Chapter 36. Urinary System Function, Assessment, and Therapeutic Measure

18. A patient with pneumonia has a blood urea nitrogen (BUN) of 32 mg/dL and creatinine of 0.8 mg/dL. What should the nurse realize is the most probable explanation for this finding? a. The patient is dehydrated. b. The patient has septicemia. c. The patient is malnourished. d. The patient has kidney damage.

a

37. The nurse is collecting data for a patient who has suspected kidney disease. What health problems should the nurse consider as being associated with a high urine specific gravity? (Select all that apply.) a. Nephrosis b. Dehydration c. Heart failure d. Diabetes mellitus e. Diabetes insipidus f. Fluid volume excess

a, b, c, d

1. The nurse is reviewing the anatomy of the kidney with a patient scheduled for renal surgery. What should the nurse explain as being the structural and functional unit of the kidney? a. Cortex b. Medulla c. Pyramid d. Nephron

d

15. The nurse is collecting data from a patient with stress incontinence. Which finding should the nurse document? a. The patient is unable to tell when there is the need to urinate. b. The patient is unable to hold urine when under emotional stress. c. The patient is unable to reach the bathroom and urinates in underwear. d. The patient loses small amounts of urine when he or she coughs or sneezes.

d

24. The nurse determines that a patients urine output is normal. How many mL of urine did the patient void within the last 24 hours? a. 150 to 400 mL b. 250 to 500 mL c. 750 to 1000 mL d. 1000 to 2000 mL

d

3. A patient has a glomerular filtration rate of 55%. What should this value indicate to the nurse? a. This is a normal value. b. The patient is in renal failure. c. The patient needs to be on a fluid restriction. d. The patients other tests will be in the normal range.

d

4. The nurse is caring for a patient with an acidbase imbalance from kidney disease. How should the nurse explain the role of the kidneys to maintain acidbase balance in the body to the patient? a. Promoting retention of proteins b. Promoting excretion of carbon dioxide c. Conserving or excreting potassium ions d. Conserving or excreting bicarbonate ions

d

32. The nurse reviews the process to obtain a midstream urine specimen for culture and sensitivity with a female patient. Which patient statements indicate understanding of this process? (Select all that apply.) a. A 24-hour urine specimen is needed. b. A second-voided specimen is preferred. c. I should wash from the back to the front. d. The labia should be kept separated while voiding. e. When urine starts to flow, collect it in the clean container provided. f. The genitalia should be thoroughly cleaned with the towelettes provided.

d, f

22. A patient recovering from radiological studies of the renal system has a nursing diagnosis of Impaired Urinary Elimination. Which outcome indicates that the nursing interventions have been effective? a. Patient voids 35 mL/hour of clear urine. b. Patient voids 30 mL/hour of cloudy urine. c. Patient voids 10 mL/hour of reddish urine. d. Patient voids an average of 15 mL/hour of dark-colored urine.

a

25. The nurse is catheterizing a patient after voiding to determine the amount of residual urine in the bladder. What should the nurse consider as being the normal amount of urine within the bladder after urination? a. 50 mL b. 75 mL c. 100 mL d. 150 mL

a

26. The nurse learns that a patient has a urine pH of 7.9. What question should the nurse ask the patient after learning of this laboratory value? a. Are you a vegetarian? b. Are you lactose intolerant? c. How much protein do you eat each day? d. How much acetaminophen do you take each day?

a

28. A female patient is embarrassed because of not being able to walk to the bathroom in time before become incontinent of urine. Which type of incontinence should the nurse plan care for this patient? a. Urge b. Total c. Stress d. Functional

a

29. The nurse is making a visit to the home of a patient with functional incontinence. Which observation indicates that teaching about the disorder has been effective? a. Patient wearing sweat pants b. Patient drinking a cup of coffee c. Patient sitting with the legs elevated d. Patient restricting fluid intake after 6 pm.

a

7. The nurse needs to obtain a urine specimen from a female patient. What action should the nurse take when obtaining this specimen? a. Obtain the first voided urine of the day. b. Direct the patient to wash her perineum before collecting the urine specimen. c. Have the patient urinate into a bedpan, then pour the urine into the specimen container. d. Have the patient void, throw that urine away, and then collect another specimen at least 1 hour later.

a

9. The nurse is reviewing a patients history and physical report. What term should the nurse recognize is being used to describe waste products building up in the blood? a. Uremia b. Septicemia c. Nitrosemia d. Proteinemia

a

38. The nurse is caring for a patient with an indwelling catheter. What should the nurse include in this patients routine care? (Select all that apply.) a. Encourage fluid intake. b. Maintain a closed system. c. Secure the catheter to the patients leg. d. Clamp the catheter for 1 hour each shift. e. Remove the catheter as soon as possible. f. Use sterile technique when emptying the drainage bag.

a, b, c, e

41. The nurse is participating in care planning for a patient with urge incontinence. What should the nurse recommend be included in this patients plan of care? (Select all that apply.) a. Void every 2 hours. b. Practice relaxation breathing. c. Use urge inhibition techniques. d. Reduce fluid intake for several hours before sleep. e. Gradually increase length of time between voidings.

a, b, c, e

35. The nurse is caring for a patient with an elevated uric acid level. Which health problems should the nurse consider as potentially causing this patients elevation? (Select all that apply.) a. Leukemia b. Steroid use c. Malnutrition d. Kidney disease e. Use of thiazide diuretics f. Gastrointestinal bleeding

a, c, d, e

11. The nurse is collecting data from a patient with kidney disease. Which adventitious lung sound should the nurse recognize as being caused by fluid overload? a. Stridor b. Crackles c. Wheezes d. Pleural friction rub

b

13. The nurse is caring for a patient who is scheduled for a cystoscopy (C&P) with basket extraction of a stone. What is the most important postoperative care for the nurse to provide? a. Limiting fluid intake b. Measuring urine output c. Monitoring daily weights d. Observing for acute kidney injury

b

16. The nurse is caring for a male patient with functional incontinence. What action should the nurse take to help prevent incontinence? a. Teach the patient how to do Kegel exercises. b. Ensure that the patient has ready access to the urinal. c. Teach the patient to increase the time between voiding. d. Give the patient cranberry juice to keep the urine acidic.

b

17. A patient is being evaluated for renal dialysis. What creatinine clearance value should the nurse realize this patient must have to live without needing dialysis treatments? a. 5 mL b. 10 mL c. 20 mL d. 50 mL

b

19. The nurse is caring for a patient with kidney disease. How should the nurse end a 24-hour urine test at the end of the 24 hours? a. The final voiding before 24 hours is discarded. b. The patient voids at the end of 24 hours, adding it to the collection container. c. One hundred milliliters of collected urine is placed into a specimen cup and sent to the laboratory. d. The patient voids, and the first and last specimens from 24 hours are sent to the laboratory.

b

2. The nurse is caring for a patient with a kidney infection. When providing prescribed medications, the nurse should recall that which structure is the capillary network in each nephron? a. Corpuscles b. Glomerulus c. Renal tubules d. Bowmans capsule

b

20. The nurse is helping to prepare a patient for a renal biopsy. In which position should the nurse help the patient assume? a. Sims b. Prone c. Supine d. Fowlers

b

21. The nurse is caring for a patient recovering from a renal biopsy. For which complication should the nurse monitor the patient during the 24 hours after the procedure? a. Polyuria b. Bleeding c. Infection d. Urinary obstruction

b

27. During an assessment, the nurse notes that a patient has crystals deposited on the skin. What should this finding indicate to the nurse? a. Gout b. Uremic frost c. Poor hygiene d. Metabolic alkalosis

b

5. The nurse is collecting data for a patient with kidney disease. When reviewing a urinalysis report, which range should the nurse recognize as normal specific gravity of urine? a. 0.080 to 0.100 b. 1.002 to 1.035 c. 2.600 to 3.000 d. 4.612 to 5.030

b

8. A patients urinalysis results are: white blood cells (WBC) 100+/hpf; red blood cells (RBC) 4/hpf; bacteria, moderate amount; nitrite, positive; specific gravity, 1.025; urine, cloudy. What should the nurse recognize these findings indicate? a. Dehydration b. Urinary tract infection c. Contamination from menstruation d. Contamination of the specimen from bacteria on the perineum

b

39. The nurse is reviewing normal kidney function with a patient experiencing an acute kidney injury. Which hormones should the nurse include that affect kidney function? (Select all that apply.) a. Estrogen b. Aldosterone c. Parathyroid hormone d. Antidiuretic hormone (ADH) e. Atrial natriuretic hormone (ANH) f. Thyroid-stimulating hormone (TSH)

b, c, d, e

33. The nurse is caring for a patient with an indwelling urinary catheter. Which instructions should the nurse provide to help prevent development of a urinary tract infection? (Select all that apply.) a. Limit fluid intake to decrease the flow of urine. b. Position the tubing to allow free flow of the urine. c. Use aseptic technique when emptying the drainage bag. d. Wash the perineum with an antibacterial soap every 8 hours. e. Keep the catheter securely taped to prevent catheter movement. f. Empty the urinary bag every 4 hours to prevent stagnation of urine.

b, c, e

36. The nurse is collecting data for a patient with kidney disease. Which information should the nurse identify as being normal urinalysis findings? (Select all that apply.) a. pH 3.5 b. Amber color c. Small amount of nitrite d. Red blood cells of 8/hpf e. Specific gravity of 1.010 f. Small quantities of enzymes

b, e, f

10. The nurse is to obtain orthostatic blood pressure measurements for a patient on dialysis for end-stage renal disease. What should the nurse do when measuring this patients blood pressure? a. Take blood pressure before and after dialysis treatments. b. Check blood pressure every minute three times for four readings. c. Obtain blood pressure while the patient is lying, sitting, and standing. d. Monitor blood pressure before and after an antihypertensive medication is given.

c

12. A patient is scheduled for an intravenous pyelogram (IVP). What care should the nurse provide before the patient has this procedure? a. IV antibiotics b. Opioid pain medication c. Enema evening before the test d. Bedrest for 16 hours before the test

c

14. The nurse contributes to the plan of care for a patient with edema. Which action should the nurse take as the best indicator of this patients fluid volume status? a. Vital signs b. Skin turgor c. Daily weight d. Intake and output

c

23. The nurse is instructing a patient on the use of Kegel exercises. How many times a day should the nurse recommend that these exercises be performed? a. 10 to 20 b. 15 to 30 c. 30 to 80 d. 85 to 100

c

6. The nurse is reviewing a urinalysis report. What should the nurse recognize as the normal average pH of urine? a. 2 b. 4.2 c. 6 d. 7.4

c

40. The nurse is contributes to the plan of care for an older patient. What should the nurse recognize as normal signs of aging within the renal system? (Select all that apply.) a. Bladder size increases b. Urethral changes position c. Number of nephrons decreases d. Detrusor muscle tone decreases e. Glomerular filtration rate increases

c, d

31. The nurse is reviewing data for a patient with acute kidney injury. Which diagnostic test results should the nurse recognize that indicate kidney injury? (Select all that apply.) a. Hematocrit 20% b. Uric acid 8 ng/dL c. Serum creatinine 4.2 mg/dL d. Blood urea nitrogen 40 mg/100 mL e. Urine output of 100 mL in 24 hours f. Fixed urine specific gravity of 1.010

c, e, f

34. A patient is recovering from a renal arteriogram. What actions should the nurse take when caring for this patient? (Select all that apply.) a. Check vital signs twice daily. b. Raise the head of the bed to 90 degrees. c. Check distal pulses in leg every 30 to 60 minutes. d. Encourage the patient to ambulate as soon as possible. e. A pressure dressing and sandbag used to apply pressure. f. Implement bedrest for 12 hours, and instruct the patient not to bend leg.

c, e, f

30. The nurse is reviewing the results of a patients urinalysis. Which components should the nurse identify as being abnormal in urine? (Select all that apply.) a. Urea b. Water c. Protein d. Ammonia e. Hormones f. Red blood cells

c, f