The patient is very anxious about the cancer.
d.
The patient is voiding every 4 hours at night.

Answer 23

b.

The patient has noticed clots in the urine.

Question 24

A patient with bladder cancer is scheduled for intravesical chemotherapy. In preparation for the treatment the nurse will teach the patient about
a.
premedicating to prevent nausea.
b.
where to obtain wigs and scarves.
c.
the importance of oral care during treatment.
d.
the need to empty the bladder before treatment.

Answer 24

d.

the need to empty the bladder before treatment.

Question 25

Which nursing action will be most helpful in decreasing the risk for hospital-acquired infection (HAI) of the urinary tract in patients admitted to the hospital?
a.
Avoid unnecessary catheterizations.
b.
Encourage adequate oral fluid intake.
c.
Test urine with a dipstick daily for nitrites.
d.
Provide thorough perineal hygiene to patients.

Answer 25

a.

Avoid unnecessary catheterizations.

Question 26

When assessing the patient who has a lower urinary tract infection (UTI), the nurse will initially ask about
a.
nausea.
b.
flank pain.
c.
poor urine output.
d.
pain with urination.

Answer 26

d.

pain with urination.

Question 27

Which assessment finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider?
a.
Foul-smelling urine
b.
Complaint of flank pain
c.
Blood pressure 88/45 mm Hg
d.
Temperature 100.1° F (57.8° C)

Answer 27

c.

Blood pressure 88/45 mm Hg

Question 28

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?
a.
Excess fluid volume related to low serum protein levels
b.
Activity intolerance related to increased weight and fatigue
c.
Disturbed body image related to peripheral edema and ascites
d.
Altered nutrition: less than required related to protein restriction

Answer 28

a.

Excess fluid volume related to low serum protein levels

Question 29

An 88-year-old with benign prostatic hyperplasia (BPH) has a markedly distended bladder and is agitated and confused. Which of the following interventions prescribed by the health care provider should the nurse implement first?
a.
Insert a urinary retention catheter.
b.
Schedule an intravenous pyelogram.
c.
Administer lorazepam (Ativan) 0.5 mg PO.
d.
Draw blood for blood urea nitrogen (BUN) and creatinine testing.

Answer 29

a.

Insert a urinary retention catheter.

Question 30

A patient with renal calculi is hospitalized with gross hematuria and severe colicky left flank pain. Which nursing action will be of highest priority at this time?
a.
Encourage oral fluid intake.
b.
Administer prescribed analgesics.
c.
Monitor temperature every 4 hours.
d.
Give antiemetics as needed for nausea.

Answer 30

b.

Administer prescribed analgesics.

Question 31

Which nursing action should the nurse who is caring for a patient who has had an ileal conduit for several years delegate to nursing assistive personnel (NAP)?
a.
Assess for symptoms of urinary tract infection (UTI).
b.
Change the ostomy appliance.
c.
Choose the appropriate ostomy bag.
d.
Monitor the appearance of the stoma.

Answer 31

b.

Change the ostomy appliance.

Question 32

When the nurse is caring for a patient who has had left-sided extracorporeal shock wave lithotripsy, which assessment finding is most important to report to the health care provider?
a.
Blood in urine
b.
Left flank pain
c.
Left flank bruising
d.
Drop in urine output

Answer 32

d.

Drop in urine output

Question 33

Following an open loop resection and fulguration of the bladder, a patient is unable to void. Which nursing action should be implemented first?
a.
Insert a straight catheter and drain the bladder.
b.
Assist the patient to take a 15-minute sitz bath.
c.
Encourage the patient to drink several glasses of water.
d.
Teach the patient how to do isometric perineal exercises.

Answer 33

b.

Assist the patient to take a 15-minute sitz bath.

Question 34

The nurse observes nursing assistive personnel (NAP) taking the following actions when caring for a patient with a retention catheter. Which action requires that the nurse intervene?
a.
Taping the catheter to the skin on the patient’s upper inner thigh
b.
Cleaning around the patient’s urinary meatus with soap and water
c.
Using an alcohol-based hand cleaner before performing catheter care
d.
Disconnecting the catheter from the drainage tube to obtain a specimen

Answer 34

d.

Disconnecting the catheter from the drainage tube to obtain a specimen

Question 35

A patient undergoes a nephrectomy after having massive trauma to the kidney. Which assessment finding obtained postoperatively is most important to communicate to the surgeon?
a.
Blood pressure is 102/58.
b.
Incisional pain level is 8/10.
c.
Urine output is 20 mL/hr for 2 hours.
d.
Crackles are heard at both lung bases.

Answer 35

c.

Urine output is 20 mL/hr for 2 hours.

Question 36

Which assessment finding for a patient who has had a cystectomy with an ileal conduit the previous day is most important for the nurse to communicate to the physician?
a.
Cloudy appearing urine
b.
Hypotonic bowel sounds
c.
Heart rate 102 beats/minute
d.
Continuous drainage from stoma

Answer 36

c.

Heart rate 102 beats/minute

Question 37

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 to discuss with the health care provider?
a.
Infuse 5% dextrose in normal saline at 75 mL/hr.
b.
Order regular diet after patient is awake and alert.
c.
Give ketorolac (Toradol) 10 mg PO PRN for pain.
d.
Obtain blood urea nitrogen (BUN), creatinine, and electrolytes in 2 hours.

Answer 37

c.
Give ketorolac (Toradol) 10 mg PO PRN for pain.

Question 38

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?
a.
Dysuria
b.
Hematuria
c.
Left-sided flank pain
d.
Temperature 100.1° F

Answer 38

c.

Left-sided flank pain