Unit 8 Med Surg Nursing Quiz 1.

How will the nurse assess the flank area of a patient with pyelonephritis for tenderness?

a. Push gently into the two lowest intercostal spaces. b. Palpate along both sides of the lumbar vertebral column. c. Position one hand flat at the costovertebral angle (CVA) and strike it with the other

fist.
d. Use two fingers to percuss the area between the iliac crest and ribs along the

midaxillary line.
ANS: C

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. 2.
a. b. c. d.

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

ANS: B

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.
ANS: A

3.
a. b. c. d.

A patient with nephrotic syndrome develops flank pain. The nurse will anticipate teaching the patient about treatment with antibiotics. anticoagulants. corticosteroids. antihypertensives.

ANS: B

Flank pain in a patient with nephrosis suggests a renal vein thrombosis, and anticoagulation is needed. Antibiotics are used to treat a patient with flank pain caused by pyelonephritis. Antihypertensives are used if the patient has high blood pressure. Corticosteroids may be used to treat nephrotic syndrome but will not resolve a thrombosis. 4. 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 ANS: A

The patient has massive edema, so the priority problem at this time is the excess fluid volume. The other nursing diagnoses also are appropriate, but the focus of nursing care should be resolution of the edema and ascites 5.
a. b. c. d.

When reading a patient’s chart, the nurse notes that the patient has dysuria. To assess whether there is any improvement, which question will the nurse ask? “Do you have any blood in your urine?” “Do you have to urinate very frequently?” “Do you have any pain when you urinate?” “Do you have to get up at night to urinate?”

ANS: C

Dysuria is painful urination. The alternate responses are used to assess other urinary tract symptoms: hematuria, nocturia, and frequency. 6.
a. b. c. d.

While assessing a patient’s urinary system, the nurse cannot palpate either kidney. Which action should the nurse take next? Obtain a urine specimen to check for hematuria. Document the information on the assessment form. Ask the patient about any history of recent sore throat. Ask the health care provider about scheduling a renal ultrasound.

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. 7.
a. b. c. d.

The result of a patient’s creatinine clearance test is 60 mL/min. The nurse equates this finding to a glomerular filtration rate (GFR) of _____ mL/min. 30 60 120 240

ANS: B

The creatinine clearance approximates the GFR. The other responses are not accurate. 8. The nurse uses auscultation during assessment of the urinary system to

a. check for ureteral peristalsis. b. assess for bladder distention.

c. identify renal artery or aortic bruits. d. determine the position of the kidneys. ANS: C

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. 9.
a. b. c. d.

When reviewing the results of a patient’s urinalysis, which information indicates that the nurse should notify the health care provider? pH 6.2 Trace protein WBC: 20-26/hpf Specific gravity: 1.021

ANS: C

10.
a. b. c. d.

A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for vasodilation. poor skin turgor. bounding pulses. rapid respirations.

ANS: D

Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AK 11.
a. b. c. d.

When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula? Check the fistula site for a bruit and thrill. Assess the rate and quality of the left radial pulse. Compare blood pressures in the left and right arms. Irrigate the fistula site with saline every 8 to 12 hours.

ANS: A

The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula. 12. A patient in the oliguric phase of acute renal failure has a 24-hour fluid output of 150 mL emesis and 250 mL urine. The nurse plans a fluid replacement for the following day of ___ mL. a. 400 b. 800 c. 1000

d. 1400 ANS: C

Usually fluid replacement should be based on the patient’s measured output plus 600 mL/day for insensible losses. 13. A patient with renal insufficiency is scheduled for an intravenous pyelogram (IVP). Which of the following orders for the patient will the nurse question? a. Ibuprofen (Advil) 400 mg PO PRN for pain b. Dulcolax suppository 4 hours before IVP procedure c. Normal saline 500 ml IV before procedure d. NPO for 6 hours before IVP procedure,

Answer: A Rationale: The contrast dye used in IVPs is nephrotoxic, and concurrent use of other nephrotoxic medications such as the NSAIDs should be avoided. The suppository and NPO status are necessary to ensure that adequate visualization during the IVP. IV fluids are used to ensure adequate hydration, which helps reduce the risk for contrast-induced renal failure. 14. A diabetic patient is admitted for evaluation of renal function because of recent fatigue, weakness, and elevated BUN and serum creatinine levels. While obtaining a nursing history, the nurse identifies an early symptom of renal insufficiency when the patient states, a. "I get up several times every night to urinate." b. "I wake up in the night feeling short of breath." c. "My memory is not as good as it used to be." d. "My mouth and throat are always dry and sore."

Answer: A Rationale: Polyuria occurs early in chronic kidney disease (CKD) as a result of the inability of the kidneys to concentrate urine. The other symptoms would be expected later in the progression of CKD. 15.
a. b. c. d.

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? Dysuria Hematuria Left-sided flank pain Temperature 100.1° F

ANS: C

Flank pain indicates that the patient may have developed pyelonephritis as a complication of the bladder infection. The other clinical manifestations are consistent with a lower urinary tract infection (UTI). 16. A client with a urinary tract infection is ordered to receive phenazopyridine hydrochloride (Pyridium) as a urinary analgesic. What information will client teaching include? a. The medication has a high rate of adverse reactions. b. Discolored urine is evidence of an anaphylactic reaction.

c. Side effects such as nausea, vomiting, and diarrhea must be reported. d. The medication will prevent future urinary tract infections. ANS: C The drug can produce gastrointestinal disturbances in the client receiving treatment 17. An older adult client with stress incontinence is ordered to receive tolterodine tartrate (Detrol). The nurse anticipates that treatment with this medication will result in: a. decreased urination. b. decreased urinary discomfort. c. prevention of urinary tract infection. d. control of an overactive bladder. ANS: D Control of an overactive bladder is the function of this medication. 18. Many of the urinary antiseptics work best with a specific urine pH. What are the optimal pH and a method to achieve this pH? a. pH of 4.8, treatment with vitamin C b. pH of 6.0, treatment with cranberry juice c. pH of 6.1, treatment with milk d. pH of 5.5, treatment with antacids ANS: A The acid pH of 4.8 is optimal. Treatment with vitamin C is the best way to ensure acid-ash urine.

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