Chapter 45

Question 1

A 32-year-old patient who is employed as a hairdresser and has a 15 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.

Answer 1

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

Question 2

A 79-year-old man has been admitted with benign prostatic hyperplasia. What is most appropriate to include in the nursing plan of care?

a. Limit fluid intake to no more than 1000 mL/day.
b. Leave a light on in the bathroom during the night.
c. Ask the patient to use a urinal so that urine can be measured. d. Pad the patient’s bed to accommodate overflow incontinence.

Answer 2

ANS: B
The patient’s 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 patient’s output is necessary or that the patient has overflow incontinence.

Question 3

A female patient being admitted with pneumonia has a history of neurogenic bladder as a result of a spinal cord injury. Which action will the nurse plan to take first?

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.

Answer 3

ANS: A
Before planning any interventions, the nurse should complete the assessment and determine the patient’s 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

Question 4

A female patient with a suspected urinary tract infection (UTI) is to provide a clean-catch urine specimen for culture and sensitivity testing. To obtain the specimen, the nurse will

a. have the patient empty the bladder completely, then obtain the next urine specimen that the patient is able to void.
b. teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup. c. insert a short sterile “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.

Answer 4

ANS: B
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 provider’s 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. The technique described in the answer beginning “have the patient empty the bladder completely” would not result in a sterile specimen

Question 5

A hospitalized patient with possible renal insufficiency after coronary artery bypass surgery is scheduled for a creatinine clearance test. Which equipment will the nurse need to obtain?

a. Urinary catheter
b. Cleaning towelettes
c. Large container for urine d. Sterile urine specimen cup

Answer 5

ANS: C
Because 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

Question 6

How will the nurse assess for flank tenderness in a 30-year-old female patient with suspected pyelonephritis?

a. Palpate along both sides of the lumbar vertebral column.
b. Strike a flat hand covering the costovertebral angle (CVA).
c. Push fingers upward into the two lowest intercostal spaces.
d. Percuss between the iliac crest and ribs along the midaxillary line.

Answer 6

ANS: B
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

Question 7

A male patient in the clinic provides a urine sample that is red-orange in color. Which action should the nurse take first?

a. Notify the patient’s health care provider.
b. Teach correct midstream urine collection.
c. Ask the patient about current medications.
d. Question the patient about urinary tract infection (UTI) risk factors.

Answer 7

ANS: C
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

Question 8

The nurse assessing the urinary system of a 45-year-old female would use auscultation to

a. determine kidney position.
b. identify renal artery bruits.
c. check for ureteral peristalsis.
d. assess for bladder distention.

Answer 8

ANS: B
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

Question 9

The nurse caring for a patient after cystoscopy plans that the patient

a. learns to request narcotics for pain.
b. understands to expect blood-tinged urine.
c. restricts activity to bed rest for a 4 to 6 hours. d. remains NPO for 8 hours to prevent vomiting.

Answer 9

ANS: B
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

Question 10

The nurse completing a physical assessment for a newly admitted male patient is unable to feel either kidney on palpation. 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.

Answer 10

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

Question 11

The nurse is caring for a 68-year-old hospitalized patient with a decreased glomerular filtration rate who is scheduled for 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

Answer 11

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 patient’s urine output. MAC sedation and retention catheterization are not required for the procedure. The contrast medium is given IV, not orally.

Question 12

A patient gives the nurse health information before a scheduled intravenous pyelogram (IVP). Which item has the most immediate implications for the patient’s care?

a. The patient has not had food or drink for 8 hours.
b. The patient lists allergies to shellfish and penicillin.
c. The patient complains of costovertebral angle (CVA) tenderness. d. The patient used a bisacodyl (Dulcolax) tablet the previous night.

Answer 12

ANS: B
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 is also important to note and document but does not have immediate implications for the patient’s care during the procedures

Question 13

A patient has elevated blood urea nitrogen (BUN) and serum creatinine levels. Which bowel preparation order would the nurse question for this patient who is scheduled for a renal arteriogram?

a. Fleet enema
b. Tap-water enema
c. Senna/docusate (Senokot-S) d. Bisacodyl (Dulcolax) tablets

Answer 13

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.

Question 14

A patient passing bloody urine is scheduled for a cystoscopy with cystogram. Which description of the procedure by the nurse is accurate?

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

Answer 14

ANS: C
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

Question 15

To assess whether there is any improvement in a patient’s dysuria, which question will the nurse ask?

a. “Do you have to urinate at night?”
b. “Do you have blood in your urine?”
c. “Do you have to urinate frequently?” d. “Do you have pain when you urinate?”

Answer 15

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

Question 16

What glomerular filtration rate (GFR) would the nurse estimate for a 30-year-old patient with a creatinine clearance result of 60 mL/min?
a. 60 mL/min b. 90 mL/min c. 120 mL/min d. 180 mL/min

Answer 16

ANS: A

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

Question 17

When a patient’s urine dipstick test indicates a small amount of protein, the nurse’s next action should be to

a. send a urine specimen to the laboratory to test for ketones.
b. obtain a clean-catch urine for culture and sensitivity testing.
c. inquire about which medications the patient is currently taking. d. ask the patient about any family history of chronic renal failure.

Answer 17

ANS: C
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

Question 18

When working in the urology/nephrology clinic, which patient could the nurse delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?
a. Patient who is scheduled for a renal biopsy after a recent kidney transplant b. Patient who will need monitoring for several hours after a renal arteriogram c. Patient who requires teaching about possible post-cystoscopy complications d. Patient who will have catheterization to check for residual urine after voiding

Answer 18

ANS: D
LPN/LVN education includes common procedures such as catheterization of stable patients. The other patients require more complex assessments and/or patient teaching that are included in registered nurse (RN) education and scope of practice.

Question 19

Which assessment of a 62-year-old patient who has just had an intravenous pyelogram (IVP) requires immediate action by the nurse?

a. The heart rate is 58 beats/minute.
b. The patient complains of a dry mouth.
c. The respiratory rate is 38 breaths/minute. d. The urine output is 400 mL after 2 hours.

Answer 19

ANS: C
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 patient’s oxygen saturation and breath sounds. The other data are not unusual findings following an IVP.

Question 20

Which information from a patient’s urinalysis requires that the nurse notify the health care provider?

a. pH 6.2
b. Trace protein
c. WBC 20 to 26/hpf d. Specific gravity 1.021

Answer 20

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

Question 21

Which medication taken at home by a 47-year-old patient with decreased renal function will be of most concern to the nurse?

a. ibuprofen (Motrin)
b. warfarin (Coumadin) c. folic acid (vitamin B9) d. penicillin (Bicillin LA)

Answer 21

ANS: A
The nonsteroidal antiinflammatory 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.

Question 22

Which nursing action is essential for a patient immediately after a renal biopsy?

a. Check blood glucose to assess for hyperglycemia or hypoglycemia.
b. Insert a urinary catheter and test urine for gross or microscopic hematuria.
c. Monitor the blood urea nitrogen (BUN) and creatinine to assess renal function. d. Apply a pressure dressing and keep the patient on the affected side for 30 minutes.

Answer 22

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

Question 23

Which statement by a patient who had a cystoscopy the previous day should be reported immediately to the health care provider?
a. “My urine looks pink.” b. “My IV site is bruised.” c. “My sleep was restless.” d. “My temperature is 101.”

Answer 23

ANS: D
The patient’s 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.