Sie sind auf Seite 1von 15

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.
ANS: C
Because uncomplicated urinary tract infections (UTIs) are usually successfully treated with 3
days of antibiotic therapy, this patient will need a urine culture and sensitivity to determine
appropriate antibiotic therapy. Acetaminophen would not be as effective as other over-the-
counter (OTC) medications such as phenazopyridine (Pyridium) in treating dysuria. The fluid
intake should be increased to at least 1800 mL/day. Because the UTI has persisted after
treatment with Bactrim, the patient is likely to need a different antibiotic.

DIF: Cognitive Level: Apply (application) REF: 1067


TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

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.
ANS: D
Voiding every 3 to 4 hours is recommended to prevent UTIs. Use of vaginal sprays is
discouraged. The bladder should be emptied before and after intercourse, but cleaning with
soap and water is not necessary. A quart of fluids is insufficient to provide adequate urine
output to decrease risk for UTI.

DIF: Cognitive Level: Apply (application) REF: 1069


TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance

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.
ANS: B
Patients should be taught that Pyridium will color the urine deep orange. Urinary analgesics
should only be needed for a few days until the prescribed antibiotics decrease the bacterial
count. Pyridium does not cause photosensitivity. Taking Pyridium before intercourse will not
be helpful in reducing the risk for UTI.

DIF: Cognitive Level: Apply (application) REF: 1067


TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

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
ANS: D
Costovertebral tenderness is characteristic of pyelonephritis. Bladder distention, foul-smelling
urine, and suprapubic discomfort are characteristic of lower UTI and are likely to be present if
the patient also has an upper UTI.

DIF: Cognitive Level: Apply (application) REF: 1070


TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

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.
ANS: C
High-potency multiple vitamins may irritate the bladder and increase symptoms. The other
patient statements indicate good understanding of the teaching.

DIF: Cognitive Level: Apply (application) REF: 1072


TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

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.
ANS: B
Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat.
It is not caused by kidney stones, hypertension, or urinary tract infection (UTI).

DIF: Cognitive Level: Apply (application) REF: 1074


TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

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.
ANS: D
Because edema is a common clinical manifestation of glomerulonephritis, resolution of the
edema indicates that the prescribed therapies have been effective. Nitrites will be negative and
the patient will not experience dysuria because the patient does not have a urinary tract
infection. Antibodies to streptococcus will persist after a streptococcal infection.

DIF: Cognitive Level: Apply (application) REF: 1074


TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

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.
ANS: C
Flank pain in a patient with nephrotic syndrome suggests a renal vein thrombosis, and
anticoagulation is needed. Antibiotics are used to treat a patient with flank pain caused by
pyelonephritis. Fungal pyelonephritis is uncommon and is treated with antifungals.
Antihypertensives are used if the patient has high blood pressure.

DIF: Cognitive Level: Apply (application) REF: 1082


TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

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
ANS: B
The patient with a nephrotic syndrome will have weight gain associated with edema.
Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal because
of the edema. Urine protein is high.

DIF: Cognitive Level: Understand (comprehension) REF: 1075-1076


TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

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.
ANS: B
Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate,
and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products,
legumes, and dried fruits may increase the incidence of calcium-containing stones.

DIF: Cognitive Level: Apply (application) REF: 1078


TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

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.
ANS: D
A fluid intake of 2000 to 3000 mL daily is recommended to help flush out minerals before
stones can form. Avoidance of calcium is not usually recommended for patients with renal
calculi. Coffee tends to increase stone recurrence. There is no need for a patient to strain all
urine routinely after a stone has passed, and this will not prevent stones.

DIF: Cognitive Level: Apply (application) REF: 1081


TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

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.
ANS: B
Hypertension is the major symptom of nephrosclerosis. Measurements of intake and output
and daily weights are not necessary unless the patient develops renal insufficiency.
Anticoagulants are not used to treat nephrosclerosis.

DIF: Cognitive Level: Apply (application) REF: 1082


TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

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
ANS: C
Because a 28-year-old patient may be considering having children, the nurse should include
information about genetic counseling when teaching the patient. The well-managed patient
will not need to choose between hemodialysis and peritoneal dialysis or know about the
effects of transplantation for many years. There is no indication that the patient has chronic
pain.

DIF: Cognitive Level: Apply (application) REF: 1083


TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

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.
ANS: B
The patients clinical manifestations are consistent with urethral strictures, a possible
complication of gonococcal urethritis. These symptoms are not consistent with benign
prostatic hyperplasia, kidney trauma, or bladder infection.

DIF: Cognitive Level: Apply (application) REF: 1071 | 1081


TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

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.
ANS: B
Cigarette smoking is a risk factor for bladder cancer. The patients risk for developing
interstitial cystitis, urinary tract infection (UTI), or kidney stones will not be reduced by
quitting smoking.

DIF: Cognitive Level: Apply (application) REF: 1085-1086


TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

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.
ANS: D
In older or confused patients, incontinence may be avoided by using scheduled toileting times.
Indwelling catheters increase the risk for urinary tract infection (UTI). Incontinent pads
increase the risk for skin breakdown. Restricting fluids is not appropriate in a patient with
dehydration.

DIF: Cognitive Level: Apply (application) REF: 1089


TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

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 patients bedside.
c. Demonstrate how to perform the Cred maneuver.
d. Teach the patient how to perform Kegel exercises.
ANS: D
Kegel exercises to strengthen the pelvic floor muscles will help reduce stress incontinence.
The Cred maneuver is used to help empty the bladder for patients with overflow
incontinence. Placing the commode close to the bedside and assisting the patient to the
bathroom are helpful for functional incontinence.

DIF: Cognitive Level: Apply (application) REF: 1089


TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

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 patients 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.
ANS: C
An ultrasound scanner can be used to check for residual urine after the patient voids. Because
the patients history and clinical manifestations are consistent with overflow incontinence, it is
not appropriate to have the patient drink small amounts. Although overflow incontinence is
not unusual after surgery, the nurse should intervene to correct the physiologic problem, not
just reassure the patient. The patient may develop reflux into the renal pelvis and discomfort
from a full bladder if the nurse waits to address the problem for several hours.

DIF: Cognitive Level: Apply (application) REF: 1088


TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

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 Cred maneuver.
b. Teach exercises to strengthen the pelvic floor.
c. Place a bedside commode close to the patients bed.
d. Use an ultrasound scanner to check postvoiding residuals.
ANS: C
Modifications in the environment make it easier to avoid functional incontinence. Checking
for residual urine and performing the Cred maneuver are interventions for overflow
incontinence. Kegel exercises are useful for stress incontinence.

DIF: Cognitive Level: Apply (application) REF: 1088


TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

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.
ANS: C
Patients who are at home can use a clean technique for intermittent self-catheterization and
change the catheter every 7 days. There is no need to use a new catheter every day, to use
sterile catheters, or to take prophylactic antibiotics.

DIF: Cognitive Level: Apply (application) REF: 1094


TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

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.
ANS: C
The health care provider should be notified if the ureteral catheter output decreases because
obstruction of this catheter may result in an increase in pressure in the renal pelvis. Tension on
the ureteral catheter should be avoided in order to prevent catheter displacement. To avoid
pressure in the renal pelvis, the catheter is not clamped. Because the patient is not usually
discharged with a ureteral catheter in place, patient teaching about both catheters is not
needed.

DIF: Cognitive Level: Apply (application) REF: 1093-1095


TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

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
ANS: C
The Indiana pouch enables the patient to self-catheterize every 4 to 6 hours. There is no need
for an ostomy device or barrier products. Catheterization of the pouch is not painful.

DIF: Cognitive Level: Apply (application) REF: 1097


TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

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.
ANS: B
The patients unwillingness to look at the stoma or participate in care indicates that disturbed
body image is the best diagnosis. No data suggest that the impact on lifestyle is a concern for
the patient. The patient does not appear to be ready for enhanced coping. The patients
insistence that only the ostomy nurse care for the stoma indicates that denial is not present.

DIF: Cognitive Level: Apply (application) REF: 1098


TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

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.
ANS: C
Clots in the urine are not expected and require further follow-up. Voiding every 4 hours, use
of opioids for pain, and anxiety are typical after this procedure.

DIF: Cognitive Level: Apply (application) REF: 1086


OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity

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.
ANS: C
The patient will be asked to empty the bladder before instillation of the chemotherapy.
Systemic side effects are not usually experienced with intravesical chemotherapy.

DIF: Cognitive Level: Apply (application) REF: 1086


TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

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
ANS: C
Because catheterization bypasses many of the protective mechanisms that prevent urinary
tract infection (UTI), avoidance of catheterization is the most effective means of reducing
HAI. The other actions will also be helpful, but are not as useful as decreasing urinary catheter
use.

DIF: Cognitive Level: Analyze (analysis) REF: 1068


OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity

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
ANS: D
Pain with urination is a common symptom of a lower UTI. Urine output does not decrease,
but frequency may be experienced. Flank pain and nausea are associated with an upper UTI.

DIF: Cognitive Level: Apply (application) REF: 1066


TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

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)
ANS: B
The low blood pressure indicates that urosepsis and septic shock may be occurring and should
be immediately reported. The other findings are typical of pyelonephritis.

DIF: Cognitive Level: Apply (application) REF: 1069


OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity

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

DIF: Cognitive Level: Apply (application) REF: 1075-1076


OBJ: Special Questions: Prioritization TOP: Nursing Process: Diagnosis
MSC: NCLEX: Physiological Integrity

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.
ANS: A
The patients history and clinical manifestations are consistent with acute urinary retention,
and the priority action is to relieve the retention by catheterization. The BUN and creatinine
measurements can be obtained after the catheter is inserted. The patients agitation may
resolve once the bladder distention is corrected, and sedative drugs should be used cautiously
in older patients. The IVP is an appropriate test but does not need to be done urgently.

DIF: Cognitive Level: Apply (application) REF: 1092


OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

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.
ANS: A
Although all of the nursing actions may be used for patients with renal lithiasis, the patients
presentation indicates that management of pain is the highest priority action. If the patient has
urinary obstruction, increasing oral fluids may increase the symptoms. There is no evidence of
infection or nausea.

DIF: Cognitive Level: Apply (application) REF: 1077 | 1080


OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

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).
ANS: A
Changing the ostomy appliance for a stable patient could be done by UAP. Assessments of the
site, choosing the appropriate ostomy bag, and assessing for (UTI) symptoms require more
education and scope of practice and should be done by the registered nurse (RN).

DIF: Cognitive Level: Apply (application) REF: 1091


OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment

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
ANS: D
Because lithotripsy breaks the stone into small sand, which could cause obstruction, it is
important to report a drop in urine output. Left flank pain, bruising, and hematuria are
common after lithotripsy.

DIF: Cognitive Level: Apply (application) REF: 1079


OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity

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.
ANS: A
Sitz baths will relax the perineal muscles and promote voiding. Although the patient should be
encouraged to drink fluids and Kegel exercises are helpful in the prevention of incontinence,
these activities would not be helpful for a patient experiencing retention. Catheter insertion
increases the risk for urinary tract infection (UTI) and should be avoided when possible

DIF: Cognitive Level: Apply (application) REF: 1071


OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

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 patients upper inner thigh
b. Cleaning around the patients 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
ANS: C
The catheter should not be disconnected from the drainage tube because this increases the risk
for urinary tract infection (UTI). The other actions are appropriate and do not require any
intervention.

DIF: Cognitive Level: Apply (application) REF: 1093


OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment

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.
ANS: B
Because the urine output should be at least 0.5 mL/kg/hr, a 40 mL output for 2 hours indicates
that the patient may have decreased renal perfusion because of bleeding, inadequate fluid
intake, or obstruction at the suture site. The blood pressure requires ongoing monitoring but
does not indicate inadequate perfusion at this time. The patient should cough and deep
breathe, but the crackles do not indicate a need for an immediate change in therapy. The
incisional pain should be addressed, but this is not as potentially life threatening as decreased
renal perfusion. In addition, the nurse can medicate the patient for pain.

DIF: Cognitive Level: Apply (application) REF: 1095


OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity

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
ANS: C
Tachycardia may indicate infection, hemorrhage, or hypovolemia, which are all serious
complications of this surgery. The urine from an ileal conduit normally contains mucus and is
cloudy. Hypotonic bowel sounds are expected after bowel surgery. Continuous drainage of
urine from the stoma is normal.

DIF: Cognitive Level: Apply (application) REF: 1097


OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

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.
ANS: C
The nonsteroidal antiinflammatory drugs (NSAIDs) should be avoided in patients with
decreased renal function because nephrotoxicity is a potential adverse effect. The other orders
do not need any clarification or change.

DIF: Cognitive Level: Apply (application) REF: 1075


TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

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
ANS: B
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).

DIF: Cognitive Level: Apply (application) REF: 1069-1070


OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity

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).
ANS: A
Monilial urethritis is caused by a fungus and antifungal medications such as nystatin
(Mycostatin) or fluconazole (Diflucan) are usually used as treatment. Because monilial
urethritis is not sexually transmitted, there is no need to refer sexual partners. Warm baths and
NSAIDS may be used to treat symptoms.

DIF: Cognitive Level: Apply (application) REF: 1071


TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

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.
ANS: B
The treatment of choice in patients with localized renal tumors who have no co-morbid
conditions is partial or total nephrectomy. A renal biopsy will not be needed in a patient who
has already been diagnosed with renal cancer. Chemotherapy is used for metastatic renal
cancer. Because renal cell cancer frequently metastasizes, treatment will be started as soon as
possible after the diagnosis.

DIF: Cognitive Level: Apply (application) REF: 1084


TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

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.
ANS: C
Crackles heard to a high level indicate a need for rapid actions such as assessment of oxygen
saturation, reporting the findings to the health care provider, initiating oxygen therapy, and
dialysis. The other findings will also be reported, but are typical of Goodpasture syndrome
and do not require immediate nursing action.

DIF: Cognitive Level: Apply (application) REF: 1073


OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity

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.
ANS: A
Because the kidney is very vascular, the initial action with renal trauma will be assessment for
bleeding and shock. The other actions are also important once the patients cardiovascular
status has been determined and stabilized.

DIF: Cognitive Level: Apply (application) REF: 1082


OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity

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
ANS: A
The patient information suggests acute urinary retention, a medical emergency. The nurse will
need to assess the patient and consider whether to insert a retention catheter. The other
patients will also be assessed, but their findings are consistent with their diagnoses and do not
require immediate assessment or possible intervention.

DIF: Cognitive Level: Analyze (analysis)


OBJ: Special Questions: Prioritization; Multiple Patients TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity

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
ANS: B, D
Meats contain purines, which are metabolized to uric acid. The other foods might be restricted
in patients who have calcium or oxalate stones.

DIF: Cognitive Level: Understand (comprehension) REF: 1080


TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity