Test Bank Urinary

Test
Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 997
Chapter 53: Assessment of Kidney and Urinary Function

1. The care team is considering the use of dialysis in a patient whose renal function is progressively
declining. Renal replacement therapy is indicated in which of the following situations?
A) When the patients creatinine level drops below 1.2 mg/dL (110 mmol/L)
B) When the patients blood urea nitrogen (BUN) is above 15 mg/dL
C) When approximately 40% of nephrons are not functioning
When about 80% of the nephrons are no longer functioning

D)
Ans: D
Feedback:
When the total number of functioning nephrons is less than 20%, renal replacement therapy needs to be
considered. Dialysis is an example of a renal replacement therapy. Prior to the loss of about 80% of the
nephron functioning ability, the patient may have mild symptoms of compromised renal function, but
symptom management is often obtained through dietary modifications and drug therapy. The listed
creatinine and BUN levels are within reference ranges.
2. A nurse knows that specific areas in the ureters have a propensity for obstruction. Prompt management
of renal calculi is most important when the stone is located where?
A) In the ureteropelvic junction
B) In the ureteral segment near the sacroiliac junction
C) In the ureterovesical junction
D) In the urethra
Ans: A
Feedback:
The three narrowed areas of each ureter are the ureteropelvic junction, the ureteral segment near the
sacroiliac junction, and the ureterovescial junction. These three areas of the ureters have a propensity for
obstruction by renal calculi or stricture. Obstruction of the ureteropelvic junction is most serious because
of its close proximity to the kidney and the risk of associated kidney dysfunction. The urethra is not part
of the ureter.
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 998
3. A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has
been ordered. The nurse should facilitate collection of what samples?
A) A fasting serum potassium level and a random urine sample
B) A 24-hour urine specimen and a serum creatinine level midway through the urine collection
process
C) A BUN and serum creatinine level on three consecutive mornings
D) A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and
phosphorus values
Ans: B
Feedback:
To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection,
the serum creatinine level is measured.
4. The nurse is assessing a patients bladder by percussion. The nurse elicits dullness after the patient has
voided. How should the nurse interpret this assessment finding?
A) The patients bladder is not completely empty.
B) The patient has kidney enlargement.
C) The patient has a ureteral obstruction.
D) The patient has a fluid volume deficit.
Ans: A
Feedback:
Dullness to percussion of the bladder following voiding indicates incomplete bladder emptying.
Enlargement of the kidneys can be attributed to numerous conditions such as polycystic kidney disease
or hydronephrosis and is not related to bladder fullness. Dehydration and ureteral obstruction are not
related to bladder fullness; in fact, these conditions result in decreased flow of urine to the bladder.
5. The nurse is providing pre-procedure teaching about an ultrasound. The nurse informs the patient that in
preparation for an ultrasound of the lower urinary tract the patient will require what?
A) Increased fluid intake to produce a full bladder

B) IV administration of radiopaque contrast agent
C) Sedation and intubation
D) Injection of a radioisotope
Ans: A
Feedback:
Ultrasonography requires a full bladder; therefore, fluid intake should be encouraged before the
procedures. The administration of a radiopaque contrast agent is required to perform IV urography
studies, such as an IV pyelogram. Ultrasonography is a quick and painless diagnostic test and does not
require sedation or intubation. The injection of a radioisotope is required for nuclear scan and
ultrasonography is not in this category of diagnostic studies.
6. The nurse is caring for a patient who has a fluid volume deficit. When evaluating this patients urinalysis
results, what should the nurse anticipate?
A) A fluctuating urine specific gravity
B) A fixed urine specific gravity
C) A decreased urine specific gravity
D) An increased urine specific gravity
Ans: D
Feedback:
Urine specific gravity depends largely on hydration status. A decrease in fluid intake will lead to an
increase in the urine specific gravity. With high fluid intake, specific gravity decreases. In patients with
kidney disease, urine specific gravity does not vary with fluid intake, and the patients urine is said to
have a fixed specific gravity.
7. A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse
should be aware of what age-related change affecting the renal or urinary system?
A) Increased ability to concentrate urine
B) Increased bladder capacity
C) Urinary incontinence
D) Decreased glomerular filtration rate
Ans: D
Feedback:
Many age-related changes in the renal and urinary systems should be taken into consideration when
taking a health history of the older adult. One change includes a decreased glomerular surface area
resulting in a decreased glomerular filtration rate. Other changes include the decreased ability to
concentrate urine and a decreased bladder capacity. It also should be understood that urinary
incontinence is not a normal age-related change, but is common in older adults, especially in women
because of the loss of pelvic muscle tone.
8. A nurse is preparing a patient diagnosed with benign prostatic hypertrophy (BPH) for a lower urinary
tract cystoscopic examination. The nurse informs the patient that the most common temporary
complication experienced after this procedure is what?
A) Urinary retention
B) Bladder perforation
C) Hemorrhage
D) Nausea
Ans: A
Feedback:
After a cystoscopic examination, the patient with obstructive pathology may experience urine retention
if the instruments used during the examination caused edema. The nurse will carefully monitor the
patient with prostatic hyperplasia for urine retention. Post-procedure, the patient will experience some
hematuria, but is not at great risk for hemorrhage. Unless the condition is associated with another
disorder, nausea is not commonly associated with this diagnostic study. Bladder perforation is rare.
9. A patient with renal failure secondary to diabetic nephropathy has been admitted to the medical unit.
What is the most life-threatening effect of renal failure for which the nurse should monitor the patient?
A) Accumulation of wastes
B) Retention of potassium
C) Depletion of calcium
D) Lack of BP control
Ans: B
Feedback:
Retention of potassium is the most life-threatening effect of renal failure.
Aldosterone causes the kidney to excrete potassium, in contrast to aldosterones effects on sodium
described previously. Acidbase balance, the amount of dietary potassium intake, and the flow rate of the
filtrate in the distal tubule also influence the amount of potassium secreted into the urine. Hypocalcemia,
the accumulation of wastes, and lack of BP control are complications associated with renal failure, but
do not have same level of threat to the patients well-being as hyperkalemia.
10. A kidney biopsy has been scheduled for a patient with a history of acute renal failure. The patient asks
the nurse why this test has been scheduled. What is the nurses best response?
A) A biopsy is routinely ordered for all patients with renal disorders.
B) A biopsy is generally ordered following abnormal x-ray findings of the renal pelvis.
C) A biopsy is often ordered for patients before they have a kidney transplant.
D) A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease.
Ans: D
Feedback:
Biopsy of the kidney is used in diagnosing and evaluating the extent of kidney disease. Indications for
biopsy include unexplained acute renal failure, persistent proteinuria or hematuria, transplant rejection,
and glomerulopathies.
11. The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory
results for this patient, the nurse interprets the presence of which substances in the urine as most
suggestive of pathology?
A) Potassium and sodium
B) Bicarbonate and urea
C) Glucose and protein
D) Creatinine and chloride
Ans: C
Feedback:
The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in
the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid.
Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is
completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is
found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that
the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because
amino acids are also filtered at the level of the glomerulus and reabsorbed so that it is not excreted in the
urine.
12. The nurse caring for a patient with suspected renal dysfunction calculates that the patients weight has
increased by 5 pounds in the past 24 hours. The nurse estimates that the patient has retained
approximately how much fluid?
A) 1,300 mL of fluid in 24 hours
B) 2,300 mL of fluid in 24 hours
C) 3,100 mL of fluid in 24 hours
D) 5,000 mL of fluid in 24 hours
Ans: B
Feedback:
An increase in body weight commonly accompanies edema. To calculate the approximate weight gain
from fluid retention, remember that 1 kg of weight gain equals approximately 1,000 mL of fluid. Five
lbs = 2.27 kg = 2,270 mL.
13. The nurse is performing a focused genitourinary and renal assessment of a patient. Where should the
nurse assess for pain at the costovertebral angle?
A) At the umbilicus and the right lower quadrant of the abdomen
B) At the suprapubic region and the umbilicus
C) At the lower border of the 12th rib and the spine
D) At the 7th rib and the xyphoid process
Ans: C
Feedback:
The costovertebral angle is the angle formed by the lower border of the 12th rib and the spine. Renal
dysfunction may produce tenderness over the costovertebral angle.
14. The staff educator is giving a class for a group of nurses new to the renal unit. The educator is discussing
renal biopsies. In what patient would the educator tell the new nurses that renal biopsies are
contraindicated?
A) A 64-year-old patient with chronic glomerulonephritis
B) A 57-year-old patient with proteinuria
C) A 42-year-old patient with morbid obesity
D) A 16-year-old patient with signs of kidney transplant rejection
Ans: C
Feedback:
There are several contraindications to a kidney biopsy, including bleeding tendencies, uncontrolled
hypertension, a solitary kidney, and morbid obesity. Indications for a renal biopsy include unexplained
acute renal failure, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.
15. The nurse is caring for a patient who describes changes in his voiding patterns. The patient states, I feel
the urge to empty my bladder several times an hour and when the urge hits me I have to get to the
restroom quickly. But when I empty my bladder, there doesnt seem to be a great deal of urine flow.
What would the nurse expect this patients physical assessment to reveal?
A) Hematuria
B) Urine retention
C) Dehydration
D) Renal failure
Ans: B
Feedback:
Increased urinary urgency and frequency coupled with decreasing urine volumes strongly suggest urine
retention. Hematuria may be an accompanying symptom, but is likely related to a urinary tract infection
secondary to the retention of urine. Dehydration and renal failure both result in a decrease in urine
output, but the patient with these conditions does not have normal urine production and decreased or
minimal flow of urine to the bladder. The symptoms of urgency and frequency do not accompany renal
failure and dehydration due to decreased urine production.
16. The nurse is caring for a patient with a nursing diagnosis of deficient fluid volume. The nurses
assessment reveals a BP of 98/52 mm Hg. The nurse should recognize that the patients kidneys will
compensate by secreting what substance?
A) Antidiuretic hormone (ADH)
B) Aldosterone
C) Renin
D) Angiotensin
Ans: C
Feedback:
When the vasa recta detect a decrease in BP, specialized juxtaglomerular cells near the afferent arteriole,
distal tubule, and efferent arteriole secrete the hormone renin. Renin converts angiotensinogen to
angiotensin I, which is then converted to angiotensin II. The vasoconstriction causes the BP to increase.
The adrenal cortex secretes aldosterone in response to stimulation by the pituitary gland, which in turn is
in response to poor perfusion or increasing serum osmolality. The result is an increase in BP.
17. A nurse is caring for a 73-year-old patient with a urethral obstruction related to prostatic enlargement.
When planning this patients care, the nurse should be aware of the consequent risk of what
complication?
A) Urinary tract infection
B) Enuresis
C) Polyuria
D) Proteinuria
Ans: A
Feedback:
An obstruction of the bladder outlet, such as in advanced benign prostatic hyperplasia, results in
abnormally high voiding pressure with a slow, prolonged flow of urine. The urine may remain in the
bladder, which increases the potential of a urinary tract infection. Older male patients are at risk for
prostatic enlargement, which causes urethral obstruction and can result in hydronephrosis, renal failure,
and urinary tract infections.
18. A patient with elevated BUN and creatinine values has been referred by her primary physician for
further evaluation. The nurse should anticipate the use of what initial diagnostic test?
A) Ultrasound
B) X-ray
C) Computed tomography (CT)
D) Nuclear scan
Ans: A
Feedback:
Ultrasonography is a noninvasive procedure that passes sound waves into the body through a transducer
to detect abnormalities of internal tissues and organs. Structures of the urinary system create
characteristic ultrasonographic images. Because of its sensitivity, ultrasonography has replaced many
other diagnostic tests as the initial diagnostic procedure.
19. A patient admitted to the medical unit with impaired renal function is complaining of severe, stabbing
pain in the flank and lower abdomen. The patient is being assessed for renal calculi. The nurse
recognizes that the stone is most likely in what anatomic location?
A) Meatus
B) Bladder
C) Ureter
D) Urethra
Ans: C
Feedback:
Ureteral pain is characterized as a dull continuous pain that may be intense with voiding. The pain may
be described as sharp or stabbing if the bladder is full. This type of pain is inconsistent with a stone
being present in the bladder. Stones are not normally situated in the urethra or meatus.
20. The nurse is caring for a patient who had a brush biopsy 12 hours ago. The presence of what assessment
finding should prompt the nurse to notify the physician?
A) Scant hematuria
B) Renal colic
C) Temperature 100.2F orally
D) Infiltration of the patients intravenous catheter
Ans: C
Feedback:
Hematuria and renal colic are common and expected findings after the performance of a renal brush
biopsy. The physician should be notified of the patients body temperature, which likely indicates the
onset of an infectious process. IV infiltration does not warrant notification of the primary care physician.
21. A patient with recurrent urinary tract infections has just undergone a cystoscopy and complains of slight
hematuria during the first void after the procedure. What is the nurses most appropriate action?
A) Administer a STAT dose of vitamin K, as ordered.
B) Reassure the patient that this is not unexpected and then monitor the patient for further bleeding.
C) Promptly inform the physician of this assessment finding.
D) Position the patient supine and insert a Foley catheter, as ordered.
Ans: B
Feedback:
Some burning on voiding, blood-tinged urine, and urinary frequency from trauma to the mucous
membranes can be expected after cystoscopy. The nurse should explain this to the patient and ensure
that the bleeding resolves. No clear need exists to report this finding and it does not warrant insertion of
a Foley catheter or vitamin K administration.
22. A patient is complaining of genitourinary pain shortly after returning to the unit from a scheduled
cystoscopy. What intervention should the nurse perform?
A) Encourage mobilization.
B) Apply topical lidocaine to the patients meatus, as ordered.
C) Apply moist heat to the patients lower abdomen.
D) Apply an ice pack to the patients perineum.
Ans: C
Feedback:
Following cystoscopy, moist heat to the lower abdomen and warm sitz baths are helpful in relieving pain
and relaxing the muscles. Ice, lidocaine, and mobilization are not recommended interventions.
23. The nurse is caring for a patient who is going to have an open renal biopsy. What would be an important
nursing action in preparing this patient for the procedure?
A) Discuss the patients diagnosis with the family.
B) Bathe the patient before the procedure with antiseptic skin wash.
C) Administer antivirals before sending the patient for the procedure.
D) Keep the patient NPO prior to the procedure.
Ans: D
Feedback:
Preparation for an open biopsy is similar to that for any major abdominal surgery. When preparing the
patient for an open biopsy you would keep the patient NPO. You may discuss the diagnosis with the
family, but that is not a preparation for the procedure. A pre-procedure wash is not normally ordered and
antivirals are not administered in anticipation of a biopsy.
24. The nurse is caring for a patient scheduled for renal angiography following a motor vehicle accident.
What patient preparation should the nurse most likely provide before this test?
A) Administration of IV potassium chloride
B) Administration of a laxative
C) Administration of Gastrografin
D) Administration of a 24-hour urine test
Ans: B
Feedback:
Before the procedure, a laxative may be prescribed to evacuate the colon so that unobstructed x-rays can
be obtained. A 24-hour urine test is not necessary prior to the procedure. Gastrografin and potassium
chloride are not administered prior to renal angiography.
25. Diagnostic testing of an adult patient reveals renal glycosuria. The nurse should recognize the need for
the patient to be assessed for what health problem?
A) Diabetes insipidus
B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C) Diabetes mellitus
D) Renal carcinoma
Ans: C
Feedback:
Renal glycosuria can occur on its own as a benign condition. It also occurs in poorly controlled diabetes,
the most common condition that causes the blood glucose level to exceed the kidneys reabsorption
capacity. Glycosuria is not associated with SIADH, diabetes insipidus, or renal carcinoma.
26. A patient with a diagnosis of respiratory acidosis is experiencing renal compensation. What function
does the kidney perform to assist in restoring acidbase balance?
A) Sequestering free hydrogen ions in the nephrons
B) Returning bicarbonate to the bodys circulation
C) Returning acid to the bodys circulation
D) Excreting bicarbonate in the urine
Ans: B
Feedback:
The kidney performs two major functions to assist in acidbase balance. The first is to reabsorb and return
to the bodys circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the
urine. Retaining bicarbonate will counteract an acidotic state. The nephrons do not sequester free
hydrogen ions.
27. A patients most recent laboratory findings indicate a glomerular filtration rate (GFR) of 58 mL/min. The
nurse should recognize what implication of this diagnostic finding?
A) The patient is likely to have a decreased level of blood urea nitrogen (BUN).
B) The patient is at risk for hypokalemia.

C) The patient is likely to have irregular voiding patterns.
D) The patient is likely to have increased serum creatinine levels.
Ans: D
Feedback:
The adult GFR can vary from a normal of approximately 125 mL/min (1.67 to 2.0 mL/sec) to a high of
200 mL/min. A low GFR is associated with increased levels of BUN, creatinine, and potassium.
28. A patient has experienced excessive losses of bicarbonate and has subsequently developed an acidbase
imbalance. How will this lost bicarbonate be replaced?
A) The kidneys will excrete increased quantities of acid.
B) Bicarbonate will be released from the adrenal medulla.
C) Alveoli in the lungs will synthesize new bicarbonate.
D) Renal tubular cells will generate new bicarbonate.
Ans: D
Feedback:
To replace any lost bicarbonate, the renal tubular cells generate new bicarbonate through a variety of
chemical reactions. This newly generated bicarbonate is then reabsorbed by the tubules and returned to
the body. The lungs and adrenal glands do not synthesize bicarbonate. Excretion of acid compensates for
a lack of bicarbonate, but it does not actively replace it.
29. A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What
related health education should the nurse provide to an older adult?
A) If possible, try to drink at least 4 liters of fluid daily.
B) Ensure that you avoid replacing water with other beverages.
C) Remember to drink frequently, even if you dont feel thirsty.
D) Make sure you eat plenty of salt in order to stimulate thirst.
Ans: C
Feedback:
The nurse emphasizes the need to drink throughout the day even if the patient does not feel thirsty,
because the thirst stimulation is decreased. Four liters of daily fluid intake is excessive and fluids other
than water are acceptable in most cases. Additional salt intake is not recommended as a prompt for
increased fluid intake.
30. A patient is scheduled for a diagnostic MRI of the lower urinary system. What pre-procedure education
should the nurse include?
A) The need to be NPO for 12 hours prior to the test
B) Relaxation techniques to apply during the test
C) The need for conscious sedation prior to the test
D) The need to limit fluid intake to 1 liter in the 24 hours before the test
Ans: B
Feedback:
Patient preparation should include teaching relaxation techniques because the patient needs to remain
still during an MRI. The patient does not normally need to be NPO or fluid-restricted before the test and
conscious sedation is not usually implemented.
31. Results of a patients 24-hour urine sample indicate osmolality of 510 mOsm/kg, which is within
reference range. What conclusion can the nurse draw from this assessment finding?
A) The patients kidneys are capable of maintaining acidbase balance.
B) The patients kidneys reabsorb most of the potassium that the patient ingests.
C) The patients kidneys can produce sufficiently concentrated urine.
D) The patients kidneys are producing sufficient erythropoietin.
Ans: C
Feedback:
Osmolality is the most accurate measurement of the kidneys ability to dilute and concentrate urine.
Osmolality is not a direct indicator of renal function as it relates to erythropoietin synthesis or
maintenance of acidbase balance. It does not indicate the maintenance of healthy levels of potassium, the
vast majority of which is excreted.
32. A patient is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary
dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all
that apply.
A) Petechiae
B) Pain
C) Gastrointestinal symptoms
D) Changes in voiding
E) Jaundice
Ans: B, C, D
Feedback:
Dysfunction of the kidney can produce a complex array of symptoms throughout the body. Pain,
changes in voiding, and gastrointestinal symptoms are particularly suggestive of urinary tract disease.
Jaundice and petechiae are not associated with genitourinary health problems.
33. A patient asks the nurse why kidney problems can cause gastrointestinal disturbances. What relationship
should the nurse describe?
A) The right kidneys proximity to the pancreas, liver, and gallbladder
B) The indirect impact of digestive enzymes on renal function
C) That the peritoneum encapsulates the GI system and the kidneys
D) The left kidneys connection to the common bile duct
Ans: A
Feedback:
The proximity of the right kidney to the colon, duodenum, head of the pancreas, common bile duct,
liver, and gallbladder may cause GI disturbances. The proximity of the left kidney to the colon (splenic
flexure), stomach, pancreas, and spleen may also result in intestinal symptoms. Digestive enzymes do
not affect renal function and the left kidney is not connected to the common bile duct.
34. A patient with a history of progressively worsening fatigue is undergoing a comprehensive assessment
which includes test of renal function relating to erythropoiesis. When assessing the oxygen transport
ability of the blood, the nurse should prioritize the review of what blood value?
A) Hematocrit
B) Hemoglobin
C) Erythrocyte sedimentation rate (ESR)
D) Serum creatinine
Ans: B
Feedback:
Although historically hematocrit has been the blood test of choice when assessing a patient for anemia,
use of the hemoglobin level rather than hematocrit is currently recommended, because that measurement
is a better assessment of the oxygen transport ability of the blood. ESR and creatinine levels are not
indicative of oxygen transport ability.
35. The nurse is reviewing the electronic health record of a patient with a history of incontinence. The nurse
reads that the physician assessed the patients deep tendon reflexes. What condition of the urinary/renal
system does this assessment address?
A) Renal calculi
B) Bladder dysfunction
C) Benign prostatic hyperplasia (BPH)
D) Recurrent urinary tract infections (UTIs)
Ans: B
Feedback:
The deep tendon reflexes of the knee are examined for quality and symmetry. This is an important part
of testing for neurologic causes of bladder dysfunction, because the sacral area, which innervates the
lower extremities, is in the same peripheral nerve area responsible for urinary continence. Neurologic
function does not directly influence the course of renal calculi, BPH or UTIs.
36. A patient with a history of incontinence will undergo urodynamic testing in the physicians office.
Because voiding in the presence of others can cause situational anxiety, the nurse should perform what
action?
A) Administer diuretics as ordered.
B) Push fluids for several hours prior to the test.

C) Discuss possible test results as the patient voids.
D) Help the patient to relax before and during the test.
Ans: D
Feedback:
Voiding in the presence of others can frequently cause guarding, a natural reflex that inhibits voiding
due to situational anxiety. Because the outcomes of these studies determine the plan of care, the nurse
must help the patient relax by providing as much privacy and explanation about the procedure as
possible. Diuretics and increased fluid intake would not address the patients anxiety. It would be
inappropriate and anxiety-provoking to discuss test results during the performance of the test.
37. A nurse is working with a patient who will undergo invasive urologic testing. The nurse has informed
the patient that slight hematuria may occur after the testing is complete. The nurse should recommend
what action to help resolve hematuria?
A) Increased fluid intake following the test
B) Use of an OTC diuretic after the test
C) Gentle massage of the lower abdomen
D) Activity limitation for the first 12 hours after the test
Ans: A
Feedback:
Drinking fluids can help to clear hematuria. Diuretics are not used for this purpose. Activity limitation
and massage are unlikely to resolve this expected consequence of testing.
38. The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that
this test will include what assessment parameters? Select all that apply.
A) Specific gravity of the patients urine
B) Testing for the presence of glucose in the patients urine
C) Microscopic examination of urine sediment for RBCs
D) Microscopic examination of urine sediment for casts
E) Testing for BUN and creatinine in the patients urine

Ans: A, B, C, D
Feedback:
Urine testing includes testing for specific gravity, glucose, RBCs, and casts. BUN and creatinine are
components of serum, not urine.
39. Dipstick testing of an older adult patients urine indicates the presence of protein. Which of the following
statements is true of this assessment finding?
A) This finding needs to be considered in light of other forms of testing.
B) This finding is a risk factor for urinary incontinence.
C) This finding is likely the result of an age-related physiologic change.
D) This result confirms that the patient has diabetes. Select all that apply.
Ans: B, C, D
Feedback:
A dipstick examination, which can detect from 30 to 1000 mg/dL of protein, should be used as a
screening test only, because urine concentration, pH, hematuria, and radiocontrast materials all affect the
results. Proteinuria is not diagnostic of diabetes and it is neither an age-related change nor a risk factor
for incontinence.
40. What nursing action should the nurse perform when caring for a patient undergoing diagnostic testing of
the renal-urologic system?
A) Withhold medications until 12 hours post-testing.
B) Ensure that the patient knows the importance of temporary fluid restriction after testing.
C) Inform the patient of his or her medical diagnosis after reviewing the results.
D) Assess the patients understanding of the test results after their completion.
Ans: D
Feedback:
The nurse should ensure that the patient understands the results that are presented by the physician.
Informing the patient of a diagnosis is normally the primary care providers responsibility. Withholding
fluids or medications is not normally required after testing.

Chapter 54: Management of Patients with Kidney Disorders

1. The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse
should expect to address what clinical manifestation that is characteristic of this health problem?
A) Hematuria
B) Precipitous decrease in serum creatinine levels
C) Hypotension unresolved by fluid administration
D) Glucosuria
Ans: A
Feedback:
The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may
be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the
eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular
membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Some
degree of edema and hypertension is noted in most patients.
2. The nurse is caring for acutely ill patient. What assessment finding should prompt the nurse to inform
the physician that the patient may be exhibiting signs of acute kidney injury (AKI)?
A) The patient is complains of an inability to initiate voiding.
B) The patients urine is cloudy with a foul odor.
C) The patients average urine output has been 10 mL/hr for several hours.
D) The patient complains of acute flank pain.
Ans: C
Feedback:
Oliguria (<500 mL/d of urine) is the most common clinical situation seen in AKI. Flank pain and
inability to initiate voiding are not characteristic of AKI. Cloudy, foul-smelling urine is suggestive of a
urinary tract infection.
3. The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently
diagnosed with end-stage kidney disease (ESKD). The patient has an elevated phosphorus level and has
been prescribed calcium acetate to bind the phosphorus. The nurse should teach the patient to take the
prescribed phosphorus-binding medication at what time?
A) Only when needed
B) Daily at bedtime
C) First thing in the morning
D) With each meal
Ans: D
Feedback:
Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in
excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding
medications must be administered with food to be effective.
4. The nurse is working on the renal transplant unit. To reduce the risk of infection in a patient with a
transplanted kidney, it is imperative for the nurse to do what?
A) Wash hands carefully and frequently.
B) Ensure immediate function of the donated kidney.
C) Instruct the patient to wear a face mask.
D) Bar visitors from the patients room.
Ans: A
Feedback:
The nurse ensures that the patient is protected from exposure to infection by hospital staff, visitors, and
other patients with active infections. Careful handwashing is imperative; face masks may be worn by
hospital staff and visitors to reduce the risk for transmitting infectious agents while the patient is
receiving high doses of immunosuppressants. Visitors may be limited, but are not normally barred
outright. Ensuring kidney function is vital, but does not prevent infection.
5. The nurse is caring for a patient receiving hemodialysis three times weekly. The patient has had surgery
to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing
care for this patient?
A) Using a stethoscope for auscultating the fistula is contraindicated.

B) The patient feels best immediately after the dialysis treatment.
C) Taking a BP reading on the affected arm can damage the fistula.
D) The patient should not feel pain during initiation of dialysis.
Ans: C
Feedback:
When blood flow is reduced through the access for any reason (hypotension, application of BP
cuff/tourniquet), the access site can clot. Auscultation of a bruit in the fistula is one way to determine
patency. Typically, patients feel fatigued immediately after hemodialysis because of the rapid change in
fluid and electrolyte status. Although the area over the fistula may have some decreased sensation, a
needle stick is still painful.
6. A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse
interprets that the patients chronic kidney disease is at what stage?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Ans: C
Feedback:
Stages of chronic renal failure are based on the GFR. Stage 3 is defined by a GFR in the range of 30 to
59 mL/min/1.73 m2. This is considered a moderate decrease in GFR.
7. A football player is thought to have sustained an injury to his kidneys from being tackled from behind.
The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an
order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this
nursing intervention is important for what reason?
A) Hematuria is the most common manifestation of renal trauma and blood losses may be
microscopic, so laboratory analysis is essential.
B) Intake and output calculations are essential and the laboratory will calculate the precise urine
output produced by this patient.
C) A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine
until it is determined if the test will be necessary.
D) There is great concern about electrolyte imbalances and the laboratory will monitor the urine for
changes in potassium and sodium concentrations.
Ans: A
Feedback:
Hematuria is the most common manifestation of renal trauma; its presence after trauma suggests renal
injury. Hematuria may not occur, or it may be detectable only on microscopic examination. All urine
should be saved and sent to the laboratory for analysis to detect RBCs and to evaluate the course of
bleeding. Measuring intake and output is not a function of the laboratory. The laboratory does not save
urine to test creatinine clearance at a later time. The laboratory does not monitor the urine for sodium or
potassium concentrations.
8. A patient admitted with nephrotic syndrome is being cared for on the medical unit. When writing this
patients care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing
diagnosis should the nurse include?
A) Constipation related to immobility
B) Risk for injury related to altered thought processes
C) Hyperthermia related to the inflammatory process
D) Excess fluid volume related to generalized edema
Ans: D
Feedback:
The major clinical manifestation of nephrotic syndrome is edema, so the appropriate nursing diagnosis is
Excess fluid volume related to generalized edema. Edema is usually soft, pitting, and commonly occurs
around the eyes, in dependent areas, and in the abdomen.
9. The nurse coming on shift on the medical unit is taking a report on four patients. What patient does the
nurse know is at the greatest risk of developing ESKD?
A) A patient with a history of polycystic kidney disease
B) A patient with diabetes mellitus and poorly controlled hypertension
C) A patient who is morbidly obese with a history of vascular disorders

D) A patient with severe chronic obstructive pulmonary disease
Ans: B
Feedback:
Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis;
pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in polycystic kidney disease;
vascular disorders; infections; medications; or toxic agents may cause ESKD. A patient with more than
one of these risk factors is at the greatest risk for developing ESKD. Therefore, the patient with diabetes
and hypertension is likely at highest risk for ESKD.
10. The nurse is caring for a patient postoperative day 4 following a kidney transplant. When assessing for
potential signs and symptoms of rejection, what assessment should the nurse prioritize?
A) Assessment of the quantity of the patients urine output
B) Assessment of the patients incision
C) Assessment of the patients abdominal girth
D) Assessment for flank or abdominal pain
Ans: A
Feedback:
After kidney transplantation, the nurse should perform all of the listed assessments. However, oliguria is
considered to be more suggestive of rejection than changes to the patients abdomen or incision.
11. The nurse is caring for a patient in acute kidney injury. Which of the following complications would
most clearly warrant the administration of polystyrene sulfonate (Kayexalate)?
A) Hypernatremia
B) Hypomagnesemia
C) Hyperkalemia
D) Hypercalcemia
Ans: C
Feedback:
Hyperkalemia, a common complication of acute kidney injury, is life-threatening if immediate action is

not taken to reverse it. The administration of polystyrene sulfonate reduces serum potassium levels.
12. Renal failure can have prerenal, renal, or postrenal causes. A patient with acute kidney injury is being
assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which
condition most likely caused it?
A) Heart failure
B) Glomerulonephritis
C) Ureterolithiasis
D) Aminoglycoside toxicity
Ans: A
Feedback:
By causing inadequate renal perfusion, heart failure can lead to prerenal failure. Glomerulonephritis and
aminoglycoside toxicity are renal causes, and ureterolithiasis is a postrenal cause.
13. A 45-year-old man with diabetic nephropathy has ESKD and is starting dialysis. What should the nurse
teach the patient about hemodialysis?
A) Hemodialysis is a treatment option that is usually required three times a week.
B) Hemodialysis is a program that will require you to commit to daily treatment.
C) This will require you to have surgery and a catheter will need to be inserted into your abdomen.
D) Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to
produce urine again.
Ans: A
Feedback:
Hemodialysis is the most commonly used method of dialysis. Patients receiving hemodialysis must
undergo treatment for the rest of their lives or until they undergo successful kidney transplantation.
Treatments usually occur three times a week for at least 3 to 4 hours per treatment.
14. A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse observes that the
dialysate drainage fluid is cloudy. What is the nurses most appropriate action?
A) Inform the physician and assess the patient for signs of infection.
B) Flush the peritoneal catheter with normal saline.
C) Remove the catheter promptly and have the catheter tip cultured.
D) Administer a bolus of IV normal saline as ordered.
Ans: A
Feedback:
Peritonitis is the most common and serious complication of peritoneal dialysis. The first sign of
peritonitis is cloudy dialysate drainage fluid, so prompt reporting to the primary care provider and rapid
assessment for other signs of infection are warranted. Administration of an IV bolus is not necessary or
appropriate and the physician would determine whether removal of the catheter is required. Flushing the
catheter does not address the risk for infection.
15. The nurse is planning patient teaching for a patient with ESKD who is scheduled for the creation of a
fistula. The nurse would include which of the following in teaching the patient about the fistula?
A) A vein and an artery in your arm will be attached surgically.
B) The arm should be immobilized for 4 to 6 days.
C) One needle will be inserted into the fistula for each dialysis treatment.
D) The fistula can be used 2 days after the surgery for dialysis treatment.
Ans: A
Feedback:
The fistula joins an artery and a vein, either side-to-side or end-to-end. This access will need time,
usually 2 to 3 months, to mature before it can be used. The patient is encouraged to perform exercises to
increase the size of the affected vessels (e.g., squeezing a rubber ball for forearm fistulas). Two needles
will be inserted into the fistula for each dialysis treatment.
16. A patient with ESKD is scheduled to begin hemodialysis. The nurse is working with the patient to adapt
the patients diet to maximize the therapeutic effect and minimize the risks of complications. The patients
diet should include which of the following modifications? Select all that apply.
A) Decreased protein intake
B) Decreased sodium intake

C) Increased potassium intake
D) Fluid restriction
E) Vitamin D supplementation
Ans: A, B, D
Feedback:
Restricting dietary protein decreases the accumulation of nitrogenous wastes, reduces uremic symptoms,
and may even postpone the initiation of dialysis for a few months. Restriction of fluid is also part of the
dietary prescription because fluid accumulation may occur. As well, sodium is usually restricted to 2 to 3
g/day. Potassium intake is usually limited, not increased, and there is no particular need for vitamin D
supplementation.
17. A patient on the critical care unit is postoperative day 1 following kidney transplantation from a living
donor. The nurses most recent assessments indicate that the patient is producing copious quantities of
dilute urine. What is the nurses most appropriate response?
A) Assess the patient for further signs or symptoms of rejection.
B) Recognize this as an expected finding.
C) Inform the primary care provider of this finding.
D) Administer exogenous antidiuretic hormone as ordered.
Ans: B
Feedback:
A kidney from a living donor related to the patient usually begins to function immediately after surgery
and may produce large quantities of dilute urine. This is not suggestive of rejection and treatment is not
warranted. There is no obvious need to report this finding.
18. A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine
level of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders?
A) Monitor the patients electrolyte values every hour before the procedure.
B) Preprocedure hydration and administration of acetylcysteine
C) Hemodialysis immediately prior to the CT scan

D) Obtain a creatinine clearance by collecting a 24-hour urine specimen.
Ans: B
Feedback:
Radiocontrast-induced nephropathy is a major cause of hospital-acquired acute kidney injury. Baseline

levels of creatinine greater than 2 mg/dL identify the patient as being high risk. Preprocedure hydration
and prescription of acetylcysteine (Mucomyst) the day prior to the test is effective in prevention. The
nurse would not monitor the patients electrolytes every hour preprocedure. Nothing in the scenario
indicates the need for hemodialysis. A creatinine clearance is not necessary prior to a CT scan with
contrast.
19. The nurse is caring for a patient with acute glomerular inflammation. When assessing for the
characteristic signs and symptoms of this health problem, the nurse should include which assessments?
Select all that apply.
A) Percuss for pain in the right lower abdominal quadrant.
B) Assess for the presence of peripheral edema.
C) Auscultate the patients apical heart rate for dysrhythmias.
D) Assess the patients BP.
E) Assess the patients orientation and judgment.
Ans: B, D
Feedback:
Most patients with acute glomerular inflammation have some degree of edema and hypertension.
Dysrhythmias, RLQ pain, and changes in mental status are not among the most common manifestations
of acute glomerular inflammation.
20. A patient is admitted to the ICU after a motor vehicle accident. On the second day of the hospital
admission, the patient develops acute kidney injury. The patient is hemodynamically unstable, but renal
replacement therapy is needed to manage the patients hypervolemia and hyperkalemia. Which of the
following therapies will the patients hemodynamic status best tolerate?
A) Hemodialysis
B) Peritoneal dialysis
C) Continuous venovenous hemodialysis (CVVHD)

D) Plasmapheresis
Ans: C
Feedback:
CVVHD facilitates the removal of uremic toxins and fluid. The hemodynamic effects of CVVHD are
usually mild in comparison to hemodialysis, so CVVHD is best tolerated by an unstable patient.
Peritoneal dialysis is not the best choice, as the patient may have sustained abdominal injuries during the
accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and
electrolyte balance.
21. A patient has presented with signs and symptoms that are characteristic of acute kidney injury, but
preliminary assessment reveals no obvious risk factors for this health problem. The nurse should
recognize the need to interview the patient about what topic?
A) Typical diet
B) Allergy status
C) Psychosocial stressors
D) Current medication use
Ans: D
Feedback:
The kidneys are susceptible to the adverse effects of medications because they are repeatedly exposed to
substances in the blood. Nephrotoxic medications are a more likely cause of AKI than diet, allergies, or
stress.
22. An 84-year-old woman diagnosed with cancer is admitted to the oncology unit for surgical treatment.
The patient has been on chemotherapeutic agents to decrease the tumor size prior to the planned surgery.
The nurse caring for the patient is aware that what precipitating factors in this patient may contribute to
AKI? Select all that apply.
A) Anxiety
B) Low BMI
C) Age-related physiologic changes
D) Chronic systemic disease
E) NPO status
Ans: C, D
Feedback:
Changes in kidney function with normal aging increase the susceptibility of elderly patients to kidney
dysfunction and renal failure. In addition, the presence of chronic, systemic diseases increases the risk of
AKI. Low BMI and anxiety are not risk factors for acute renal disease. NPO status is not a risk, provided
adequate parenteral hydration is administered.
23. A patient is being treated for AKI and the patient daily weights have been ordered. The nurse notes a
weight gain of 3 pounds over the past 48 hours. What nursing diagnosis is suggested by this assessment
finding?
A) Imbalanced nutrition: More than body requirements
B) Excess fluid volume
C) Sedentary lifestyle
D) Adult failure to thrive
Ans: B
Feedback:
If the patient with AKI gains or does not lose weight, fluid retention should be suspected. Short-term
weight gain is not associated with excessive caloric intake or a sedentary lifestyle. Failure to thrive is not
associated with weight gain.
24. A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The
nurse should recognize that this form of kidney disease may have been precipitated by what event?
A) Psychosocial stress
B) Hypersensitivity to an immunization
C) Menarche
D) Streptococcal infection
Ans: D
Feedback:
Postinfectious causes of postinfectious glomerular disease are group A beta-hemolytic streptococcal

infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks. Menarche, stress,
and hypersensitivity are not typical causes.
25. A patient on the medical unit has a documented history of polycystic kidney disease (PKD). What
principle should guide the nurses care of this patient?
A) The disease is self-limiting and cysts usually resolve spontaneously in the fifth or sixth decade of
life.
B) The patients disease is incurable and the nurses interventions will be supportive.
C) The patient will eventually require surgical removal of his or her renal cysts.
D) The patient is likely to respond favorably to lithotripsy treatment of the cysts.
Ans: B
Feedback:
PKD is incurable and care focuses on support and symptom control. It is not self-limiting and is not
treated surgically or with lithotripsy.
26. The nurse is providing a health education workshop to a group of adults focusing on cancer prevention.
The nurse should emphasize what action in order to reduce participants risks of renal carcinoma?
A) Avoiding heavy alcohol use
B) Control of sodium intake
C) Smoking cessation
D) Adherence to recommended immunization schedules
Ans: C
Feedback:
Tobacco use is a significant risk factor for renal cancer, surpassing the significance of high alcohol and
sodium intake. Immunizations do not address an individuals risk of renal cancer.
27. The nurse performing the health interview of a patient with a new onset of periorbital edema has
completed a genogram, noting the health history of the patients siblings, parents, and grandparents. This
assessment addresses the patients risk of what kidney disorder?
A) Nephritic syndrome
B) Acute glomerulonephritis
C) Nephrotic syndrome
D) Polycystic kidney disease (PKD)
Ans: D
Feedback:
PKD is a genetic disorder characterized by the growth of numerous cysts in the kidneys. Nephritic
syndrome, acute glomerulonephritis, and nephrotic syndrome are not genetic disorders.
28. A patient is brought to the renal unit from the PACU status post resection of a renal tumor. Which of the
following nursing actions should the nurse prioritize in the care of this patient?
A) Increasing oral intake
B) Managing postoperative pain
C) Managing dialysis
D) Increasing mobility
Ans: B
Feedback:
The patient requires frequent analgesia during the postoperative period and assistance with turning,
coughing, use of incentive spirometry, and deep breathing to prevent atelectasis and other pulmonary
complications. Increasing oral intake and mobility are not priority nursing actions in the immediate
postoperative care of this patient. Dialysis is not necessary following kidney surgery.
29. A nurse is caring for a patient who is in the diuresis phase of AKI. The nurse should closely monitor the
patient for what complication during this phase?
A) Hypokalemia
B) Hypocalcemia
C) Dehydration
D) Acute flank pain
Ans: C
Feedback:
The diuresis period is marked by a gradual increase in urine output, which signals that glomerular
filtration has started to recover. The patient must be observed closely for dehydration during this phase;
if dehydration occurs, the uremic symptoms are likely to increase. Excessive losses of potassium and
calcium are not typical during this phase, and diuresis does not normally result in pain.
30. The nurse is caring for a patient status after a motor vehicle accident. The patient has developed AKI.
What is the nurses role in caring for this patient? Select all that apply.
A) Providing emotional support for the family
B) Monitoring for complications
C) Participating in emergency treatment of fluid and electrolyte imbalances
D) Providing nursing care for primary disorder (trauma)
E) Directing nutritional interventions
Ans: A, B, C, D
Feedback:
The nurse has an important role in caring for the patient with AKI. The nurse monitors for
complications, participates in emergency treatment of fluid and electrolyte imbalances, assesses the
patients progress and response to treatment, and provides physical and emotional support. Additionally,
the nurse keeps family members informed about the patients condition, helps them understand the
treatments, and provides psychological support. Although the development of AKI may be the most
serious problem, the nurse continues to provide nursing care indicated for the primary disorder (e.g.,
burns, shock, trauma, obstruction of the urinary tract). The nurse does not direct the patients nutritional
status; the dietician and the physician normally collaborate on directing the patients nutritional status.
31. A 71-year-old patient with ESKD has been told by the physician that it is time to consider hemodialysis
until a transplant can be found. The patient tells the nurse she is not sure she wants to undergo a kidney
transplant. What would be an appropriate response for the nurse to make?
A) The decision is certainly yours to make, but be sure not to make a mistake.
B) Kidney transplants in patients your age are as successful as they are in younger patients.
C) I understand your hesitancy to commit to a transplant surgery. Success is comparatively rare.

D) Have you talked this over with your family?
Ans: B
Feedback:
Although there is no specific age limitation for renal transplantation, concomitant disorders (e.g.,
coronary artery disease, peripheral vascular disease) have made it a less common treatment for the
elderly. However, the outcome is comparable to that of younger patients. The other listed options either
belittle the patient or give the patient misinformation.
32. The nurse has identified the nursing diagnosis of risk for infection in a patient who undergoes peritoneal
dialysis. What nursing action best addresses this risk?
A) Maintain aseptic technique when administering dialysate.
B) Wash the skin surrounding the catheter site with soap and water prior to each exchange.
C) Add antibiotics to the dialysate as ordered.
D) Administer prophylactic antibiotics by mouth or IV as ordered.
Ans: A
Feedback:
Aseptic technique is used to prevent peritonitis and other infectious complications of peritoneal dialysis.
It is not necessary to cleanse the skin with soap and water prior to each exchange. Antibiotics may be
added to dialysate to treat infection, but they are not used to prevent infection.
33. The nurse is caring for a patient who has returned to the postsurgical suite after post-anesthetic recovery
from a nephrectomy. The nurses most recent hourly assessment reveals a significant drop in level of
consciousness and BP as well as scant urine output over the past hour. What is the nurses best response?
A) Assess the patient for signs of bleeding and inform the physician.
B) Monitor the patients vital signs every 15 minutes for the next hour.
C) Reposition the patient and reassess vital signs.
D) Palpate the patients flanks for pain and inform the physician.
Ans: A
Feedback:
Bleeding may be suspected when the patient experiences fatigue and when urine output is less than 30
mL/h. The physician must be made aware of this finding promptly. Palpating the patients flanks would
cause intense pain that is of no benefit to assessment.
34. The critical care nurse is monitoring the patients urine output and drains following renal surgery. What
should the nurse promptly report to the physician?
A) Increased pain on movement
B) Absence of drain output
C) Increased urine output
D) Blood-tinged serosanguineous drain output
Ans: B
Feedback:
Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type
or characteristics. Decreased or absent drainage is promptly reported to the physician because it may
indicate obstruction that could cause pain, infection, and disruption of the suture lines. Reporting
increased pain on movement has nothing to do with the scenario described. Increased urine output and
serosanguineous drainage are expected.
35. The nurse is creating an education plan for a patient who underwent a nephrectomy for the treatment of a
renal tumor. What should the nurse include in the teaching plan?
A) The importance of increased fluid intake
B) Signs and symptoms of rejection
C) Inspection and care of the incision
D) Techniques for preventing metastasis
Ans: C
Feedback:
The nurse teaches the patient to inspect and care for the incision and perform other general postoperative
care, including activity and lifting restrictions, driving, and pain management. There would be no need
to teach the signs or symptoms of rejection as there has been no transplant. Increased fluid intake is not
normally recommended and the patient has minimal control on the future risk for metastasis.
36. A patient with chronic kidney disease has been hospitalized and is receiving hemodialysis on a
scheduled basis. The nurse should include which of the following actions in the plan of care?
A) Ensure that the patient moves the extremity with the vascular access site as little as possible.
B) Change the dressing over the vascular access site at least every 12 hours.
C) Utilize the vascular access site for infusion of IV fluids.
D) Assess for a thrill or bruit over the vascular access site each shift.
Ans: D
Feedback:
The bruit, or thrill, over the venous access site must be evaluated at least every shift. Frequent dressing
changes are unnecessary and the patient does not normally need to immobilize the site. The site must not
be used for purposes other than dialysis.
37. The nurse is caring for a patient who has just returned to the post-surgical unit following renal surgery.
When assessing the patients output from surgical drains, the nurse should assess what parameters? Select
all that apply.
A) Quantity of output
B) Color of the output
C) Visible characteristics of the output
D) Odor of the output
E) pH of the output
Ans: A, B, C
Feedback:
Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type
or characteristics. Odor and pH are not normally assessed.
38. The nurse is caring for a patient after kidney surgery. The nurse is aware that bleeding is a major
complication of kidney surgery and that if it goes undetected and untreated can result in hypovolemia
and hemorrhagic shock in the patient. When assessing for bleeding, what assessment parameter should
the nurse evaluate?
A) Oral intake
B) Pain intensity
C) Level of consciousness
D) Radiation of pain
Ans: C
Feedback:
Bleeding is a major complication of kidney surgery. If undetected and untreated, this can result in
hypovolemia and hemorrhagic shock. The nurses role is to observe for these complications, to report
their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood
components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision,
and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood,
and fluid volume and cardiac output. Bleeding is not normally evidenced by changes in pain or oral
intake.
39. A nurse on the renal unit is caring for a patient who will soon begin peritoneal dialysis. The family of the
patient asks for education about the peritoneal dialysis catheter that has been placed in the patients
peritoneum. The nurse explains the three sections of the catheter and talks about the two cuffs on the
dialysis catheter. What would the nurse explain about the cuffs? Select all that apply.
A) The cuffs are made of Dacron polyester.
B) The cuffs stabilize the catheter.
C) The cuffs prevent the dialysate from leaking.
D) The cuffs provide a barrier against microorganisms.
E) The cuffs absorb dialysate
Ans: A, B, C, D
Feedback:
Most of these catheters have two cuffs, which are made of Dacron polyester. The cuffs stabilize the
catheter, limit movement, prevent leaks, and provide a barrier against microorganisms. They do not
absorb dialysate.
40. A patient with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse
observes that the peritoneal fluid is draining slowly and that the patients abdomen is increasing in girth.
What is the nurses most appropriate action?
A) Advance the catheter 2 to 4 cm further into the peritoneal cavity.
B) Reposition the patient to facilitate drainage.
C) Aspirate from the catheter using a 60-mL syringe.
D) Infuse 50 mL of additional dialysate.
Ans: B
Feedback:
If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the patient
from side to side or raising the head of the bed. The catheter should never be pushed further into the
peritoneal cavity. It would be unsafe to aspirate or to infuse more dialysate.
Chapter 55: Management of Patients with Urinary Disorders

1. A female patient has been experiencing recurrent urinary tract infections. What health education should
the nurse provide to this patient?
A) Bathe daily and keep the perineal region clean.
B) Avoid voiding immediately after sexual intercourse.
C) Drink liberal amounts of fluids.
D) Void at least every 6 to 8 hours.
Ans: C
Feedback:
The patient is encouraged to drink liberal amounts of fluids (water is the best choice) to increase urine
production and flow, which flushes the bacteria from the urinary tract. Frequent voiding (every 2 to 3
hours) is encouraged to empty the bladder completely because this can significantly lower urine bacterial
counts, reduce urinary stasis, and prevent reinfection. The patient should be encouraged to shower rather
than bathe.
2. A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she
sneezes. The clinic nurse should recognize what type of incontinence?
A) Stress incontinence
B) Reflex incontinence
C) Overflow incontinence
D) Functional incontinence
Ans: A
Feedback:
Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden
increase in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia or
involuntary urethral relaxation in the absence of normal sensations usually associated with voiding.
Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder.
Functional incontinence refers to those instances in which the function of the lower urinary tract is
intact, but other factors (outside the urinary system) make it difficult or impossible for the patient to
reach the toilet in time for voiding.
3. A nurse is caring for a female patient whose urinary retention has not responded to conservative
treatment. When educating this patient about self-catheterization, the nurse should encourage what
practice?
A) Assuming a supine position for self-catheterization
B) Using clean technique at home to catheterize
C) Inserting the catheter 1 to 2 inches into the urethra
D) Self-catheterizing every 2 hours at home
Ans: B
Feedback:
The patient may use a clean (nonsterile) technique at home, where the risk of cross-contamination is
reduced. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just
before bedtime. The female patient assumes a Fowlers position and uses a mirror to help locate the
urinary meatus. The nurse teaches her to catheterize herself by inserting a catheter 7.5 cm (3 inches) into
the urethra, in a downward and backward direction.
4. A 52-year-old patient is scheduled to undergo ileal conduit surgery. When planning this patients
discharge education, what is the most plausible nursing diagnosis that the nurse should address?
A) Impaired mobility related to limitations posed by the ileal conduit
B) Deficient knowledge related to care of the ileal conduit
C) Risk for deficient fluid volume related to urinary diversion
D) Risk for autonomic dysreflexia related to disruption of the sacral plexus
Ans: B
Feedback:
The patient will most likely require extensive teaching about the care and maintenance of a new urinary
diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is unlikely to be
impaired after the immediate postsurgical recovery. The sacral plexus is not threatened by the creation of
a urinary diversion.
5. The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal calculi.
When planning this patients health education, what nutritional guidelines should the nurse provide?
A) Restrict protein intake as ordered.
B) Increase intake of potassium-rich foods.
C) Follow a low-calcium diet.
D) Encourage intake of food containing oxalates.
Ans: A
Feedback:
Protein is restricted to 60 g/d, while sodium is restricted to 3 to 4 g/d. Low-calcium diets are generally
not recommended except for true absorptive hypercalciuria. The patient should avoid intake of oxalate-
containing foods and there is no need to increase potassium intake.
6. The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day. What
instruction should the nurse give the patient?
A) Limit oral fluid intake for 1 to 2 days.
Report the presence of fine, sand like particles through the nephrostomy tube.
B)
C) Notify the physician about cloudy or foul-smelling urine.
D) Report any pink-tinged urine within 24 hours after the procedure.
Ans: C
Feedback:
The patient should report the presence of foul-smelling or cloudy urine since this is suggestive of a UTI.
Unless contraindicated, the patient should be instructed to drink large quantities of fluid each day to
flush the kidneys. Sand like debris is normal due to residual stone products. Hematuria is common after
lithotripsy.
7. A female patients most recent urinalysis results are suggestive of bacteriuria. When assessing this
patient, the nurses data analysis should be informed by what principle?
A) Most UTIs in female patients are caused by viruses and do not cause obvious symptoms.
B) A diagnosis of bacteriuria requires three consecutive positive results.
C) Urine contains varying levels of healthy bacterial flora.

D) Urine samples are frequently contaminated by bacteria normally present in the urethral area.
Ans: D
Feedback:
Because urine samples (especially in women) are commonly contaminated by the bacteria normally
present in the urethral area, a bacterial count exceeding 105 colonies/mL of clean-catch, midstream urine
is the measure that distinguishes true bacteriuria from contamination. A diagnosis does not require three
consecutive positive results and urine does not contain a normal flora in the absence of a UTI. Most
UTIs have a bacterial etiology.
8. The clinic nurse is preparing a plan of care for a patient with a history of stress incontinence. What role
will the nurse have in implementing a behavioral therapy approach?
A) Provide medication teaching related to pseudoephedrine sulfate.
B) Teach the patient to perform pelvic floor muscle exercises.
C) Prepare the patient for an anterior vaginal repair procedure.
D) Provide information on periurethral bulking.
Ans: B
Feedback:
Pelvic floor muscle exercises (sometimes called Kegel exercises) represent the cornerstone of behavioral
intervention for addressing symptoms of stress, urge, and mixed incontinence. None of the other listed
interventions has a behavioral approach.
9. The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic
obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain the
patients bladder?
A) Insertion of a suprapubic catheter
B) Scheduling the patient immediately for a prostatectomy
C) Application of warm compresses to the perineum to assist with relaxation
D) Medication administration to relax the bladder muscles and reattempting catheterization in 6 hours
Ans: A
Feedback:
When the patient cannot void, catheterization is used to prevent overdistention of the bladder. In the case
of prostatic obstruction, attempts at catheterization by the urologist may not be successful, requiring
insertion of a suprapubic catheter. A prostatectomy may be necessary, but would not be undertaken for
the sole purpose of relieving a urethral obstruction. Delaying by applying compresses or administering
medications could result in harm.
10. The nurse has implemented a bladder retraining program for an older adult patient. The nurse places the
patient on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse
notes that the patient typically has approximately 50 mL of urine remaining in her bladder after voiding.
What would be the nurses best response to this finding?
A) Perform a straight catheterization on this patient.
B) Avoid further interventions at this time, as this is an acceptable finding.
C) Place an indwelling urinary catheter.
D) Press on the patients bladder in an attempt to encourage complete emptying.
Ans: B
Feedback:
In adults older than 60 years of age, 50 to 100 mL of residual urine may remain after each voiding
because of the decreased contractility of the detrusor muscle. Consequently, further interventions are not
likely warranted.
11. The nurse is caring for a patient recently diagnosed with renal calculi. The nurse should instruct the
patient to increase fluid intake to a level where the patient produces at least how much urine each day?
A) 1,250 mL
B) 2,000 mL
C) 2,750 mL
D) 3,500 mL
Ans: B
Feedback:
Unless contraindicated by renal failure or hydronephrosis, patients with renal stones should drink at least
eight 8-ounce glasses of water daily or have IV fluids prescribed to keep the urine dilute. A urine output
exceeding 2 L a day is advisable.
12. A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create
an ileal conduit. The nurse is monitoring the patients urine output hourly and notifies the physician when
the hourly output is less than what?
A) 30 mL
B) 50 mL
C) 100 mL
D) 125 mL
Ans: A
Feedback:
A urine output below 30 mL/hr may indicate dehydration or an obstruction in the ileal conduit, with
possible backflow or leakage from the ureteroileal anastomosis.
13. The nurse is caring for a patient with an indwelling urinary catheter. The nurse is aware that what
nursing action helps prevent infection in a patient with an indwelling catheter?
A) Vigorously clean the meatus area daily.
B) Apply powder to the perineal area twice daily.
C) Empty the drainage bag at least every 8 hours.
D) Irrigate the catheter every 8 hours with normal saline.
Ans: C
Feedback:
To reduce the risk of bacterial proliferation, the nurse should empty the collection bag at least every 8
hours through the drainage spout, and more frequently if there is a large volume of urine. Vigorous
cleaning of the meatus while the catheter is in place is discouraged, because the cleaning action can
move the catheter, increasing the risk of infection. The spout (or drainage port) of any urinary drainage
bag can become contaminated when opened to drain the bag. Irrigation of the catheter opens the closed
system, increasing the likelihood of infection.
14. The nurse is teaching a health class about UTIs to a group of older adults. What characteristic of UTIs
should the nurse cite?
A) Men over age 65 are equally prone to UTIs as women, but are more often asymptomatic.
B) The prevalence of UTIs in men older than 50 years of age approaches that of women in the same
age group.
C) Men of all ages are less prone to UTIs, but typically experience more severe symptoms.
D) The prevalence of UTIs in men cannot be reliably measured, as men generally do not report UTIs.
Ans: B
Feedback:
The antibacterial activity of the prostatic secretions that protect men from bacterial colonization of the
urethra and bladder decreases with aging. The prevalence of infection in men older than 50 years of age
approaches that of women in the same age group. Men are not more likely to be asymptomatic and are
not known to be reluctant to report UTIs.
15. A patient has been admitted to the postsurgical unit following the creation of an ileal conduit. What
should the nurse measure to determine the size of the appliance needed?
A) The circumference of the stoma
B) The narrowest part of the stoma
C) The widest part of the stoma
D) Half the width of the stoma
Ans: C
Feedback:
The correct appliance size is determined by measuring the widest part of the stoma with a ruler. The
permanent appliance should be no more than 1.6 mm (1/8 inch) larger than the diameter of the stoma
and the same shape as the stoma to prevent contact of the skin with drainage.
16. A patient being treated in the hospital has been experiencing occasional urinary retention. What nursing
action should the nurse take to encourage a patient who is having difficulty voiding?
A) Use a slipper bedpan.
B) Apply a cold compress to the perineum.
C) Have the patient lie in a supine position.

D) Provide privacy for the patient.
Ans: D
Feedback:
Nursing measures to encourage normal voiding patterns include providing privacy, ensuring an
environment and body position conducive to voiding, and assisting the patient with the use of the
bathroom or bedside commode, rather than a bedpan, to provide a more natural setting for voiding. Most
people find supine positioning not conducive to voiding.
17. A nurses colleague has applied an incontinence pad to an older adult patient who has experienced
occasional episodes of functional incontinence. What principle should guide the nurses management of
urinary incontinence in older adults?
A) Diuretics should be promptly discontinued when an older adult experiences incontinence.
B) Restricting fluid intake is recommended for older adults experiencing incontinence.
C) Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence.
D) Urinary incontinence is not considered a normal consequence of aging.
Ans: D
Feedback:
Nursing management is based on the premise that incontinence is not inevitable with illness or aging and
that it is often reversible and treatable. Diuretics cannot always be safely discontinued. Fluid restriction
and catheterization are not considered to be safe, first-line interventions for the treatment of
incontinence.
18. The nurse is working with a patient who has been experiencing episodes of urinary retention. What
assessment finding would suggest that the patient is experiencing retention?
A) The patients suprapubic region is dull on percussion.
B) The patient is uncharacteristically drowsy.
C) The patient claims to void large amounts of urine 2 to 3 times daily.
D) The patient takes a beta adrenergic blocker for the treatment of hypertension.
Ans: A
Feedback:
Dullness on percussion of the suprapubic region is suggestive of urinary retention. Patients retaining
urine are typically restless, not drowsy. A patient experiencing retention usually voids frequent, small
amounts of urine and the use of beta-blockers is unrelated to urinary retention.
19. A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What
should the nurse include in the patients post-procedure care?
A) Strain the patients urine following the procedure.
B) Administer a bolus of 500 mL normal saline following the procedure.
C) Monitor the patient for fluid overload following the procedure.
D) Insert a urinary catheter for 24 to 48 hours after the procedure.
Ans: A
Feedback:
Following ESWL, the nurse should strain the patients urine for gravel or sand. There is no need to
administer an IV bolus after the procedure and there is not a heightened risk of fluid overload. Catheter
insertion is not normally indicated following ESWL.
20. The nurse is caring for a patient who has undergone creation of a urinary diversion. Forty-eight hours
postoperatively, the nurses assessment reveals that the stoma is a dark purplish color. What is the nurses
most appropriate response?
A) Document the presence of a healthy stoma.
B) Assess the patient for further signs and symptoms of infection.
C) Inform the primary care provider that the vascular supply may be compromised.
D) Liaise with the wound-ostomy-continence (WOC) nurse because the ostomy appliance around the
stoma may be too loose.
Ans: C
Feedback:
A healthy stoma is pink or red. A change from this normal color to a dark purplish color suggests that
the vascular supply may be compromised. A loose ostomy appliance and infections do not cause a dark
purplish stoma.
21. A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know
that incomplete emptying of the bladder due to bladder outlet obstruction can cause what?
A) Hydronephrosis
B) Nephritic syndrome
C) Pylonephritis
D) Nephrotoxicity
Ans: A
Feedback:
If voiding dysfunction goes undetected and untreated, the upper urinary system may become
compromised. Chronic incomplete bladder emptying from poor detrusor pressure results in recurrent
bladder infection. Incomplete bladder emptying due to bladder outlet obstruction, causing high-pressure
detrusor contractions, can result in hydronephrosis from the high detrusor pressure that radiates up the
ureters to the renal pelvis. This problem does not normally cause nephritic syndrome or pyelonephritis.
Nephrotoxicity results from chemical causes.
22. The nurse is assessing a patient admitted with renal stones. During the admission assessment, what
parameters would be priorities for the nurse to address? Select all that apply.
A) Dietary history
B) Family history of renal stones
C) Medication history
D) Surgical history
E) Vaccination history
Ans: A, B, C
Feedback:
Dietary and medication histories and family history of renal stones are obtained to identify factors
predisposing the patient to stone formation. When caring for a patient with renal stones it would not
normally be a priority to assess the vaccination history or surgical history, since these factors are not
usually related to the etiology of kidney stones.
23. A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of
urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this
population?
A) Administer prophylactic antibiotics as ordered.
B) Limit the use of indwelling urinary catheters.
C) Encourage frequent mobility and repositioning.
D) Toilet residents who are immobile on a scheduled basis.
Ans: B
Feedback:
When indwelling catheters are used, the risk of UTI increases dramatically. Limiting their use
significantly reduces an older adults risk of developing a UTI. Regular toileting promotes continence,
but has only an indirect effect on the risk of UTIs. Prophylactic antibiotics are not normally
administered. Mobility does not have a direct effect on UTI risk.
24. A gerontologic nurse is assessing a patient who has numerous comorbid health problems. What
assessment findings should prompt the nurse to suspect a UTI? Select all that apply.
A) Food cravings
B) Upper abdominal pain
C) Insatiable thirst
D) Uncharacteristic fatigue
E) New onset of confusion
Ans: D
Feedback:
The most common subjective presenting symptom of UTI in older adults is generalized fatigue. The
most common objective finding is a change in cognitive functioning. Food cravings, increased thirst, and
upper abdominal pain necessitate further assessment and intervention, but none is directly suggestive of
a UTI.
25. A female patient has been prescribed a course of antibiotics for the treatment of a UTI. When providing
health education for the patient, the nurse should address what topic?
A) The risk of developing a vaginal yeast infection as a consequent of antibiotic therapy

B) The need to expect a heavy menstrual period following the course of antibiotics
C) The risk of developing antibiotic resistance after the course of antibiotics
D) The need to undergo a series of three urine cultures after the antibiotics have been completed
Ans: A
Feedback:
Yeast vaginitis occurs in as many as 25% of patients treated with antimicrobial agents that affect vaginal
flora. Yeast vaginitis can cause more symptoms and be more difficult and costly to treat than the original
UTI. Antibiotics do not affect menstrual periods and serial urine cultures are not normally necessary.
Resistance is normally a result of failing to complete a prescribed course of antibiotics.
26. An adult patient has been hospitalized with pyelonephritis. The nurses review of the patients intake and
output records reveals that the patient has been consuming between 3 L and 3.5 L of oral fluid each day
since admission. How should the nurse best respond to this finding?
A) Supplement the patients fluid intake with a high-calorie diet.
B) Emphasize the need to limit intake to 2 L of fluid daily.
C) Obtain an order for a high-sodium diet to prevent dilutional hyponatremia.
D) Encourage the patient to continue this pattern of fluid intake.
Ans: D
Feedback:
Unless contraindicated, 3 to 4 L of fluids per day is encouraged to dilute the urine, decrease burning on
urination, and prevent dehydration. No need to supplement this fluid intake with additional calories or
sodium.
27. An older adult has experienced a new onset of urinary incontinence and family members identify this
problem as being unprecedented. When assessing the patient for factors that may have contributed to
incontinence, the nurse should prioritize what assessment?
A) Reviewing the patients 24-hour food recall for changes in diet
B) Assessing for recent contact with individuals who have UTIs
C) Assessing for changes in the patients level of psychosocial stress

D) Reviewing the patients medication administration record for recent changes
Ans: D
Feedback:
Many medications affect urinary continence in addition to causing other unwanted or unexpected effects.
Stress and dietary changes could potentially affect the patients continence, but medications are more
frequently causative of incontinence. UTIs can cause incontinence, but these infections do not result
from contact with infected individuals.
28. A nurse is working with a female patient who has developed stress urinary incontinence. Pelvic floor
muscle exercises have been prescribed by the primary care provider. How can the nurse best promote
successful treatment?
A) Clearly explain the potential benefits of pelvic floor muscle exercises.
B) Ensure the patient knows that surgery will be required if the exercises are unsuccessful.
C) Arrange for biofeedback when the patient is learning to perform the exercises.
D) Contact the patient weekly to ensure that she is performing the exercises consistently.
Ans: C
Feedback:
Research shows that written or verbal instruction alone is usually inadequate to teach an individual how
to identify and strengthen the pelvic floor for sufficient bladder and bowel control. Biofeedback-assisted
pelvic muscle exercise (PME) uses either electromyography or manometry to help the individual
identify the pelvic muscles as he or she attempts to learn which muscle group is involved when
performing PME. This objective assessment is likely superior to weekly contact with the patient.
Surgery is not necessarily indicated if behavioral techniques are unsuccessful.
29. A patient has a flaccid bladder secondary to a spinal cord injury. The nurse recognizes this patients high
risk for urinary retention and should implement what intervention in the patients plan of care?
A) Relaxation techniques
B) Sodium restriction
C) Lower abdominal massage
D) Double voiding
Ans: D
Feedback:
To enhance emptying of a flaccid bladder, the patient may be taught to double void. After each voiding,
the patient is instructed to remain on the toilet, relax for 1 to 2 minutes, and then attempt to void again in
an effort to further empty the bladder. Relaxation does not affect the neurologic etiology of a flaccid
bladder. Sodium restriction and massage are similarly ineffective.
30. A patient with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new
intervention, the nurse should prioritize what nursing diagnosis in the patients plan of care?
A) Impaired physical mobility related to presence of an indwelling urinary catheter
B) Risk for infection related to presence of an indwelling urinary catheter
C) Toileting self-care deficit related to urinary catheterization
D) Disturbed body image related to urinary catheterization
Ans: B
Feedback:
Catheters create a high risk for UTIs. Because of this acute physiologic threat, the patients risk for
infection is usually prioritized over functional and psychosocial diagnoses.
31. A patient has had her indwelling urinary catheter removed after having it in place for 10 days during
recovery from an acute illness. Two hours after removal of the catheter, the patient informs the nurse
that she is experiencing urinary urgency resulting in several small-volume voids. What is the nurses best
response?
A) Inform the patient that urgency and occasional incontinence are expected for the first few weeks
post-removal.
B) Obtain an order for a loop diuretic in order to enhance urine output and bladder function.
C) Inform the patient that this is not unexpected in the short term and scan the patients bladder
following each void.
D) Obtain an order to reinsert the patients urinary catheter and attempt removal in 24 to 48 hours.
Ans: C
Feedback:
Immediately after the indwelling catheter is removed, the patient is placed on a timed voiding schedule,
usually every 2 to 3 hours. At the given time interval, the patient is instructed to void. The bladder is
then scanned using a portable ultrasonic bladder scanner; if the bladder has not emptied completely,
straight catheterization may be performed. An indwelling catheter would not be reinserted to resolve the
problem and diuretics would not be beneficial. Ongoing incontinence is not an expected finding after
catheter removal.
32. A nurse on a busy medical unit provides care for many patients who require indwelling urinary catheters
at some point during their hospital care. The nurse should recognize a heightened risk of injury
associated with indwelling catheter use in which patient?
A) A patient whose diagnosis of chronic kidney disease requires a fluid restriction
B) A patient who has Alzheimers disease and who is acutely agitated
C) A patient who is on bed rest following a recent episode of venous thromboembolism
D) A patient who has decreased mobility following a transmetatarsal amputation
Ans: B
Feedback:
Patients who are confused and agitated risk trauma through the removal of an indwelling catheter which
has the balloon still inflated. Recent VTE, amputation, and fluid restriction do not directly create a risk
for injury or trauma associated with indwelling catheter use.
33. A patient has been admitted to the medical unit with a diagnosis of ureteral colic secondary to
urolithiasis. When planning the patients admission assessment, the nurse should be aware of the signs
and symptoms that are characteristic of this diagnosis? Select all that apply.
A) Diarrhea
B) High fever
C) Hematuria
D) Urinary frequency
E) Acute pain
Ans: C, D, E
Feedback:
Stones lodged in the ureter (ureteral obstruction) cause acute, excruciating, colicky, wavelike pain,
radiating down the thigh and to the genitalia. Often, the patient has a desire to void, but little urine is
passed, and it usually contains blood because of the abrasive action of the stone. This group of
symptoms is called ureteral colic. Diarrhea is not associated with this presentation and a fever is usually
absent due to the noninfectious nature of the health problem.
34. A patient with a recent history of nephrolithiasis has presented to the ED. After determining that the
patients cardiopulmonary status is stable, what aspect of care should the nurse prioritize?
A) IV fluid administration
B) Insertion of an indwelling urinary catheter
C) Pain management
D) Assisting with aspiration of the stone
Ans: C
Feedback:
The patient with kidney stones is often in excruciating pain, and this is a high priority for nursing
interventions. In the short term, this would supersede the patients need for IV fluids or for
catheterization. Kidney stones cannot be aspirated.
35. A patient has been successfully treated for kidney stones and is preparing for discharge. The nurse
recognizes the risk of recurrence and has planned the patients discharge education accordingly. What
preventative measure should the nurse encourage the patient to adopt?
A) Increasing intake of protein from plant sources
B) Increasing fluid intake
C) Adopting a high-calcium diet
D) Eating several small meals each day
Ans: B
Feedback:
Increased fluid intake is encouraged to prevent the recurrence of kidney stones. Protein intake from all
sources should be limited. Most patients do not require a low-calcium diet, but increased calcium intake
would be contraindicated for all patients. Eating small, frequent meals does not influence the risk for
recurrence.
36. A patient who has recently undergone ESWL for the treatment of renal calculi has phoned the urology
unit where he was treated, telling the nurse that he has a temperature of 101.1F (38.4C). How should the
nurse best respond to the patient?
A) Remind the patient that renal calculi have a noninfectious etiology and that a fever is unrelated to
their recurrence.
B) Remind the patient that occasional febrile episodes are expected following ESWL.
C) Tell the patient to report to the ED for further assessment.
D) Tell the patient to monitor his temperature for the next 24 hours and then contact his urologists
office.
Ans: C
Feedback:
Following ESWL, the development of a fever is abnormal and is suggestive of a UTI; prompt medical
assessment and treatment are warranted. It would be inappropriate to delay further treatment.
37. The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder
cancer. What health promotion action most directly addresses a major risk factor for bladder cancer?
A) Smoking cessation
B) Reduction of alcohol intake
C) Maintenance of a diet high in vitamins and nutrients
D) Vitamin D supplementation
Ans: A
Feedback:
People who smoke develop bladder cancer twice as often as those who do not smoke. High alcohol
intake and low vitamin intake are not noted to contribute to bladder cancer.
38. Resection of a patients bladder tumor has been incomplete and the patient is preparing for the
administration of the first ordered instillation of topical chemotherapy. When preparing the patient, the
nurse should emphasize the need to do which of the following?
A) Remain NPO for 12 hours prior to the treatment.
B) Hold the solution in the bladder for 2 hours before voiding.

C) Drink the intravesical solution quickly and on an empty stomach.
D) Avoid acidic foods and beverages until the full cycle of treatment is complete.
Ans: B
Feedback:
The patient is allowed to eat and drink before the instillation procedure. Once the bladder is full, the
patient must retain the intravesical solution for 2 hours before voiding. The solution is instilled through
the meatus; it is not consumed orally. There is no need to avoid acidic foods and beverages during
treatment.
39. The nurse has tested the pH of urine from a patients newly created ileal conduit and obtained a result of
6.8. What is the nurses best response to this assessment finding?
A) Obtain an order to increase the patients dose of ascorbic acid.
B) Administer IV sodium bicarbonate as ordered.
C) Encourage the patient to drink at least 500 mL of water and retest in 3 hours.
D) Irrigate the ileal conduit with a dilute citric acid solution as ordered.
Ans: A
Feedback:
Because severe alkaline encrustation can accumulate rapidly around the stoma, the urine pH is kept
below 6.5 by administration of ascorbic acid by mouth. An increased pH may suggest a need to increase
ascorbic acid dosing. This is not treated by administering bicarbonate or citric acid, nor by increasing
fluid intake.
40. A patient is postoperative day 3 following the creation of an ileal conduit for the treatment of invasive
bladder cancer. The patient is quickly learning to self-manage the urinary diversion, but expresses
concern about the presence of mucus in the urine. What is the nurses most appropriate response?
A) Report this finding promptly to the primary care provider.
B) Obtain a sterile urine sample and send it for culture.
C) Obtain a urine sample and check it for pH.
D) Reassure the patient that this is an expected phenomenon.

Ans: D
Feedback:
Because mucous membrane is used in forming the conduit, the patient may excrete a large amount of
mucus mixed with urine. This causes anxiety in many patients. To help relieve this anxiety, the nurse
reassures the patient that this is a normal occurrence after an ileal conduit procedure. Urine testing for
culture or pH is not required.
41. The nurse is collaborating with the wound-ostomy-continence (WOC) nurse to teach a patient how to
manage her new ileal conduit in the home setting. To prevent leakage or skin breakdown, the nurse
should encourage which of the following practices?
A) Empty the collection bag when it is between one-half and two-thirds full.
B) Limit fluid intake to prevent production of large volumes of dilute urine.
C) Reinforce the appliance with tape if small leaks are detected.
D) Avoid using moisturizing soaps and body washes when cleaning the peristomal area.
Ans: D
Feedback:
The patient is instructed to avoid moisturizing soaps and body washes when cleaning the area because
they interfere with the adhesion of the pouch. To maintain skin integrity, a skin barrier or leaking pouch
is never patched with tape to prevent accumulation of urine under the skin barrier or faceplate. Fluids
should be encouraged, not limited, and the collection bag should not be allowed to become more than
one-third full.
42. A patient has undergone the creation of an Indiana pouch for the treatment of bladder cancer. The nurse
identified the nursing diagnosis of disturbed body image. How can the nurse best address the effects of
this urinary diversion on the patients body image?
A) Emphasize that the diversion is an integral part of successful cancer treatment.
B) Encourage the patient to speak openly and frankly about the diversion.
C) Allow the patient to initiate the process of providing care for the diversion.
D) Provide the patient with detailed written materials about the diversion at the time of discharge.
Ans: B
Feedback:
Allowing the patient to express concerns and anxious feelings can help with body image, especially in
adjusting to the changes in toileting habits. The nurse may have to initiate dialogue about the
management of the diversion, especially if the patient is hesitant. Provision of educational materials is
rarely sufficient to address a sudden change and profound change in body image. Emphasizing the role
of the diversion in cancer treatment does not directly address the patients body image.

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Chapter 53: Assessment of Kidney and Urinary Function

B) When the patients blood urea nitrogen (BUN) is above 15 mg/dL

C) When approximately 40% of nephrons are not functioning

When about 80% of the nephrons are no longer functioning

A) In the ureteropelvic junction

B) In the ureteral segment near the sacroiliac junction

C) In the ureterovesical junction

A) A fasting serum potassium level and a random urine sample

C) A BUN and serum creatinine level on three consecutive mornings

A) The patients bladder is not completely empty.

B) The patient has kidney enlargement.

C) The patient has a ureteral obstruction.

D) The patient has a fluid volume deficit.

A) Increased fluid intake to produce a full bladder

B) IV administration of radiopaque contrast agent

C) Sedation and intubation

A) A fluctuating urine specific gravity

B) A fixed urine specific gravity

C) A decreased urine specific gravity

D) An increased urine specific gravity

A) Increased ability to concentrate urine

B) Increased bladder capacity

D) Decreased glomerular filtration rate

Retention of potassium is the most life-threatening effect of renal failure.

A) A biopsy is routinely ordered for all patients with renal disorders.

A) Potassium and sodium

B) Bicarbonate and urea

C) Glucose and protein

D) Creatinine and chloride

A) 1,300 mL of fluid in 24 hours

B) 2,300 mL of fluid in 24 hours

C) 3,100 mL of fluid in 24 hours

D) 5,000 mL of fluid in 24 hours

A) At the umbilicus and the right lower quadrant of the abdomen

B) At the suprapubic region and the umbilicus

C) At the lower border of the 12th rib and the spine

D) At the 7th rib and the xyphoid process

dysfunction may produce tenderness over the costovertebral angle.

A) A 64-year-old patient with chronic glomerulonephritis

B) A 57-year-old patient with proteinuria

C) A 42-year-old patient with morbid obesity

D) A 16-year-old patient with signs of kidney transplant rejection

A) Antidiuretic hormone (ADH)

A) Urinary tract infection

C) Computed tomography (CT)

C) Temperature 100.2F orally

D) Infiltration of the patients intravenous catheter

A) Administer a STAT dose of vitamin K, as ordered.

C) Promptly inform the physician of this assessment finding.

D) Position the patient supine and insert a Foley catheter, as ordered.

B) Apply topical lidocaine to the patients meatus, as ordered.

C) Apply moist heat to the patients lower abdomen.

D) Apply an ice pack to the patients perineum.

A) Discuss the patients diagnosis with the family.

C) Administer antivirals before sending the patient for the procedure.

D) Keep the patient NPO prior to the procedure.

A) Administration of IV potassium chloride

D) Administration of a 24-hour urine test

the patient to be assessed for what health problem?