Primary Care Art and Science of

Advanced Practice Nursing 4th Edition

Dunphy Test Bank
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Chapter 12. Renal Problems

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. A patient is seen in the clinic with a chief complaint of hematuria. To make a differential diagnosis,
which of the following questions should be asked?
a. “Do you have a history of liver disease?”
b. “What medications are you currently taking?”
c. “Have you noticed swelling in your ankles?”
d. All of the above

____ 2. The result of the patient’s 24-hour urine for protein was 4.2 g/day. The clinician should take which
of the following actions?
a. Repeat the test.
b. Refer to a nephrologist.
c. Measure the serum protein.
d. Obtain a blood urea nitrogen (BUN) and creatinine.

____ 3. A patient is seen complaining of “leaking urine when I sneeze.” Which of the following actions
should the clinician take first?
a. Order a cystometrogram.
b. Obtain a computed tomography scan.
c. Instruct the patient on Kegel exercises.
d. Prescribe imipramine.

____ 4. A patient is seen in the clinic with hematuria confirmed on microscopic examination. The clinician
should inquire about the ingestion of which of these substances that might be the cause of
hematuria?
a. NSAIDs
b. Beets
c. Vitamin A
d. Red meat

____ 5. A 27-year-old female presents with a chief complaint of burning and pain on urination. She has no
previous history of urinary tract infection (UTI). What are some additional symptoms consistent with
a diagnosis of lower UTI?
a. Back and abdominal pain
b. Fever, chills, costovertebral angle (CVA) tenderness
c. Blood in urine and frequency
d. Foul-smelling discharge, perineal itch

____ 6. A 30-year-old patient presents with pain on urination. The urine microscopy of unspun urine shows
greater than 10 leukocytes/mL, and a dipstick is positive for nitrites. What is the probable diagnosis?
a. Lower urinary tract infection
b. Chlamydia infection
c. Candidiasis
d. Pyelonephritis
____ 7. A patient presents with CVA tenderness and a several-day history of high fever, chills, and dysuria.
Which of the following diagnoses is most likely given the above information?
a. Pyelonephritis
b. Cystitis
c. Renal calculi
d. Bladder tumor

____ 8. Which of the following information is essential before prescribing Bactrim DS to a 24-year-old
woman with a UTI?
a. Last menstrual period
b. Method of birth control
c. Last unprotected sexual contact
d. All of the above

____ 9. A patient is seen in the office complaining of severe flank pain. The clinician should assess this
patient for which risk factor for kidney stones?
a. Hypertension
b. Constipation
c. Tubal ligation
d. Diabetes

____ 10. A patient is diagnosed with urge incontinence. Before prescribing Detrol XL, the provider should
question the patient about which of these contraindications to this medication?
a. Diarrhea
b. Parkinson’s disease
c. Closed-angle glaucoma
d. Breast cancer

____ 11. A patient is diagnosed with overactive bladder. Which of the following instructions should be given
to this woman?
a. “Limit the amount of water that you drink.”
b. “Eliminate caffeine from your diet.”
c. “Wear panty liners.”
d. All of the above

____ 12. A 34-year-old patient was treated for a UTI and has not responded to antibiotic therapy. Which of
the following actions should be taken next?
a. Send a urine specimen for microscopy and evaluate for fungal colonies.
b. Increase the dose of antibiotic.
c. Order a cytoscopy.
d. Order a different antibiotic.

____ 13. Which of the following are predisposing factors for pyelonephritis?
a. Pregnancy
b. Dehydration
c. Smoking
d. Alkaline urine
____ 14. A 42-year-old woman is seen in the clinic with fever, chills, vomiting, and severe dysuria. She is
diagnosed with acute pyelonephritis. How should this patient be managed?
a. 3-day course of oral antibiotics
b. Hospitalization
c. Encourage cranberry juice intake.
d. 6-week course of antibiotics

____ 15. A patient is seen with a sudden onset of flank pain accompanied by nausea, vomiting, and
diaphoresis. In addition to nephrolithiasis, which of the following should be added to the list of
differential diagnoses?
a. Pancreatitis
b. Peptic ulcer disease
c. Diverticulitis
d. All of the above

____ 16. Which of the following instructions should be given to the patient with nephrolithiasis?
a. Take ibuprofen, 600 mg every 8 hours.
b. Take Tums for stomach upset.
c. Drink more black tea.
d. Increase intake of vegetables, like spinach.

____ 17. Which of the following patients is at risk for developing urinary tract cancer?
a. The 45-year-old woman who is 100 lbs overweight
b. The 78-year-old man who smokes three packs of cigarettes a day
c. The 84-year-old man who worked in the asbestos mines
d. All of the above

____ 18. A patient is seen in the clinic and diagnosed with Stage I renal cancer. The provider should refer the
patient to a nephrologist for which of these treatments?
a. Chemotherapy
b. Nephrectomy
c. Palliative treatment
d. Radiation

____ 19. An 86-year-old woman is seen in the clinic for recurrent hematuria. The provider suspects bladder
cancer. Which of the following data from the history is considered a risk factor for this type of
cancer?
a. History of alcoholism
b. Sedentary lifestyle
c. Obesity
d. 65-year smoking history

____ 20. Which of the following diagnostic tests should be ordered for a patient suspected of having bladder
cancer?
a. Kidneys, ureter, bladder x-ray
b. Cystoscopy with biopsy
c. Magnetic resonance imaging
d. Urine tumor marker (NMP22)
____ 21. A 78-year-old man is diagnosed with Stage D bladder cancer and asks the provider what that means.
Which is the best response?
a. “There is no such thing as Stage D cancer.”
b. “You have cancer that has spread to the surrounding tissue.”
c. “Your cancer has spread to other organs.”
d. “Your cancer can be cured by removing your bladder.”

____ 22. The patient is diagnosed with acute renal failure (ARF). Which of the following data obtained from
the history should alert the provider that this is a case of prerenal azotemia?
a. Recent heat stroke
b. Nephrolithiasis
c. Recent infection where gentamicin was used in treatment
d. All of the above

____ 23. The patient is diagnosed with ARF. Which of the following conditions is the most common cause?
a. Renal calculi
b. Acute tubular necrosis
c. Cardiac failure
d. Acute glomerulonephritis

____ 24. An 82-year-old woman with renal failure is seen in the clinic. The provider should question the
patient about the intake of which of these substances that can cause renal toxicity?
a. Ibuprofen
b. Captopril
c. Losartan
d. All of the above

____ 25. Which of the following clinical manifestations are consistent with a patient in ARF?
a. Pruritis
b. Glycosuria
c. Irritability
d. Hypotension

____ 26. Which of the following examination findings should be expected in a patient with chronic renal
failure (CRF)?
a. Weak, thready pulse
b. Auscultatory crackles
c. Hypotension
d. Pleural friction rub

____ 27. Which of the following tests is most useful in determining renal function in a patient suspected of
CRF?
a. BUN and creatinine
b. Electrolytes
c. Creatinine clearance
d. Urinalysis

____ 28. Which of the following foods should be limited in a patient with CRF?
a. Milk
 b. Bananas
c. Soy sauce
d. All of the above

True/False
Indicate whether the statement is true or false.

____ 1. The urine osmolality is greater than 500 mOsm/L in patients with postrenal ARF.

____ 2. Cigarette smoking is a risk factor for CRF.

Chapter 12. Renal Problems
Answer Section

MULTIPLE CHOICE

1. ANS: B PTS: 1
2. ANS: B PTS: 1
3. ANS: C PTS: 1
4. ANS: A PTS: 1
5. ANS: C PTS: 1
6. ANS: A PTS: 1
7. ANS: A PTS: 1
8. ANS: D PTS: 1
9. ANS: A PTS: 1
10. ANS: C PTS: 1
11. ANS: B PTS: 1
12. ANS: A PTS: 1
13. ANS: A PTS: 1
14. ANS: B PTS: 1
15. ANS: D PTS: 1
16. ANS: A PTS: 1
17. ANS: D PTS: 1
18. ANS: B PTS: 1
19. ANS: D PTS: 1
20. ANS: B PTS: 1
21. ANS: C PTS: 1
22. ANS: A PTS: 1
23. ANS: B PTS: 1
24. ANS: D PTS: 1
25. ANS: A PTS: 1
26. ANS: B PTS: 1
27. ANS: C PTS: 1
28. ANS: D PTS: 1

TRUE/FALSE

1. ANS: F PTS: 1
2. ANS: T PTS: 1