Chapter 42: Urologic Disorders Nursing School Test Banks

Chapter 42: Urologic Disorders
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. A nurse is assessing a patient with renal impairment. Which facial characteristic is a sign of fluid retention?
a. Broken blood vessels around the nose
b. Periorbital edema
c. Rash on cheeks and neck
d. Facial twitching
ANS: B
Periorbital edema is a sign of fluid retention. Because the patient with renal impairment has generalized edema, this facial feature is extremely significant in assessing edema.

DIF: Cognitive Level: Comprehension REF: p. 895 OBJ: 1
TOP: Sign of Fluid Retention KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

2. What laboratory value change should indicate to a nurse that a patient with renal failure has entered the oliguric stage?
a. Blood urea nitrogen (BUN) level rises.
b. Serum calcium increases.
c. Blood volume decreases.
d. Urine osmolality increases.
ANS: A
In the oliguric stage of renal failure, the urine output decreases to less than 400 mL/day; the BUN, creatinine, and potassium increase; and the serum calcium decreases. The patient becomes hypervolemic as the urine osmolality increases.

DIF: Cognitive Level: Comprehension REF: p. 896 OBJ: 1
TOP: Oliguric Stage of Renal Failure KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. What should nursing care focus on when caring for a patient with a ureteral catheter in place after the removal of a kidney stone?
a. Irrigating the catheter regularly
b. Assessing for patency
c. Including ureteral output with the bladder output
d. Early ambulation
ANS: B
Patency of the ureteral catheter is essential to prevent injury to the kidney. The patient is on bedrest until the ureteral catheter is removed. The output from the ureteral catheter is measured and recorded separately, and irrigation, if performed, is not done on a regular schedule and is not more than 5 mL.

DIF: Cognitive Level: Application REF: p. 903 OBJ: 2
TOP: Ureteral Catheter KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

4. What is true about the urine osmolality when the kidney is adequately functioning?
a. Equal to the osmolality of the serum
b. Approximately half of the serum
c. In a ratio of 10:1 with the serum
d. Equal to the excretion of urea
ANS: A
If the blood osmolality is high, the kidneys need to dilute the blood and excrete more concentrated urine, and the reverse is true. The osmolality of the serum and the urine should be equal.

DIF: Cognitive Level: Comprehension REF: p. 885 OBJ: 2
TOP: Kidney Function Tests KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

5. Which urine test provides the most accurate measurement of renal function?
a. BUN
b. Phosphates
c. Specific gravity
d. Creatinine
ANS: D
Creatinine is not affected by diet, hydration, or liver function and is a better measurement of liver function than the BUN.

DIF: Cognitive Level: Knowledge REF: p. 896 OBJ: 2
TOP: Creatinine KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

6. A nurse is caring for a patient after urinary diversion surgery. What postoperative nursing assessment is the priority?
a. Level of fluid intake
b. Position on the left side
c. Keep the bed flat
d. Bowel sounds
ANS: D
The bowel is manipulated during urinary diversion surgeries and frequently leads to the patient with a paralytic ileus.

DIF: Cognitive Level: Application REF: p. 903 OBJ: 6
TOP: Urinary Diversion KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

7. A nurse is performing frequent catheterizations for residual urine. What causes the greatest concern for the nurse?
a. Introduction of pathogens into the bladder
b. Frequent genital exposure of the patient
c. Presence of the indwelling catheter
d. Causing urethral erosion
ANS: A
The frequency of introducing a catheter into the bladder offers a very real risk of infection.

DIF: Cognitive Level: Application REF: p. 902 OBJ: 3
TOP: Urinary Catheterization KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

8. A patient has a nephrostomy tube that has been inserted because of an obstruction in the ureter. What special precautions in the care of the nephrostomy tube should the nurse implement?
a. Clamping every 2 hours to allow expansion of the kidney pelvis
b. Instilling no more than 50 mL of sterile water if sterile irrigations are ordered
c. Being certain the tube is connected, not kinked, or not clamped to ensure that it continually drains
d. Leaving the nephrostomy site open to air
ANS: C
Because of the small capacity of the renal pelvis, drainage must be continuous; otherwise, the urine may back up and destroy the kidney.

DIF: Cognitive Level: Application REF: p. 903 OBJ: 4
TOP: Nephrostomy Tube KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

9. A patient comes to the medical clinic with complaints of urgency, frequency, pain in the area of the symphysis pubis, and dark cloudy urine. What should the nurse suspect that this patient has?
a. Urinary calculi, probably located in the ureter
b. Kidney infection, most likely pyelonephritis
c. Cystitis, probably from bacterial contamination
d. Interstitial cystitis (although rare in a male patient)
ANS: C
Cystitis causes urgency, dysuria, and pain behind the symphysis pubis. Cystitis is usually caused by bacterial infection.

DIF: Cognitive Level: Analysis REF: p. 908 OBJ: 5
TOP: Urinary Tract Infection KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. A patient who has cystitis has been told to drink at least 30 mL for each kilogram of body weight. Her weight is 154 lb. How many mL/day should the nurse instruct the patient to drink?
a. 1500
b. 2100
c. 2700
d. 3100
ANS: B
154 lb 2.2 lb/kg = 70 kg; 70 kg 30 mL = 2100 mL.

DIF: Cognitive Level: Analysis REF: p. 909 OBJ: 4
TOP: Cystitis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

11. A home health patient diagnosed with cystitis has been prescribed the medication phenazopyridine (Pyridium). When providing patient teaching, what should the nurse caution the patient about?
a. Staying out of the heat
b. Nausea
c. Staining of clothing
d. Skin rash
ANS: C
Pyridium causes the urine to be a bright orange color, which can stain clothing.

DIF: Cognitive Level: Comprehension REF: p. 909 OBJ: 6
TOP: Urinary Drugs KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. A nurse is collecting data from a hospital patient who has been admitted with pyelonephritis. He is acutely ill with a high fever, chills, nausea, and vomiting. He also has severe pain in the flank area. What is the primary goal of treatment?
a. Provide adequate nutrition with a stable body weight.
b. Provide adequate hydration with pulse and blood pressure within patient norms.
c. Give pain relief with analgesics and antispasmodics.
d. Prevent further damage to his kidneys that could lead to renal failure.
ANS: D
Pyelonephritis can cause scarring of the renal parenchyma and result in atrophy of the affected kidney, which means the kidney is failing.

DIF: Cognitive Level: Application REF: p. 910 OBJ: 6
TOP: Pyelonephritis KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

13. What is the usual cause of the autoimmune disease of acute glomerulonephritis?
a. Frequent cystitis
b. Streptococcal infection
c. Childhood disease of mumps
d. Recent wound infection
ANS: B
The cause is an upper respiratory infection caused by a beta-hemolytic Streptococcus.

DIF: Cognitive Level: Comprehension REF: p. 911 OBJ: 5
TOP: Acute Glomerulonephritis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

14. A nurse is caring for a patient with acute glomerulonephritis. What should the nurse be aware that the inflammation of the capillary loops in the glomeruli will lead to?
a. Moderate to high blood pressure
b. Low blood volume with polyuria
c. Irritability and hyperactivity
d. Low levels of BUN and creatinine
ANS: A
The inflammatory process in the glomeruli decreases the filtration rate, and the blood volume increases, raising the patients blood pressure.

DIF: Cognitive Level: Comprehension REF: p. 911-912 OBJ: 5
TOP: Acute Glomerulonephritis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

15. A 16-year-old patient with acute glomerulonephritis complains of boredom with bed rest and asks when he can become more active. He asks, What has to happen for me to get off of bed rest? What is the most accurate statement by the nurse?
a. Dialysis starts.
b. The antibiotic protocol is completed.
c. Potassium levels are normal.
d. Blood pressure drops to normal levels.
ANS: D
Bed rest, when ordered, is for the protection of the patient because of high blood pressure. Bed rest will continue until the treatment causes diuresis and a drop in the blood pressure.

DIF: Cognitive Level: Application REF: p. 912 OBJ: 6
TOP: Glomerulonephritis with Bed Rest KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Physiological Adaptation

16. What discharge teaching is appropriate for the nurse to provide to a patient who has had a lithotripsy?
a. Check for edema of the legs and ankles.
b. Watch for stone debris in the urine in 1 to 4 weeks.
c. Decrease fluid intake to 1000 mL/day.
d. Remain on restricted activity for a week.
ANS: B
The stones that have shattered with the sound waves will show up as debris in 1 to 4 weeks. Fluid intake is encouraged, and activity is resumed the next day. Edema is not a concern.

DIF: Cognitive Level: Application REF: p. 913-914 OBJ: 5
TOP: Extracorporeal Shock Wave Lithotripsy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

17. Which outcome is most necessary for a patient diagnosed with renal calculi?
a. Patient states an awareness of signs and symptoms of kidney stones and knows where to find pain relief.
b. Patient will measure intake and output so that they will be approximately equal.
c. Patient will avoid infections and situations that would increase stress.
d. Patient is able to describe measures to prevent recurrence of calculi.
ANS: D
Recurrence of renal calculi is common. The patient needs to possess the information necessary to understand the formation of stones to reduce the risk of their recurrence.

DIF: Cognitive Level: Application REF: p. 914-915 OBJ: 6
TOP: Renal Calculi KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

18. A nurse is caring for a patient with an atrioventricular (AV) fistula in the forearm and assesses that a trill is absent when palpating the venous side of the fistula. What action should the nurse implement?
a. Inject the ordered amount of heparin into the fistula.
b. Apply warm compresses and lower the arm below the heart level.
c. Send the patient to dialysis for remedy.
d. Report to the charge nurse that the fistula is occluded.
ANS: D
If the trill is absent, the fistula is occluded and should be reported. Dialysis is not possible with the occlusion. Injecting the shunt is not in the scope of practice of the licensed practical nurse (LPN). Warm compresses are not helpful.

DIF: Cognitive Level: Application REF: p. 929-930 OBJ: 5
TOP: Occluded Fistula KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

19. A patient on dialysis asks why he is receiving aluminum hydroxide gel (Amphojel), a phosphate binder, for his renal disorder. What should the nurse explain regarding the action of that Amphojel?
a. Calms the frequent upset stomach experienced by patients on dialysis
b. Binds with phosphorus to increase the serum calcium level
c. Increases the appetite
d. Corrects the pH of the bowel
ANS: B
Amphojel binds phosphorus, which increases the serum calcium level and decreases hypocalcemia.

DIF: Cognitive Level: Comprehension REF: p. 905 | p. 927
OBJ: 4 TOP: Use of Aluminum Hydroxide Gel in Patients on Dialysis
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

20. Which statement by a patient on dialysis, taking gentamicin (Garamycin), should cause the nurse the most concern?
a. I have a horrible headache.
b. Speak up! I cant hear you.
c. Ive had diarrhea once or twice today.
d. Im thirsty. I cant get enough water.
ANS: B
Garamycin is ototoxic. Indication of hearing impairment suggests drug toxicity.

DIF: Cognitive Level: Comprehension REF: p. 905 OBJ: 2
TOP: Garamycin KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

21. A family member of a patient who has returned to the special unit after renal transplantation is alarmed by blood in the urine of the patient. What is the nurses best explanation when explaining the reason for hematuria in this patient?
a. It is related to the immunosuppressant drugs taken before transplantation.
b. It is a normal postoperative expectation.
c. It is caused by dye injected during surgery.
d. It is caused by a small vessel that may be bleeding but will coagulate as urine flow increases.
ANS: B
Blood in the urine is an expected postoperative expectation and will gradually clear up.

DIF: Cognitive Level: Comprehension REF: p. 936 OBJ: 5
TOP: Postoperative Care for Transplant Recipients
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. A 10-year-old boy tells a nurse that he wants to give his kidney to his grandfather. How many years of age should the nurse explain that kidney donors must be?
a. At least 14 years old
b. At least 16 years old
c. At least 18 years old
d. At least 21 years old
ANS: C
The donor must be at least 18 years old, have no systemic disease, and have normal renal function.

DIF: Cognitive Level: Knowledge REF: p. 934 OBJ: 1
TOP: Kidney Donor KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

23. Erythropoietin is a hormone produced by the kidney. What will a deficiency of erythropoietin in a patient in chronic renal failure result in?
a. Diminished immunologic function with fewer white blood cells
b. Elevated lipid levels in the bloodstream, contributing to accelerated atherosclerosis
c. Anemia as a result of the diminished number of red blood cells being produced
d. Hypertension as a result of the increased, concentrated blood volume
ANS: C
Erythropoietin is excreted by the kidneys and stimulates bone marrow to produce red blood cells.

DIF: Cognitive Level: Comprehension REF: p. 894 OBJ: 5
TOP: Erythropoietin KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

24. A patient with chronic renal failure is to begin renal dialysis treatment and asks for advice about which type of dialysis would be best. The patient is considering peritoneal dialysis because it is less expensive and has fewer dietary and fluid restrictions. What is the most accurate information for the nurse to provide about peritoneal dialysis?
a. It has literally no drawbacks.
b. It gives more independence and more closely resembles normal kidney function.
c. It is a lot more work than hemodialysis, in which the health care staff takes care of everything.
d. It usually does not work very well and has many complications, such as a high blood sugar level.
ANS: B
Peritoneal dialysis increases independence and resembles normal kidney function. It can be performed in any hospital or at home.

DIF: Cognitive Level: Comprehension REF: p. 930-931 OBJ: 5
TOP: Peritoneal Dialysis KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

25. Why are patients diagnosed with chronic renal failure and on dialysis prone to injury?
a. Bone demineralization and peripheral neuropathy
b. Fatigue and drug side effects
c. Impaired immune response and malnutrition
d. Multiple life changes and hormone deficiencies
ANS: A
Loss of calcium from the bones leaves them weak, and the lack of sensation in the hands and feet leaves patients with a lack of proprioception. Realizing these factors, the nurse can draw up implementations to help prevent injuries.

DIF: Cognitive Level: Knowledge REF: p. 928 OBJ: 6
TOP: Chronic Renal Failure KEY: Nursing Process Step: Nursing Diagnosis
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

26. A nurse assesses a Grey Turner sign in a patient who was admitted 2 days earlier after an automobile accident. What does this finding indicate?
a. Retroperitoneal bleeding and bruising over the flank
b. Hematuria with abdominal bruising
c. Distended bladder with painful urination
d. Bladder spasms on palpation of abdomen
ANS: A
The Grey Turner sign is bruising over the flank and retroperitoneal bleeding. This is observed in blunt trauma to the kidney.

DIF: Cognitive Level: Comprehension REF: p. 918 OBJ: 1
TOP: Grey Turner Sign KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

MULTIPLE RESPONSE

27. A nurse is planning the care for an older adult patient. Which age-related changes in kidney function should the nurse consider when providing care to this patient? (Select all that apply.)
a. Thinning of nephron membranes
b. Sclerosis of renal blood vessels
c. Decreasing glomerular filtrations
d. Decreasing ability to concentrate or dilute urine
e. Decreasing erythropoietin
ANS: B, C, D, E
Sclerosis of renal blood vessels, decreasing glomerular filtration, decreasing ability to concentrate urine, and decreasing erythropoietin are associated with aging.

DIF: Cognitive Level: Knowledge REF: p. 894 OBJ: 6
TOP: Age-Related Changes to the Kidney
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

28. A nurse is caring for a patient with a Foley catheter. What actions should the nurse implement to decrease this patients risk for infection? (Select all that apply.)
a. Keep the bag below the level of the bed.
b. Provide perineal care twice a day.
c. Flushing the tubing as needed.
d. Using standard precautions when handling urine and tubing.
e. Keep the drainage system open.
ANS: A, B, D
Keeping the bag below the level of the bed, providing perineal care twice daily, and using standard precautions will assist in decreasing infection risk. Tubing is only flushed with a physicians order if required. The drainage system should be closed.

DIF: Cognitive Level: Application REF: p. 902-903 OBJ: 4
TOP: Foley Catheter KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

29. A female patient reports very painful urethritis. What should the home health care nurse question the patient about the use of? (Select all that apply.)
a. Bubble bath
b. Vitamin preparations
c. Herbal remedies
d. Vaginal sprays
e. Exercise machines
ANS: A, D
Bath additives and vaginal sprays are causative for urethritis. Vitamins, herbal preparations, and exercise machinery are noncontributory.

DIF: Cognitive Level: Comprehension REF: p. 908 OBJ: 1
TOP: Urethritis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

30. A nurse reads the serum calcium laboratory report of a patient as 4.2 mEq/L. Which symptoms should the nurse anticipate that the patient might exhibit? (Select all that apply.)
a. Irritability
b. Tingling sensations in limbs
c. Tetany
d. Nausea
e. Visual disturbances
ANS: A, B, C
Symptoms of hypocalcemia include irritability, tingling sensations, tetany, muscle twitching, and muscle contractions.

DIF: Cognitive Level: Comprehension REF: p. 927 OBJ: 5
TOP: Hypocalcemia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

COMPLETION

31. The major risk of peritoneal dialysis is _____.

ANS:
peritonitis
Peritonitis is the major risk of peritoneal dialysis.

DIF: Cognitive Level: Comprehension REF: p. 930 OBJ: 5
TOP: Risk of Peritoneal Dialysis KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

32. A nurse is aware that if a ureter is blocked by a kidney stone, the urine backs up into the kidney, causing _____.

ANS:
hydronephrosis
Hydronephrosis results when a ureter is obstructed and urine backs up into the pelvis of the kidney. If unrelieved, this condition will require the removal of the kidney.

DIF: Cognitive Level: Comprehension REF: p. 917 OBJ: 5
TOP: Topic: Hydronephrosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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