Chapter 46: Nursing Management: Renal and Urologic Problems
Test Bank

MULTIPLE CHOICE

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. |

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

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.” |

2. The nurse determines that instruction regarding prevention of future urinary tract infections (UTIs) for a patient with cystitis has been effective when the patient states,
|a. |“I can use vaginal 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.” |

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. |

3. Which information will the nurse include when teaching the patient with a urinary tract infection (UTI) about the use of phenazopyridine (Pyridium)?
|a. |Take the medication for at least 7 days. |
|b. |Use sunscreen while taking the Pyridium. |
|c. |The urine may turn a reddish-orange color. |
|d. |Use the Pyridium before sexual intercourse. |

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 |

4. A 72-year-old who has benign prostatic hyperplasia is admitted to the hospital with chills, fever, and vomiting. Which finding by the nurse will be most helpful in determining whether the patient has an upper urinary tract infection (UTI)?
|a. |Suprapubic pain |
|b. |Bladder distention |
|c. |Foul-smelling urine |
|d. |Costovertebral tenderness |

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.” |

5. After teaching a patient with interstitial cystitis about management of the condition, the nurse determines that further instruction is needed when the patient says,
|a. |“I will have to stop having coffee and orange juice for breakfast.” |
|b. |“I should start taking a high potency multiple vitamin every morning.” |
|c. |“I will buy some calcium glycerophosphate (Prelief) at the pharmacy.” |
|d. |“I should call the doctor about increased bladder pain or odorous urine.” |

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. |

6. When admitting a patient with acute glomerulonephritis, it is most important that the nurse ask the patient about
|a. |recent sore throat and fever. |
|b. |history of high blood pressure. |
|c. |frequency of bladder infections. |
|d. |family history of kidney stones. |

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. |

7. Which finding by the nurse for a patient admitted with glomerulonephritis indicates that treatment has been effective?
|a. |The patient denies pain with voiding. |
|b. |The urine dipstick is negative for nitrites. |
|c. |Peripheral and periorbital edema is resolved. |
|d. |The antistreptolysin-O (ASO) titer is decreased. |

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. |

8. A patient with nephrotic syndrome develops flank pain. The nurse will anticipate teaching the patient about treatment with
|a. |antibiotics. |
|b. |anticoagulants. |
|c. |corticosteroids. |
|d. |antihypertensives. |

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 |

9. A patient is admitted to the hospital with new onset nephrotic syndrome. Which assessment data will the nurse expect to find related to this illness?
|a. |Poor skin turgor |
|b. |High urine ketones |
|c. |Recent weight gain |
|d. |Low blood pressure |

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. |

10. A patient’s renal calculus is analyzed as being very high in uric acid. To prevent recurrence of stones, the nurse teaches the patient to avoid eating
|a. |milk and dairy products. |
|b. |legumes and dried fruits. |
|c. |organ meats and sardines. |
|d. |spinach, chocolate, and tea. |

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. |

11. To prevent the recurrence of renal calculi, the nurse teaches the patient to
|a. |use a filter to strain all urine. |
|b. |avoid dietary sources of calcium. |
|c. |drink diuretic fluids such as coffee. |
|d. |have 2000 to 3000 mL of fluid a day. |

12. When planning teaching for a 59-year-old male patient with benign nephrosclerosis the nurse should include instructions regarding
|a. |preventing bleeding with anticoagulants. |
|b. |monitoring and recording blood pressure. |
|c. |obtaining and documenting daily weights. |
|d. |measuring daily intake and output volumes. |

12. When planning teaching for a patient with benign nephrosclerosis the nurse should include instructions regarding
|a. |monitoring and recording blood pressure. |
|b. |obtaining and documenting daily weights. |
|c. |measuring daily intake and output amounts. |
|d. |preventing bleeding caused by anticoagulants. |

13. A 28-year-old male patient is diagnosed with polycystic kidney disease. Which information is most appropriate for the nurse to include in teaching at this time?
|a. |Complications of renal transplantation |
|b. |Methods for treating severe chronic pain |
|c. |Discussion of options for genetic counseling |
|d. |Differences between hemodialysis and peritoneal dialysis |

13. A 32-year-old patient is diagnosed with polycystic kidney disease. Which information is most appropriate for the nurse to include in teaching at this time?
|a. |Importance of genetic counseling |
|b. |Complications of renal transplantation |
|c. |Methods for treating chronic and severe pain |
|d. |Differences between hemodialysis and peritoneal dialysis |

14. 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. |

14. When assessing a 30-year-old man who complains of a feeling of incomplete bladder emptying and a split, spraying urine stream, the nurse asks about a history of
|a. |bladder infection. |
|b. |recent kidney trauma. |
|c. |gonococcal urethritis. |
|d. |benign prostatic hyperplasia. |

15. 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. |

15. After obtaining the health history for a 25-year-old who smokes two packs of cigarettes daily, the nurse will plan to do teaching about the increased risk for
|a. |kidney stones. |
|b. |bladder cancer. |
|c. |bladder infection. |
|d. |interstitial cystitis. |

16. 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. |

16. A 78-year-old who has been 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. |Apply absorbent incontinent pads. |
|b. |Restrict fluids after the evening meal. |
|c. |Insert an indwelling catheter until the symptoms have resolved. |
|d. |Assist the patient to the bathroom every 2 hours during the day. |

17. 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. |

17. A 62-year-old 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. |

18. 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. |

18. Following rectal surgery, a patient voids about 50 mL of urine every 30 to 60 minutes. Which nursing action is most appropriate?
|a. |Use an ultrasound scanner to check the postvoiding residual. |
|b. |Monitor the patient’s intake and output over the next few hours. |
|c. |Have the patient take small amounts of fluid frequently throughout the day. |
|d. |Reassure the patient that this is normal after rectal surgery because of anesthesia. |

19. 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. |

19. A patient in the hospital has a history of functional urinary incontinence. Which nursing action will be included in the plan of care?
|a. |Place a bedside commode near the patient’s bed. |
|b. |Demonstrate the use of the Credé maneuver to the patient. |
|c. |Use an ultrasound scanner to check postvoiding residuals. |
|d. |Teach the use of Kegel exercises to strengthen the pelvic floor. |

20. 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.” |

20. After 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 use a sterile catheter and gloves for each time I self-catheterize.” |
|b. |“I will clean the catheter carefully before and after each catheterization.” |
|c. |“I will need to buy seven new catheters weekly and use a new one every day.” |
|d. |“I will need to take prophylactic antibiotics to prevent any urinary tract infections.” |

21. 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. |

21. Which action will the nurse include in the plan of care for a patient who has had a ureterolithotomy and has a left ureteral catheter and a urethral catheter in place?
|a. |Provide education about home care for both catheters. |
|b. |Apply continuous steady tension to the ureteral catheter. |
|c. |Clamp the ureteral catheter unless output from the urethral catheter stops. |
|d. |Call the health care provider if the ureteral catheter output drops suddenly. |

22. A 68-year-old male patient who has bladder cancer had a cystectomy with creation of an Indiana pouch. Which topic will be included in patient teaching?
|a. |Application of ostomy appliances |
|b. |Barrier products for skin protection |
|c. |Catheterization technique and schedule |
|d. |Analgesic use before emptying the pouch |

22. A patient who has bladder cancer had a cystectomy with creation of an Indiana pouch. Which topic will be included in patient teaching?
|a. |Application of ostomy appliances |
|b. |Catheterization technique and schedule |
|c. |Analgesic use before emptying the pouch |
|d. |Use of barrier products for skin protection |

23. A patient who had surgery for creation of an ileal conduit 3 days ago will not look at the stoma and requests that only the ostomy nurse specialist does the stoma care. The nurse identifies a nursing diagnosis of
|a. |anxiety related to effects of procedure on lifestyle. |
|b. |disturbed body image related to change in function. |
|c. |readiness for enhanced coping related to need for information. |
|d. |self-care deficit, toileting, related to denial of altered body function. |

23. Two days after surgery for an ileal conduit, the patient will not look at the stoma or participate in care. The patient insists that no one but the ostomy nurse specialist care for the stoma. The nurse identifies a nursing diagnosis of
|a. |anxiety related to effects of procedure on lifestyle. |
|b. |disturbed body image related to change in body function. |
|c. |readiness for enhanced coping related to need for information. |
|d. |self-care deficit, toileting, related to denial of altered body function. |

24. 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. |

24. A patient who has had a transurethral resection with fulguration for bladder cancer 3 days previously calls the nurse at the urology clinic. Which information given by the patient is most important to report to the health care provider?
|a. |The patient is using opioids for pain. |
|b. |The patient has noticed clots in the urine. |
|c. |The patient is very anxious about the cancer. |
|d. |The patient is voiding every 4 hours at night. |

25. 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. |

25. A patient with bladder cancer is scheduled for intravesical chemotherapy. In preparation for the treatment the nurse will teach the patient about
|a. |premedicating to prevent nausea. |
|b. |where to obtain wigs and scarves. |
|c. |the importance of oral care during treatment. |
|d. |the need to empty the bladder before treatment. |

26. 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 |

26. Which nursing action will be most helpful in decreasing the risk for hospital-acquired infection (HAI) of the urinary tract in patients admitted to the hospital?
|a. |Avoid unnecessary catheterizations. |
|b. |Encourage adequate oral fluid intake. |
|c. |Test urine with a dipstick daily for nitrites. |
|d. |Provide thorough perineal hygiene to patients. |

27. 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 |

27. When assessing the patient who has a lower urinary tract infection (UTI), the nurse will initially ask about
|a. |nausea. |
|b. |flank pain. |
|c. |poor urine output. |
|d. |pain with urination. |

28. 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) |

28. 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. |Foul-smelling urine |
|b. |Complaint of flank pain |
|c. |Blood pressure 88/45 mm Hg |
|d. |Temperature 100.1° F (57.8° C) |

29. 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 |

29. A patient who is diagnosed with nephrotic syndrome has 3+ ankle and leg edema and ascites. Which nursing diagnosis is a priority for the patient?
|a. |Excess fluid volume related to low serum protein levels |
|b. |Activity intolerance related to increased weight and fatigue |
|c. |Disturbed body image related to peripheral edema and ascites |
|d. |Altered nutrition: less than required related to protein restriction |

30. 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. |

30. An 88-year-old with benign prostatic hyperplasia (BPH) has a markedly distended bladder and is agitated and confused. Which of the following interventions prescribed by the health care provider should the nurse implement first?
|a. |Insert a urinary retention catheter. |
|b. |Schedule an intravenous pyelogram. |
|c. |Administer lorazepam (Ativan) 0.5 mg PO. |
|d. |Draw blood for blood urea nitrogen (BUN) and creatinine testing. |

31. 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. |

31. A patient with renal calculi is hospitalized with gross hematuria and severe colicky left flank pain. Which nursing action will be of highest priority at this time?
|a. |Encourage oral fluid intake. |
|b. |Administer prescribed analgesics. |
|c. |Monitor temperature every 4 hours. |
|d. |Give antiemetics as needed for nausea. |

32. 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). |

32. Which nursing action should the nurse who is caring for a patient who has had an ileal conduit for several years delegate to nursing assistive personnel (NAP)?
|a. |Assess for symptoms of urinary tract infection (UTI). |
|b. |Change the ostomy appliance. |
|c. |Choose the appropriate ostomy bag. |
|d. |Monitor the appearance of the stoma. |

33. 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 |

33. When the nurse is caring for a patient who has had left-sided extracorporeal shock wave lithotripsy, which assessment finding is most important to report to the health care provider?
|a. |Blood in urine |
|b. |Left flank pain |
|c. |Left flank bruising |
|d. |Drop in urine output |

34. 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. |

34. Following an open loop resection and fulguration of the bladder, a patient is unable to void. Which nursing action should be implemented first?
|a. |Insert a straight catheter and drain the bladder. |
|b. |Assist the patient to take a 15-minute sitz bath. |
|c. |Encourage the patient to drink several glasses of water. |
|d. |Teach the patient how to do isometric perineal exercises. |

35. 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 |

35. The nurse observes nursing assistive personnel (NAP) taking the following actions when caring for a patient with a retention 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. |Using an alcohol-based hand cleaner before performing catheter care |
|d. |Disconnecting the catheter from the drainage tube to obtain a specimen |

36. 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. |

36. A patient undergoes a nephrectomy after having massive trauma to the kidney. Which assessment finding obtained postoperatively is most important to communicate to the surgeon?
|a. |Blood pressure is 102/58. |
|b. |Incisional pain level is 8/10. |
|c. |Urine output is 20 mL/hr for 2 hours. |
|d. |Crackles are heard at both lung bases. |

37. 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 |

37. Which assessment finding for a patient who has had a cystectomy with an ileal conduit the previous day 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 drainage from stoma |

38. 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. |

38. A 26-year-old patient with a history of polycystic kidney disease is admitted to the surgical unit after having knee 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. |Obtain blood urea nitrogen (BUN), creatinine, and electrolytes in 2 hours. |

39. 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 |

39. Which information noted by the nurse when caring for a patient with a bladder infection is most important to report to the health care provider?
|a. |Dysuria |
|b. |Hematuria |
|c. |Left-sided flank pain |
|d. |Temperature 100.1° F |

40. 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). |

41. 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. |

42. Which information about a patient with Goodpasture syndrome requires the most rapid action by the nurse?
|a. |Blood urea nitrogen level is 70 mg/dL. |
|b. |Urine output over the last 2 hours is 30 mL. |
|c. |Audible crackles bilaterally over the posterior chest to the midscapular level. |
|d. |Elevated level of antiglomerular basement membrane (anti-GBM) antibodies. |

43. 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. |

44. 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 |

MULTIPLE RESPONSE

1. A patient has been diagnosed with urinary tract calculi that are high in uric acid. Which foods will the nurse teach the patient to avoid (select all that apply)?
|a. |Milk |
|b. |Liver |
|c. |Spinach |
|d. |Chicken |
|e. |Cabbage |
|f. |Chocolate |