Ch.46

Question 1

A 46-year-old female 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. Teach the patient to take the prescribed Bactrim for 3 more days.
b. Remind the patient about the need to drink 1000 mL of fluids daily.
c. Obtain a midstream urine specimen for culture and sensitivity testing.
d. Suggest that the patient use acetaminophen (Tylenol) to treat the symptoms.

Answer 1

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

Question 2

The nurse determines that instruction regarding prevention of future urinary tract infections (UTIs) has been effective for a 22-year-old female patient with cystitis when the patient states which of the following?

a. “I can use vaginal antiseptic 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 2

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

Question 3

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

a. Pyridium may cause photosensitivity
b. Pyridium may change the urine color.
c. Take the Pyridium for at least 7 days.
d. Take Pyridium before sexual intercourse.

Answer 3

b. Pyridium may change the urine color.

Question 4

Which finding by the nurse will be most helpful in determining whether a 67-year-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)?

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

Answer 4

d. Costovertebral tenderness

Question 5

The nurse determines that further instruction is needed for a patient with interstitial cystitis when the patient says which of the following?

a. “I should stop having coffee and orange juice for breakfast.”
b. “I will buy calcium glycerophosphate (Prelief) at the pharmacy.”
c. “I will start taking high potency multiple vitamins every morning.”
d. “I should call the doctor about increased bladder pain or odorous urine.”

Answer 5

c. “I will start taking high potency multiple vitamins every morning.”

Question 6

It is most important that the nurse ask a patient admitted with acute glomerulonephritis about

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

Answer 6

b. recent sore throat and fever

Question 7

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

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

Answer 7

d. The periorbital and peripheral edema is resolved.

Question 8

The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about treatment with

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

Answer 8

c. anticoagulants.

Question 9

A 56-year-old female patient is admitted to the hospital with new onset nephrotic syndrome. Which assessment data will the nurse expect?

a. Poor skin turgor
b. Recent weight gain
c. Elevated urine ketones
d. Decreased blood pressure

Answer 9

b. Recent weight gain

Question 10

To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating

a. milk and cheese.
b. sardines and liver.
c. legumes and dried fruit.
d. spinach, chocolate, and tea.

Answer 10

b. sardines and liver.

Question 11

The nurse teaches a 64-year-old woman to prevent the recurrence of renal calculi by

a. using a filter to strain all urine.
b. avoiding dietary sources of calcium.
c. choosing diuretic fluids such as coffee.
d. drinking 2000 to 3000 mL of fluid a day.

Answer 11

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

Question 12

A 34-year-old male patient seen at the primary care clinic complains of feeling continued fullness after voiding and a split, spraying urine stream. The nurse will ask about a history of

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

Answer 12

b. gonococcal urethritis.

Question 13

The nurse will plan to teach a 27-year-old female who smokes 2 packs of cigarettes daily about the increased risk for

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

Answer 13

b. bladder cancer

Question 14

A 68-year-old female patient 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. Restrict fluids between meals and after the evening meal.
b. Apply absorbent incontinent pads liberally over the bed linens.
c. Insert an indwelling catheter until the symptoms have resolved.
d. Assist the patient to the bathroom every 2 hours during the day.

Answer 14

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

Question 15

A 55-year-old woman admitted for shoulder surgery 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 15

d. Teach the patient how to perform Kegel exercises.

Question 16

Following rectal surgery, a patient voids about 50 mL of urine every 30 to 60 minutes for the first 4 hours. Which nursing action is most appropriate?

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

Answer 16

c. Use an ultrasound scanner to check the postvoiding residual volume.

Question 17

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

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

Answer 17

c. Place a bedside commode close to the patient’s bed.

Question 18

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 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 clean the catheter carefully before and after each catheterization.”
d. “I will need to take prophylactic antibiotics to prevent any urinary tract infections.”

Answer 18

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

Question 19

After a ureterolithotomy, a female patient has a left ureteral catheter and a urethral catheter in place. Which action will the nurse include in the plan of care?

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

Answer 19

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

Question 20

Which information from a patient who had a transurethral resection with fulguration for bladder cancer 3 days ago is most important to report to the health care provider?

a. The patient is voiding every 4 hours.
b. The patient is using opioids for pain.
c. The patient has seen clots in the urine.
d. The patient is anxious about the cancer.

Answer 20

c. The patient has seen clots in the urine.

Question 21

When preparing a female patient with bladder cancer for intravesical chemotherapy, the nurse will teach about

a. premedicating to prevent nausea.
b. obtaining wigs and scarves to wear.
c. emptying the bladder before the medication.
d. maintaining oral care during the treatments.

Answer 21

c. emptying the bladder before the medication.

Question 22

Nursing staff on a hospital unit are reviewing rates of hospital-acquired infections (HAI) of the urinary tract. Which nursing action will be most helpful in decreasing the risk for HAI in patients admitted to the hospital?

a. Encouraging adequate oral fluid intake
b. Testing urine with a dipstick daily for nitrites
c. Avoiding unnecessary urinary catheterizations
d. Providing frequent perineal hygiene to patients

Answer 22

c. Avoiding unnecessary urinary catheterizations

Question 23

Which assessment data reported by a 28-year-old male patient is consistent with a lower urinary tract infection (UTI)?

a. Poor urine output
b. Bilateral flank pain
c. Nausea and vomiting
d. Burning on urination

Answer 23

d. Burning on urination

Question 24

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. Complaint of flank pain
b. Blood pressure 90/48 mm Hg
c. Cloudy and foul-smelling urine
d. Temperature 100.1° F (57.8° C)

Answer 24

b. Blood pressure 90/48 mm Hg

Question 25

A 58-year-old male patient who is diagnosed with nephrotic syndrome has ascites and 4+ leg edema. Which nursing diagnosis is a priority for the patient?

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

Answer 25

b. Excess fluid volume related to low serum protein levels

Question 26

A 76-year-old with benign prostatic hyperplasia (BPH) is agitated and confused, with a markedly distended bladder. Which intervention prescribed by the health care provider should the nurse implement first?

a. Insert a urinary retention catheter.
b. Schedule an intravenous pyelogram (IVP).
c. Draw blood for a serum creatinine level.
d. Administer lorazepam (Ativan) 0.5 mg PO.

Answer 26

a. Insert a urinary retention catheter.

Question 27

Which nursing action is of highest priority for a 68-year-old patient with renal calculi who is being admitted to the hospital with gross hematuria and severe colicky left flank pain?

a. Administer prescribed analgesics.
b. Monitor temperature every 4 hours.
c. Encourage increased oral fluid intake.
d. Give antiemetics as needed for nausea.

Answer 27

a. Administer prescribed analgesics.

Question 28

The nurse is caring for a patient who has had an ileal conduit for several years. Which nursing action could be delegated to unlicensed assistive personnel (UAP)?

a. Change the ostomy appliance.
b. Choose the appropriate ostomy bag.
c. Monitor the appearance of the stoma.
d. Assess for possible urinary tract infection (UTI).

Answer 28

a. Change the ostomy appliance

Question 29

Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy?

a. Blood in urine
b. Left flank bruising
c. Left flank discomfort
d. Decreased urine output

Answer 29

d. Decreased urine output

Question 30

A 44-year-old patient is unable to void after having an open loop resection and fulguration of the bladder. Which nursing action should be implemented first?

a. Assist the patient to soak in a 15-minute sitz bath.
b. Insert a straight urethral catheter and drain the bladder.
c. Encourage the patient to drink several glasses of water.
d. Teach the patient how to do isometric perineal exercises.

Answer 30

a. Assist the patient to soak in a 15-minute sitz bath.

Question 31

The nurse observes unlicensed assistive personnel (UAP) taking the following actions when caring for a female patient with a urethral 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. Disconnecting the catheter from the drainage tube to obtain a specimen
d. Using an alcohol-based gel hand cleaner before performing catheter care

Answer 31

c. Disconnecting the catheter from the drainage tube to obtain a specimen

Question 32

A 58-year-old male patient who weighs 242 lb (110 kg) undergoes a nephrectomy for massive kidney trauma due to a motor vehicle crash. Which postoperative assessment finding is most important to communicate to the surgeon?

a. Blood pressure is 102/58.
b. Urine output is 20 mL/hr for 2 hours.
c. Incisional pain level is reported as 9/10.
d. Crackles are heard at bilateral lung bases.

Answer 32

b. Urine output is 20 mL/hr for 2 hours.

Question 33

A 63-year-old male patient had a cystectomy with an ileal conduit yesterday. Which new assessment data 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 stoma drainage

Answer 33

c. Heart rate 102 beats/minute

Question 34

A 32-year-old patient with a history of polycystic kidney disease is admitted to the surgical unit after having shoulder 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. Draw blood urea nitrogen (BUN) and creatinine in 2 hours.

Answer 34

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

Question 35

A 22-year-old female patient seen in the clinic for a bladder infection describes the following symptoms. Which information is most important for the nurse to report to the health care provider?

a. Urinary urgency
b. Left-sided flank pain
c. Intermittent hematuria
d. Burning with urination

Answer 35

b. Left-sided flank pain

Question 36

A patient in the urology clinic is diagnosed with monilial urethritis. Which action will the nurse include in the plan of care?

a. Teach the patient about the use of antifungal medications.
b. Tell the patient to avoid tub baths until the symptoms resolve.
c. Instruct the patient to refer recent sexual partners for treatment.
d. Teach the patient to avoid nonsteroidal antiinflammatory drugs (NSAIDs).

Answer 36

a. Teach the patient about the use of antifungal medications.

Question 37

Which action will the nurse anticipate taking for an otherwise healthy 50-year-old who has just been diagnosed with Stage 1 renal cell carcinoma?

a. Prepare patient for a renal biopsy.
b. Provide preoperative teaching about nephrectomy.
c. Teach the patient about chemotherapy medications.
d. Schedule for a follow-up appointment in 3 months.

Answer 37

b. Provide preoperative teaching about nephrectomy.

Question 38

A patient is admitted to the emergency department with possible renal trauma after an automobile accident. Which prescribed intervention will the nurse implement first?

a. Check blood pressure and heart rate.
b. Administer morphine sulfate 4 mg IV.
c. Transport to radiology for an intravenous pyelogram.
d. Insert a urethral catheter and obtain a urine specimen.

Answer 38

a. Check blood pressure and heart rate.

Question 39

After change-of-shift report, which patient should the nurse assess first?

a. Patient with a urethral stricture who has not voided for 12 hours
b. Patient who has cloudy urine after orthotopic bladder reconstruction
c. Patient with polycystic kidney disease whose blood pressure is 186/98 mm Hg
d. Patient who voided bright red urine immediately after returning from lithotripsy

Answer 39

a. Patient with a urethral stricture who has not voided for 12 hours