Test bank for medical surgical nursing in canada 2nd edition by lewis

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Test Bank for Medical Surgical Nursing in Canada 2nd
Edition by Lewis
Chapter 46: Nursing Assessment: Urinary System
Test Bank
MULTIPLE CHOICE
1. When reading a client’s chart, the nurse notes that the client has had dysuria. To assess
whether there is any improvement, which question will the nurse ask?
a. “Do you have any blood in your urine?”
b. “Do you have to get up at night to urinate?”
c. “Do you have any pain when you urinate?”
d. “Do you have to urinate very frequently?”

ANS: C
Dysuria is painful urination.
DIF: Cognitive Level: Analysis

REF: p. 1220 (Table 46-7)

2. When admitting a client who has a history of paraplegia as a result of a spinal cord injury,
the nurse will plan to do which of the following?
a. Check the client for urinary incontinence every 2 hours to maintain skin integrity.
b. Assist the client to the toilet on a scheduled basis to help ensure bladder emptying.
c. Use intermittent catheterization on a regular schedule to avoid the risk of infection.
d. Ask the client about the usual urinary pattern and measures used for bladder
control.

ANS: D
Before planning any interventions, the nurse should complete the assessment and

determine the client’s normal bladder pattern and the usual measures used by the client at
home.
DIF: Cognitive Level: Application

REF: p. 1217 (Table 46-4)

3. A client’s urine dipstick reveals a large amount of protein in the urine. What is the next
nursing action?
a. Check which medications the client is currently taking.
b. Ask the client about any family history of chronic renal failure.
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c. Send a urine specimen to the laboratory to test for ketones and glucose.
d. Obtain a clean-catch urine specimen for culture and sensitivity testing.

ANS: A
Normally, the urinalysis will show zero to trace amounts of protein, but some
medications may give false-positive readings.
DIF: Cognitive Level: Application

REF: p. 1221 (Table 46-8)

4. A creatinine clearance test is ordered for a hospitalized client with possible renal
insufficiency. Which equipment will the nurse need to obtain?
a. Foley catheter and drainage bag

b. Towelettes for perineal cleaning
c. Basin of ice
d. Sterile specimen cup

ANS: C
Creatinine clearance testing involves a 24-hour urine specimen collection. The urine
should be refrigerated or cooled, or a preservative should be used.
DIF: Cognitive Level: Application

REF: p. 1221 (Table 46-8)

5. A 20-year-old client who is employed as a hairdresser and has a 10-pack-year history of
cigarette smoking is scheduled for an annual physical examination. The nurse will plan to
teach the client about the increased risk for which of the following?
a. Bladder cancer
b. Renal failure
c. Pyelonephritis
d. Kidney stones

ANS: A
Exposure to the chemicals involved when working as a hairdresser and smoking both
increase the risk of bladder cancer, and the nurse should assess whether the client
understands this risk.
DIF: Cognitive Level: Application

REF: p. 1218

6. During assessment of a client with a disorder of the urinary system, the nurse identifies a
potentially nephrotoxic agent when the client reports the use of which of the following
drugs?

a. Anticoagulants
b. Vitamin supplements
c. Nonsteroidal anti-inflammatory drugs (NSAIDs)

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d. Prophylactic penicillin therapy

ANS: C
NSAIDs are nephrotoxic and should be avoided in clients with renal insufficiency.
DIF: Cognitive Level: Comprehension REF: p. 1216
7. When the nurse is planning care for an 82-year-old man, which of the following is an
appropriate intervention based on an understanding of age-related changes of the urinary
system?
a. Limit fluid intake to 1500 mL/day.
b. Leave a light on in the bathroom at night.
c. Ask the client to use a urinal so that all urine can be measured.
d. Provide diapers to absorb overflow incontinence and dribbling.

ANS: B

DIF: Cognitive Level: Application

REF: p. 1219

8. While assessing a client’s urinary system, the nurse cannot palpate either kidney. What is
the most appropriate interpretation of this finding?
a. It is a normal finding.
b. It is suggestive of hydronephrosis.
c. It is diagnostic for polycystic disease.
d. It indicates the presence of atrophied kidneys.

ANS: A
The kidneys are protected by the abdominal organs, ribs, and muscles of the back and
may not be palpable under normal circumstances, so it is a normal finding.
DIF: Cognitive Level: Comprehension REF: p. 1219
9. How will the nurse assess the flank area for tenderness?
a. Percuss the area between the iliac crest and ribs along the midaxillary line.
b. Palpate along both sides of the lumbar vertebral column.
c. Place one hand flat at the costovertebral angle (CVA) and strike it with the other
fist.
d. Push gently into the two lowest intercostal spaces.

ANS: C
This technique is performed by striking the fist (kidney punch) of one hand against the
dorsal surface of the other hand, which is placed flat along the posterior CVA margin.
Normally, a firm blow in the flank area should not elicit pain. If CVA tenderness and
pain are present, they may indicate a kidney infection or polycystic kidney disease.

Test Bank for Medical Surgical Nursing in Canada 2nd Edition by Lewis




DIF: Cognitive Level: Comprehension REF: p. 1219

10. The result of a client’s creatinine clearance test is 60 mL/min. The nurse equates this
finding to which of the following glomerular filtration rates (GFRs)?
a. 30 mL/min
b. 60 mL/min
c. 120 mL/min
d. 240 mL/min

ANS: B
The creatinine clearance approximates the GFR, in this case, 60 mL/min.
DIF: Cognitive Level: Comprehension REF: p. 1221 (Table 46-8)
11. For what purpose does the nurse use auscultation during assessment of the urinary
system?
a. To determine the position of the kidneys
b. To assess fluid wave patterns in the bladder
c. To determine the level of a distended bladder
d. To identify renal artery and abdominal aortic bruits

ANS: D
The presence of a bruit may indicate problems such as renal artery tortuosity or
abdominal aortic aneurysm.
DIF: Cognitive Level: Comprehension REF: p. 1219
12. When analyzing the results of a client’s urinalysis, the nurse recognizes that a urinary
tract infection is indicated by which of the following findings?
a. Protein 4+
b. Glucose 3+
c. White blood cell (WBC) count 20–26/hpf
d. Specific gravity 1.01

ANS: C
The increased number of WBCs indicates the presence of urinary tract infection or

inflammation.
DIF: Cognitive Level: Comprehension REF: p. 1224 (Table 46-9)

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13. A client with a possible renal cell tumour who is scheduled for an intravenous pyelogram
(IVP) and computed tomography (CT) scanning of the abdomen gives the nurse all the
following data. Which information has the most immediate implications for the client’s
care?
a. The client has not had anything to eat or drink for 8 hours.
b. The client used a bisacodyl (Dulcolax) tablet the previous night.
c. The client describes allergies to shellfish and penicillin.
d. The client complains of CVA tenderness.

ANS: C
Iodine-based contrast dye is used during IVP and for many CT scans. As with all contrast
studies, possible iodine and shellfish allergies should be determined before the study. The
nurse will need to notify the physician before the procedures so that the client can receive
medications such as antihistamines or corticosteroids before the procedures are started.
DIF: Cognitive Level: Application

REF: p. 1222 (Table 46-8)

14. When teaching a client scheduled for a cystogram via a cystoscope about the procedure,
which following statement would the nurse make to the client?
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 inject a dye into your
kidneys through little catheters inserted into the ureters.”
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 dye into a vein in your arm that is carried to the urinary
system. Then a lighted tube in your bladder will be used to see when the dye
appears.”

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.
DIF: Cognitive Level: Application

REF: p. 1226

15. The nurse should tell the client undergoing cystoscopy that which of the following will
occur following the procedure?
a. He will receive narcotics as necessary for pain.
b. He will be on nothing by mouth (NPO) status for 8 hours to prevent nausea and
vomiting.
c. He may experience blood-tinged urine and urinary frequency.
d. He will be on bedrest for 12 to 24 hours following the procedure.

Test Bank for Medical Surgical Nursing in Canada 2nd Edition by Lewis

ANS: C
Pink-tinged urine and urinary frequency are expected after cystoscopy. Burning on
urination is common, but pain that requires narcotics for relief is not expected.
DIF: Cognitive Level: Comprehension REF: p. 1226
16. A client with an elevated blood urea nitrogen (BUN) and serum creatinine is scheduled
for a renal arteriogram. The nurse should question an order from Radiology for which of
the following bowel preparations?
a. Castor oil
b. Fleet enema
c. Tap-water enemas
d. Bisacodyl (Dulcolax) tablets

ANS: B
High-phosphate enemas, such as Fleet enemas, should be avoided in clients with renal
insufficiency (as evidenced by an increased BUN and creatinine).
DIF: Cognitive Level: Comprehension REF: p. 1220
17. The physician orders a clean-catch urine specimen for culture and sensitivity testing for a
female client with a suspected urinary tract infection. When teaching the client to obtain
the specimen, what should the nurse instruct the client to do?
a. Sit on a bedpan, and after she starts to urinate, the nurse will catch the remaining
urine in a specimen cup.
b. Clean the urethral area, void a small amount into the toilet, and then void into a
sterile specimen cup.
c. Insert a short, small, “mini” catheter attached to a collecting container into the
urinary meatus to obtain urine for testing.
d. Wash the perineal area with soap and water, start the stream of urine, and then pass
a clean specimen cup into the urine flow to catch the remainder of the urine.

ANS: B
This answer describes the technique for obtaining a clean-catch specimen.
DIF: Cognitive Level: Comprehension REF: p. 1221 (Table 46-8)
18. A client who had a cystoscopy the previous day calls the urology clinic and gives the
nurse the following information. Which statement by the client should be reported
immediately to the physician?
a. “My urine still looks pink.”
b. “I did not sleep well last night.”
c. “I have a temperature of 39°C.”

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d. “My IV site is still bruised.”

ANS: C
The client’s elevated temperature may indicate a bladder infection, a possible
complication of cystoscopy. The physician should be notified so that antibiotic therapy
can be started.
DIF: Cognitive Level: Application

REF: p. 1226

19. A hospitalized client with renal insufficiency is scheduled to have an IVP. Which nursing
action will be needed during this procedure?
a. Assist with monitoring for conscious sedation.
b. Insert a large-size urinary catheter prior to the IVP.
c. Monitor the urinary output after the procedure.
d. Give oral contrast solution before the procedure.

ANS: C
Clients 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 client’s
urinary output.
DIF: Cognitive Level: Application

REF: p. 1222 (Table 46-8)

20. Following an IVP, all of these assessment data are obtained. Which one requires the
nurse’s immediate action?
a. The urinary output is 400 mL in the first 2 hours.
b. The client complains of a dry mouth.
c. The heart rate is 58 beats/min.
d. The respiratory rate is 38 breaths/min.

ANS: D
The increased respiratory rate indicates that the client may be experiencing an allergic
reaction to the contrast medium used during the procedure. The nurse should immediately
assess the client’s oxygen saturation and breath sounds.
DIF: Cognitive Level: Application

REF: p. 1227

21. A client with diabetic nephropathy is admitted for a right renal biopsy. Immediately after
the biopsy, which of these is an essential nursing action?
a. Check blood glucose to assess for hyperglycemia or hypoglycemia.
b. Obtain a urine specimen to check for hematuria.
c. Monitor the BUN and creatinine to assess renal function.
d. Place the client on the right side to put pressure on the site.

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ANS: D
The client is placed in a supine position to put pressure on the biopsy side and decrease
the risk for bleeding.
DIF: Cognitive Level: Application

REF: pp. 1223 (Table 46-8), 1226

Test Bank for Medical Surgical Nursing in Canada 2nd Edition by Lewis