Professional Documents
Culture Documents
Christensen
MULTIPLE CHOICE
1. The amount of water that is eliminated with the urine is regulated by a complex
mechanism within the nephron and influenced by a hormone from the posterior pituitary
gland called
a. pitocin.
b. rennin hormone.
c. antidiuretic hormone.
d. ACTH.
ANS: C
ADH causes the cells of the distal convoluted tubules to increase their rate of water
reabsorption.
2. As the body breaks down protein, nitrogen wastes are broken down into urea, ammonia,
and
a. nitrogen.
b. uric acid.
c. nitrates.
d. creatinine.
ANS: D
As proteins break down, nitrogenous wastes—urea, ammonia, and creatinine—are
produced.
3. Because the kidneys are located in proximity to the vertebrae and are protected by the
ribs, their location in documentation is referred to as
a. retroperitoneal.
b. diaphragm-vertebral.
c. costovertebral.
d. urachal-peritoneal.
ANS: A
The kidneys lie behind the parietal peritoneum (retroperitoneal).
DIF: Cognitive Level: Analysis REF: Page 472, Health Promotion box
OBJ: 7 TOP: Chronic renal failure (CRF)
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
5. Chronic renal failure (CRF) affects both patients and their families because of the
financial predicament and facing the death of a loved one. Which would be an
appropriate nursing intervention to address these concerns?
a. Encourage open discussion with social services.
b. Allow family privacy to resolve their issues.
c. Refer the family to a support group.
d. Have the physician speak to the family.
ANS: A
Encourage verbalization of financial concerns and long term care options with
representative from social services. Support groups are not designed to assist with
financial concerns.
DIF: Cognitive Level: Application REF: Page 472, Health Promotion box
OBJ: 12 TOP: Coping KEY: Nursing Process Step:
Implementation
MSC: NCLEX: Psychosocial Integrity
6. A nursing intervention to assist the patient with chronic renal failure (CRF) in learning
about available community resources would be a consultation with
a. a chaplain.
b. social services.
c. the physician’s office.
d. administrative services.
ANS: B
Patient teaching—inform the patient of community resources.
9. A 56-year-old patient with cancer of the bladder is recovering from a cystectomy with an
ileal conduit. An important aspect in nursing interventions of the patient with an ileal
conduit is
a. instructing the patient to void when the urge is felt.
b. maintenance of skin integrity.
c. prevention of tissue rejection.
d. limiting acid-ash foods.
ANS: B
Care of the patient with an ileal conduit is a nursing challenge because of the continual
drainage of urine through the stoma. Complication of this procedure is wound infection,
dehiscence, and urinary leakage.
11. In teaching a patient how to decrease the chance of further problems with urolithiasis,
barring any other contraindication, the nurse would encourage him to
a. increase his fluid intake.
b. avoid contact sports.
c. restrict his protein intake.
d. take one baby aspirin daily.
ANS: A
Fluid intake should be encouraged to at least 2,000 mL of fluid in 24 hours, unless
contraindicated.
12. The nurse notes the amount and color of the urine of the patient with urolithiasis. While
using standard precautions, the nurse’s next action would be to
a. discard the urine.
b. add the urine to a 24-hour collector.
c. save the urine for physician assessment.
d. strain the urine.
ANS: D
All urine should be strained. Because stones may be any size, even the smallest speck
must be saved for assessment.
13. When a patient on Lasix, a loop diuretic, complains of weakness and irregular pulse,
there may be an electrolyte deficiency of
a. magnesium.
b. sodium.
c. potassium.
d. calcium.
ANS: C
The loop diuretic prototype, furosemide (Lasix), affects electrolytes to cause
hypokalemia,
the deficiency of the electrolyte can cause arrhythmias and muscle weakness.
14. The patient is scheduled for a cystogram via a cystoscope. Which is the best explanation
of this procedure by the nurse?
a. “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 film.”
b. “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 is used to see when the dye appears.”
c. “Your doctor will insert a lighted tube into the bladder and inject a dye into your
kidneys through little catheters inserted into the ureters.”
d. “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.”
ANS: A
Cystoscopy is a visual examination to inspect, treat, or diagnose disorders of the urinary
bladder and proximal structures.
15. The physician orders a urinalysis and urine culture. To obtain the urine specimen, the
nurse would first instruct the patient about
a. collecting the urine for a 24 hour period.
b. obtaining a clean-catch specimen.
c. bringing in an early morning specimen.
d. limiting fluid intake to concentrate the urine.
ANS: B
Urinalysis is completed on a clean-catch or catheterized specimen.
17. A patient, age 71, has benign prostatic hypertrophy. He is recovering from a
transurethral prostatic resection. The physician orders removal of the indwelling catheter
2 days after the TURP procedure. The patient should be instructed that at first he might
experience
a. an intolerance to acidic fluids.
b. normal voiding patterns.
c. dribbling of urine.
d. no urine output for 6-8 hours.
ANS: C
The patient is informed that initially he may experience frequency and voiding small
amounts with some dribbling.
18. A patient, age 69, is admitted to the hospital with gross hematuria and history of a
20-pound weight loss during the last 3 months. The physician suspects renal cancer. In
obtaining a nursing history from this patient, the nurse recognizes which factor as a
significant risk factor for renal cancer?
a. High caffeine intake
b. Cigarette smoking
c. Use of artificial sweeteners
d. Chronic cystitis
ANS: B
Risk factors include smoking; familial incidence; and preexisting renal disorders such as
adult polycystic kidney disease and renal cystic disease secondary to renal failure.
20. The patient is on postoperative day 1 after having undergone a TURP procedure. He has
continuous bladder irrigation (CBI). Actual urine output during continuous bladder
irrigation is calculated by
a. measuring and recording all fluid output in the drainage bag.
b. measuring the total output and deducting the total of the irrigating and intravenous
solutions.
c. adding the total of the intravenous and irrigating solutions and then deducting the
amount of output.
d. measuring total output and deducting the amount of irrigating solution used.
ANS: D
To determine urine output, the nurse will subtract the amount of irrigation fluid used
with the Foley catheter output to calculate urine output.
21. A patient has nephrotic syndrome. Which of these statements made by the patient
indicates that she understands the dietary modifications?
a. “I will need to increase protein and decrease sodium intake.”
b. “I will need to drink more milk to get my calcium.”
c. “Carbohydrate restriction will be difficult.”
d. “Potassium restriction won’t be hard since I don’t like fruit.”
ANS: A
Medical management for nephrotic syndrome depends on the extent of tissue
involvement and may include the use of corticosteroids and a low-sodium, high-protein
diet.
DIF: Cognitive Level: Analysis REF: Page 468 OBJ: 6
TOP: Nephrotic syndrome KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity
22. A 69-year-old patient is admitted with severe diarrhea. His urinalysis report indicates an
increased level of ketone bodies. This occurs with
a. kidney disease.
b. starvation or carbohydrate-restricted diets.
c. infection.
d. urolithiasis.
ANS: A
The presence of ketone bodies in the urine, ketoaciduria, occurs when excessive
quantities for fatty acids are oxidized.
23. The patient has end-stage renal disease (ESRD) and is admitted with a blood urea
nitrogen (BUN) level of 93 mg/dL. An excessive elevation of BUN could result in
a. dehydration.
b. disorientation.
c. edema.
d. catabolism.
ANS: B
If the BUN is elevated, preventive nursing measures should be instituted to protect the
patient from possible disorientation or seizures.
24. The patient, age 30, has a history of renal calculi and is admitted to the hospital with
gross hematuria and severe colicky left flank pain that radiates to his left testicle. An
intravenous pyelogram confirms the presence of a 4-mm renal calculus in the proximal
left ureter. Physician orders include meperidine (Demerol) 100 mg IM q4h prn, strain all
urine, and encourage fluids to 4,000 mL/day. In planning care for this patient, the nurse
gives the highest priority to which nursing diagnosis?
a. Pain related to irritation of a stone
b. Anxiety related to unclear outcome of condition
c. Ineffective health maintenance related to lack of knowledge about prevention of
stones
d. Risk for injury related to disorientation
ANS: A
Nursing diagnoses include, but are not limited to, patient pain related to mobility of renal
calculus.
DIF: Cognitive Level: Analysis REF: Page 456 OBJ: 7
TOP: Renal calculi KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
26. The patient, age 43, has cystitis with dysuria. She is receiving Pyridium to decrease her
pain. Her urine is reddish-orange. The nurse should
a. report this immediately.
b. explain to the patient that this is normal.
c. increase fluid intake.
d. send a specimen to the laboratory for analysis.
ANS: B
Pyridium will turn the urine reddish-orange.
27. The patient, age 43, has cancer of the urinary bladder. He has received a cystectomy with
an ileal conduit. Which characteristics would be considered normal for his urine?
a. Hematuria
b. Clear amber with mucus shreds
c. Dark bile-colored
d. Dark amber
ANS: B
There will be mucus present in the urine from the intestinal secretions.
29. Which complementary and alternative therapies are used to prevent and/or treat urinary
tract infections (UTIs)?
a. Grape juice
b. Caffeine
c. Tea
d. Cranberry juice
ANS: D
Cranberry (Cranberry Plus, Ultra Cranberry) has been used to prevent urinary tract
infections (UTIs), particularly in women prone to recurrent infection. It has also been
used to treat acute UTI. Monitor patients for lack of therapeutic effect. Caffeine and tea
will increase diuresis but not prevent UTI.
30. Which can reduce the risk of skin impairment secondary to urinary incontinence?
a. Decreasing fluid intake
b. Catheterization of the elderly patient
c. Limiting the use of medication (diuretics, etc.)
d. Frequent toileting and meticulous skin care
ANS: D DIF: Cognitive Level: Analysis
REF: Page 439, Life Span Considerations box OBJ: 8
TOP: Urinary frequency KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
31. Pediatric patients, especially girls, are susceptible to urinary tract infections because
a. genetically females have a weaker immune system.
b. females have a short and proximal urethra in relation to the vagina.
c. girls are more sexually active than males.
d. girls have a weakened musculature and sphincter tone.
ANS: B
Pediatric patients, especially girls, are susceptible to urinary tract infections because of
the short urethra.
32. Patients on diuretics who become hypokalemic should make sure they include which
foods in their daily diet?
a. Bananas, oranges, cantaloupe
b. Carrots, summer squash, green beans
c. Apples, pineapple, watermelon
d. Winter squash, cauliflower, lettuce
ANS: A
The use of most diuretics, with the exception of the potassium-sparing diuretics, requires
adding daily potassium sources (e.g., baked potatoes, raw bananas, apricots, or navel
oranges, cantaloupe, winter squash).
33. One method of monitoring for signs and symptoms of fluid overload when administering
diuretics is
a. record daily morning weights (same time, scale, clothes).
b. record random weights throughout the day (same scale, clothes, staff member).
c. assess abdomen every shift.
d. eat a diet high in sodium.
ANS: A
Because patients receiving diuretics often have complicated disease conditions such as
heart failure and pulmonary edema, record daily morning weights for the patient
receiving diuretics. Diet should be low in sodium with no added salt in cooking.
34. The following constituent of the urinalysis test indicates possible renal disease, muscle
exertion, or dehydration
a. proteinuria
b. positive glucose
c. positive bilirubin
d. bacteriuria
ANS: A
Protein in the urine usually indicates possible renal disease, muscle exertion, or
dehydration. Positive glucose indicates diabetes. Positive bilirubin indicates liver disease
with obstruction or damage. Positive bacteria indicates urinary infection.
MULTIPLE RESPONSE
35. For a patient who is recovering from acute glomerulonephritis, which symptoms may
exist even when other symptoms have subsided? (Select all that apply.)
a. Proteinuria
b. Oliguria
c. Hematuria
d. Anasarca
ANS: A, C
Proteinuria and hematuria may exist microscopically even when other symptoms
subside.
36. Urinary frequency, urgency, nocturia, retention, and incontinence are common with
aging. These occur because of (Select all that apply.)
a. weakened musculature in the bladder and urethra.
b. 1,000 to 2,000 mL fluids per 24 hours.
c. diminished neurologic sensation combined with decreased bladder capacity.
d. increased hormonal changes and muscle strength.
e. the effects of medications such as diuretics.
ANS: A, C, E
Urinary frequency, urgency, nocturia, retention, and incontinence are common with
aging. These occur because of weakened musculature in the bladder and urethra,
diminished neurologic sensation combined with decreased bladder capacity, and the
effects of medications such as diuretics. Older women are at risk for stress incontinence
because of hormonal changes and weakened pelvic musculature. Inadequate fluid intake
(less than 1,000 to 2,000 mL per 24 hours) can lead to urinary stasis.
DIF: Cognitive Level: Knowledge REF: Page 439, Life Span Considerations
box
OBJ: 5 TOP: Urinary frequency
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
37. Which are signs and symptoms of fluid overload in a patient receiving diuretics? (Select
all that apply)
a.
Changes in cardiac and lung sounds
b. Increase in daily weight
c. Decrease in daily weight
d. Dry skin
ANS: A, B
Signs and symptoms of fluid overload: changes in pulse rate, respirations, cardiac
sounds, and lung fields. Increase in daily morning weights.
38. The type and size of urinary catheter are determined by the (Select all that apply.)
a.
location of the urinary tract problem.
b. urinary output.
c. cause of the urinary tract problem.
d. weight of the patient.
ANS: A, C
The type and size of urinary catheter are determined by the location and cause of the
urinary tract problem.
COMPLETION
39. Exercises to increase muscle tone of the pelvic floor are known as ____________
exercises.
ANS:
Kegel
Women with weakened structures of the pelvic floor are prone to stress incontinence.
For the female patient, Kegel exercises are helpful; 10 repetitions, 5 to 10 times a day, is
suggested to improve muscle tone.
ANS:
Anasarca
The patient with nephritic syndrome has severe generalized edema (anasarca), anorexia,
fatigue, and impaired renal function.
Test Bank for Adult Health Nursing, 6th Edition: Christensen
ANS:
glomerulonephritis
The health history commonly reveals that the onset of acute glomerulonephritis is
preceded by an infection, such as a sore throat or skin infection.
ANS:
potassium
43. _________ training involves developing the muscles of the perineum to improve
voluntary control over voiding; bladder training may be modified for different problems.
ANS: Bladder
44. Bladder distention may be assessed by palpating above the ___________ _________.