Chapter 32: Assessment of Elimination Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 32: Assessment of Elimination

MULTIPLE CHOICE

1. The history finding in a client with elevated carcinoembryonic antigen (CEA) that suggests to the nurse that this result might not be related to colorectal cancer is a

a.

high-fiber diet.

b.

history of heavy smoking.

c.

regular exercise program.

d.

sedentary lifestyle.

ANS: B

High CEA levels are characteristic of nonmalignant conditions such as cirrhosis, liver disease, alcoholic pancreatitis, heavy smoking, and inflammatory bowel disease.

DIF: Comprehension/Understanding REF: pp. 661-662 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

2. A large, frothy, foul-smelling stool that floats in toilet water indicates to the nurse that the client has an alteration in the metabolism of

a.

carbohydrates.

b.

fats.

c.

milk products.

d.

protein.

ANS: B

When fats are poorly metabolized and appear in the stool as fecal lipids, the stool will appear large, frothy, and will float in the water (steatorrhea).

DIF: Comprehension/Understanding REF: p. 662 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

3. A nurse is assessing a client with right upper quadrant pain. The nurse asks questions directly related to the health of the clients

a.

appendix.

b.

kidneys.

c.

liver.

d.

spleen.

ANS: C

The liver is located in the right upper quadrant of the abdomen. Right lower quadrant pain might be indicative of appendicitis. Kidney pain is typically felt at the costovertebral angle. The spleen is found in the left upper quadrant.

DIF: Application REF: pp. 654-655 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

4. A client is being admitted for hematochezia. The nurse would plan to assess for

a.

blood in the stool.

b.

blood in the urine.

c.

large frothy stools.

d.

manifestations of malabsorption.

ANS: A

Hematochezia is blood in the stool. Hematuria is blood in the urine. Steatorrhea describes large, frothy stools. Manifestations of malabsorption could include weight loss, anemia, weakness, and fatigue in addition to abnormal stool characteristics.

DIF: Application/Applying REF: p. 655 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

5. A client is complaining of arthritis in the hands and wrists. The nurse questions the client about bowel habits and the client asks why. The best response by the nurse is

a.

All the Motrin you are taking for your symptoms can cause other problems.

b.

Arthritis complaints often go along with inflammatory bowel conditions.

c.

Often bowel habits change with a change in physical activity.

d.

The stress from your arthritis can cause you to have diarrhea.

ANS: B

Inflammatory arthritis can be seen both with inflammatory bowel disease and with Whipples disease. The nurse does not know that the client is taking Motrin or has decreased activity. Stress can cause diarrhea, but there is no commonly-known connection among arthritis, stress, and diarrhea.

DIF: Analysis/Analyzing REF: p. 655 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

6. A client has a history of diarrhea. The nurse is attempting to obtain information from the review of systems. When the nurse asks if several different foods cause diarrhea, the client responds, Hmm, I dont usually eat that. Which action by the nurse is most appropriate?

a.

Ask the client why he/she doesnt eat specific foods.

b.

Continue to ask about other food associations with diarrhea.

c.

Have the client list the foods eaten on a typical day.

d.

Inquire about familial bowel problems.

ANS: A

All answers are appropriate ways to gather information when conducting a client history. However, the best response by the nurse at this time is to explore the topic of eating restrictions further before moving on to other topics. Many clients have self-imposed dietary restrictions in order to control unpleasant manifestations. This client may have stopped eating many foods to avoid diarrhea.

DIF: Analysis/Analyzing REF: p. 658 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

7. The nurse explains that the non-urinary manifestations that frequently accompany urinary diseases are

a.

blurred vision and nystagmus.

b.

disorientation and insomnia.

c.

joint pain and stiffness.

d.

nausea, vomiting, and anorexia.

ANS: D

Gastrointestinal (GI) manifestations (e.g., nausea, vomiting, diarrhea) occur with many urinary disorders.

DIF: Comprehension/Understanding REF: pp. 667-668 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

8. When a client tells the nurse that she recently began experiencing urgency and frequency, the appropriate question for the nurse to ask as part of the psychosocial history is

a.

Are you depressed?

b.

Have you had a change in lifestyle?

c.

Have you been experiencing any anxiety?

d.

How old were you when you were toilet-trained?

ANS: C

Anxiety and stress can stimulate or inhibit urination and may provoke urgency and frequency. Depression does not usually lead to urinary symptoms. Change in lifestyle may affect voiding patterns but probably not urgency and frequency. Young adults can have long-standing problems with urination caused by toilet training and bathroom access during early school years.

DIF: Application/Applying REF: p. 671 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Stress Management

9. A client is admitted to the emergency department with severe, colicky pain that radiates to his bladder and scrotum. The nurse assesses these manifestations to be indicative of

a.

a kidney stone in the ureter.

b.

alcohol-related bladder spasm.

c.

pneumaturia.

d.

urinary tract infection.

ANS: A

Colicky pain typically involves the ureter. Kidney stones causing pain in the ureter that radiates to the testes are usually in the upper region of the ureter.

DIF: Comprehension/Understanding REF: p. 665 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

10. Before palpating the bladder of a client with chronic urinary retention, the nurse should

a.

have the client drink several glasses of water so the bladder is full and easy to palpate.

b.

get the bladder scanner to determine if the bladder is full.

c.

review intake and output instead; the bladder cannot be palpated at all.

d.

ask the client to take a deep breath and relax the abdominal muscles.

ANS: B

An empty bladder cannot be palpated or percussed. However, in the case of chronic urinary retention, the bladder becomes atonic and difficult to palpate. The nurse will need to use the bladder scanner to determine if the bladder is full.

DIF: Application/Applying REF: p. 673 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

11. A client has an oral intake of 1500 ml and a urine output of 350 ml in a 24-hour period. The nurse can correctly chart that the client is

a.

anuric.

b.

hematuric.

c.

oliguric.

d.

polyuric.

ANS: C

Oliguria is a urine volume significantly below normal, below 400 ml/day in a person who can concentrate urine normally. In the elderly, oliguria is considered below 600 ml/day. In a person with limited ability to concentrate urine, oliguria can be described as less than 1000-1500 ml/day. Anuria is a total urine output of less than 100 ml/24 hours. Hematuric is not a commonly used word but would mean a person with blood in the urine. Polyuria refers to larger than normal urine output.

DIF: Comprehension/Understanding REF: pp. 663-664 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

12. A client was released from the hospital following a lengthy course of IV antibiotics. The home health care nurse assesses that the client has been having new-onset diarrhea. What would the nurse suspect to be the cause of this problem?

a.

C. difficile infection

b.

Contaminated water supply

c.

Noncompliance with ordered diet

d.

Not spacing medications properly

ANS: A

Suspect infection with Clostridium difficile following use of antibiotics, chemotherapy, or invasive procedures. It is a special problem in the hospital, with the CDC reporting 61 cases per 100,000 hospitalized clients in 2003. This client has two risk factors: antibiotic use and recent hospitalization.

DIF: Analysis/Analyzing REF: p. 662 OBJ: Intervention

MSC: Physiological Integrity

13. An 83-year-old client is seen for urinary frequency and burning. A dipstick urine test reveals positive nitrates. Which action by the nurse is most appropriate?

a.

Assume the client has a UTI.

b.

Catheterize the client for a sterile specimen.

c.

Nothing; this is a normal finding.

d.

Send the urine for a culture.

ANS: D

Positive nitrates are 95% specific for an infection originating in the urinary tract. Being elderly, this client is in a high-risk group for urosepsis, and cultures are mandatory to guide treatment. The client does not need a catheterized specimen, but the nurse should not just assume the client has a UTI and do nothing more.

DIF: Analysis/Analyzing REF: p. 676 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Health Screening

14. A nurse is taking a history from a middle-age male client. He states that he takes no prescribed medications, but he does take saw palmetto and pumpkin daily. The nurse recognizes these herbs as being used to

a.

acidify the urine.

b.

maintain prostate health.

c.

prevent bladder cancer.

d.

ward off sexually transmitted diseases.

ANS: B

Common herbal products used for prostate health include saw palmetto, pygeum, pumpkin, and nettle root.

DIF: Knowledge/Remembering REF: pp. 653, 670-671

OBJ: Intervention

MSC: Physiological Adaptation Reduction of Risk Potential-Diagnostic Tests

15. The nurse explains to the client that the glucosuria in the urinalysis indicates that

a.

a pancreatic disorder is present.

b.

the serum glucose level is above the renal threshold.

c.

the client is diabetic.

d.

the client is experiencing some type of stress.

ANS: B

Glucosuria occurs when the blood glucose level exceeds the resorptive capacity of the kidneys, a level of 180 mg/dl.

DIF: Analysis/Analyzing REF: p. 676 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

16. A client experiencing hematuria tells the nurse that the bleeding occurs at the end of urination, which could indicate a lesion in the

a.

prostate.

b.

renal pelvis.

c.

upper bladder.

d.

upper urinary tract.

ANS: A

Terminal hematuria, occurring only during the last few drops of voiding, indicates bleeding from the prostate. Blood seen at the start of the stream indicates urethral causes. Bleeding that occurs at any time during urination can indicate a problem in any site of the GU tract.

DIF: Comprehension/Understanding REF: p. 675 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

17. The nurse explains that a large increase of urobilinogen in the clients urine is consistent with the diagnosis of

a.

acquired immunodeficiency syndrome (AIDS).

b.

cancer of the kidney or bladder.

c.

gastroenteritis.

d.

hepatitis or other liver disease.

ANS: D

Increased levels of urobilinogen, the end product of conjugated bilirubin metabolism, in the urine indicate liver disease or a hemolytic disorder.

DIF: Comprehension/Understanding REF: p. 676 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

18. The nurse explains that the serum creatinine level is a better indicator for renal disorders because serum creatinine

a.

closely reflects the dietary intake.

b.

does not change in other systemic disorders.

c.

has a constant ratio of 20:1 to blood urea nitrogen (BUN).

d.

is unaffected by hydration status.

ANS: B

The serum creatinine level is not affected by dietary intake or hydration status. It is elevated in renal disorders, hypertension, and diabetes and has a normal ratio of 10:1 to BUN.

DIF: Analysis/Analyzing REF: p. 676 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

19. A client is in the emergency department with a suspected kidney stone and is scheduled for an intravenous pyelogram (IVP). Pre-procedure, which action is most important for the nurse to do? The nurse should

a.

ask the client about iodine allergies.

b.

administer a laxative.

c.

document the history of the clients complaint.

d.

insert a Foley catheter.

ANS: A

Iodine-based IV contrast dye is used in an IVP. Clients with iodine allergies can have potentially fatal allergic reactions to the dye. Documenting the clients complaint is an important action also, but client safety is the priority. Foley catheters are not inserted before an IVP, and the client in the emergency department would not be given a pre-IVP laxative.

DIF: Analysis/Analyzing REF: p. 670 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

20. In counseling a pregnant woman scheduled for an ultrasound of the kidneys, the nurse would advise that

a.

a full bladder is required.

b.

bed rest will be necessary.

c.

the dye may cause a reaction.

d.

the procedure is safe for the fetus.

ANS: D

Ultrasound is noninvasive, involves no contrast media, does not expose the client to radiation, and has produced no adverse effects in anyone, including the offspring of women pregnant at examination.

DIF: Comprehension/Understanding REF: p. 674 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

21. For a client who has just undergone cystourethroscopy with biopsy, the nurse should

a.

encourage the client to drink fluids to flush the dye from the renal system.

b.

instruct the client that strict bed rest will be needed after the procedure.

c.

offer throat lozenges to help with the clients sore throat.

d.

plan care for a client having general anesthesia.

ANS: D

This procedure is done under general anesthesia. None of the other options is correct.

DIF: Application/Applying REF: p. 674 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

22. In the post-procedural nursing care of a client who has undergone a cystourethroscopy, the nurse would include

a.

ambulating the client 8 hours after the procedure.

b.

maintaining a pressure dressing at the puncture site for 8 hours.

c.

monitoring the client for manifestations of urinary tract infection.

d.

obtaining a 24-hour urine specimen.

ANS: C

A cystourethroscopy is visualization of the urinary tract with a lighted instrument and is an invasive procedure. The client is at high risk for developing a secondary infection from the procedure.

DIF: Application/Applying REF: pp. 674-675 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

23. A woman who delivered a baby 10 hours ago has not been able to void. She is complaining of severe abdominal pain and feels the need to urinate but cannot. The nurse should anticipate an order for

a.

anti-anxiety medication.

b.

antibiotics.

c.

immediate catheterization.

d.

sitz bath.

ANS: C

Acute urinary retention is sudden inability to void and can occur after surgery or delivery. It also can be a side effect of medications or caused by bladder outlet obstruction. This is a medical emergency requiring immediate catheterization.

DIF: Application/Applying REF: pp. 665-666 OBJ: Intervention

MSC: Physiological Integrity

MATCHING

Match each item to the correct description below.

When assessing a clients abdomen, in which order does the nurse proceed?

a.

1

b.

2

c.

3

d.

4

1. Auscultation

2. Inspection

3. Palpation

4. Percussion

1. ANS: B DIF: Knowledge/Remembering REF: p. 659

OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

2. ANS: A DIF: Knowledge/Remembering REF: p. 659

OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

3. ANS: D DIF: Knowledge/Remembering REF: p. 659

OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

4. ANS: C DIF: Knowledge/Remembering REF: p. 659

OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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