urin

8. The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following? A) Kidney stones B) Neurogenic bladder C) Chronic renal failure D) Fistula

Ans: A Feedback: A client with hyperparathyroidism is at risk for kidney stones. The client with diabetes mellitus is a risk factor for developing chronic renal failure and neurogenic bladder. A client with radiation to the pelvis is at risk for urinary tract fistula.

13. A child is brought into the clinic with symptoms of periorbital edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem? A) Sore throat 2 weeks ago B) Red blood cells in the urine C) Elevation of blood pressure D) Protein elevation in the urine

Ans: A Feedback: Acute glomerulonephritis usually occurs as a result of bacterial infection such as seen with a beta-hemolytic streptococcal infection or impetigo. RBC and protein found in the urine and elevation of blood pressure are symptoms associated with glomerulonephritis.

25. A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? A) Decrease in the blood flow through the kidneys B) Obstruction of urine flow from the kidneys C) Blood clot formed in the kidneys interfered with the flow D) Structural damage occurred in the nephrons of the kidneys

Ans: A Feedback: Acute renal failure can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.

30. The hemodialysis client is scheduled to receive weekly injections of epoetin (Epogen). Which is the most important consideration to be taken by the nurse in the administration of this medication? A) Schedule injection on nondialysis day. B) Administer immediately after dialysis. C) Monitor complete blood count prior to dose. D) Administer with low-dose aspirin to prevent clot formation.

Ans: A Feedback: After dialysis, do not administer injections for 2 to 4 hours to allow time for the metabolism and excretion of heparin (which is administered during dialysis). Serum laboratory tests are performed on a routine basis to identify normal and abnormal findings. Aspirin use is not indicated with Epogen use.

10. An ileal conduit is created for a client after a radical cystectomy. Which of the following would the nurse expect to include in the client's plan of care? A) Application of an ostomy pouch B) Intermittent catheterizations C) Exercises to promote sphincter control D) Irrigating the urinary diversion

Ans: A Feedback: An ileal conduit involves care of a urinary stoma, much like that of a fecal stoma, including the application of an ostomy pouch, skin protection, and stoma care. Intermittent catheterizations and irrigations are appropriate for a continent urinary diverse such as a Kock or Indiana pouch. Exercises to promote sphincter control are appropriate for an ureterosigmoidoscopy.

16. A client with chronic glomerulonephritis has generalized edema. Which response by the nurse best describes why anasarca occurs with this disorder? A) Fluid shifting occurs due to loss of serum protein. B) Albumin levels increase in the blood dragging fluid inside the vessels. C) Increased intake of sodium in the diet results in anasarca. D) Urinary retention promotes the absorption of fluid into tissue spaces.

Ans: A Feedback: Anasarca is caused by the shift of fluid from the intravascular space to interstitial and intracellular locations. The fluid shift results from depletion of protein from the blood (serum) to the urine. Sodium intake should be limited in clients with renal disease. Urinary retention is not indicated with anasarca.

23. In a client with benign prostatic hyperplasia (BPH), which assessment finding provides the best indication of urinary retention? A) Frequency B) Urgency C) Hesitancy D) Dribbling

Ans: A Feedback: As residual urine accumulates, the client has an urge to void more often. Urgency, hesitancy, and dribbling are all urinary symptoms associated with BPH but not specific to urinary retention.

21. The nurse is caring for a client with recurrent urinary tract infections. Which of the following body structures would the nurse instruct as the most frequent cause of women's urinary tract infections? A) The urethra B) The bladder C) The rectum D) The ureters

Ans: A Feedback: Because the urethra is short in women, ascending infections or microorganisms carried from the vagina or rectum are common. Males have a longer urethra, causing the organisms travel farther to the bladder. Although structures of the urinary system, the other options are where the client has bacteria and microorganisms located. The ureters connect the bladder to kidney thus do not obtain bacteria, just transmit when available.

19. The office nurse is providing information to a client who has experienced recurrent renal calculi. Which of the following jobs would place a client at greatest risk for calculi formation? A) Over-the-road truck driver B) Mining engineer C) Nursing instructor D) Rumba instructor

Ans: A Feedback: Calculi formation is often associated with immobility and/or stasis of urine. Working as an OTR truck driver requires prolonged sitting. Mining engineer, nursing instructors, and rumba dance instructors are less immobile.

22. Which of the following urine characteristics would the nurse anticipate when caring for a client whose lab work reveals a high urine specific gravity related to dehydration? A) Dark amber urine B) Clear or light yellow urine C) Red urine D) Turbid urine

Ans: A Feedback: Concentrated urine (one with a high specific gravity) is a dark amber color due to the solutes in the urine. Clear or yellow urine indicates a flushing of the urinary system. Red urine indicates hematuria. A turbid urine may indicate bacteriuria.

25. The client with benign prostatic hyperplasia (BPH) is considering use of medication in the management of symptoms. Which of the following drugs reduces the size of the prostate without lowering circulating levels of testosterone? A) Finasteride (Proscar) B) Tamsulosin (Flomax) C) Terazosin (Hytrin) D) Oxybutynin chloride (Ditropan)

Ans: A Feedback: Finasteride (Proscar) inhibits the conversion of testosterone depriving the gland of dihydrotestosterone (more potent type of testosterone), which stimulates prostatic growth. Tamsulosin (Flomax) and terazosin (Hytrin) work by reducing the tone of smooth muscle in the bladder neck and prostate gland but have little effect on reducing prostate size. Oxybutynin chloride (Ditropan) is antimuscarinic, antispasmodic drug used for treatment of overactive bladder.

18. The client is admitted to the nursing unit for a biopsy of the urinary tract tissue. When planning nursing care for the postoperative period, which nursing intervention documents the prescribed activity level? A) Maintain the client on bedrest B) Assist the client for bathroom privileges C) Ambulate the client in the hall D) Activity as tolerated

Ans: A Feedback: In the postoperative period, the client remains on bed rest as the nurse assess for signs of bleeding. If the client is to be discharged on the following day, the client is to maintain limited activity for several days to avoid spontaneous bleeding.

4. A female client who is diagnosed with a malignant tumor in her bladder is advised to undergo cystectomy followed by a urinary diversion procedure. Which of the following would be most important for the nurse to assess preoperatively? A) Client's manual dexterity and vision B) History of allergy to iodine and seafood C) Dietary habits involving cholesterol-laden food D) Menstrual history

Ans: A Feedback: It is essential to assess manual dexterity, vision, and level of understanding of a client who undergoes a urinary diversion procedure because this information will determine the client's ability to manage stoma care and self-catheterization following the urinary diversion procedure. The client's history of allergy to iodine and seafood, dietary habits related to high cholesterol intake, and menstrual history are not important factors for this situation.

30. The nurse is caring for a client diagnosed with bladder stones. The client is scheduled for a litholapaxy. Which nursing action is most important to complete prior to the procedure? A) Strain all urine B) Maintain the intake and output C) Maintain 12 hours of nothing by mouth D) Make sure that the nurse has the consent signed

Ans: A Feedback: It is most important to strain all urine up to the time of the procedure. Should the client pass the stone, the procedure may be able to be cancelled. Maintaining intake and output is important in considering fluid balance. Most clients are ordered nothing by mouth after midnight for a morning procedure. The physician is responsible for explaining the procedure and obtaining the signatures on the consent.

19. The nurse is employed in an urologist office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? A) Anticholinergic B) Diuretics C) Anticonvulsant D) Cholinergic

Ans: A Feedback: Pharmacologic agents that can improve bladder retention, emptying, and control include anticholinergic drugs. In this classification are medications such as Detrol, Ditropan, and Urecholine. Diuretics eliminate fluid from the body but do not affect the muscles of urinary elimination. Anticonvulsant and cholinergic medications also do not directly help with control.

33. The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure? A) The kidneys can improve over a period of months. B) Once on dialysis, the need will be permanent. C) Kidney function will improve with transplant. D) Acute renal failure tends to turn to end-stage failure.

Ans: A Feedback: The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute renal failure can progress to chronic renal failure.

14. The client tells the nurse of the feeling of always needing to void. The nurse instructs on normal urine elimination. At which amount of urine accumulation in the bladder is the nerve reflex triggered to signal the need to void? A) 150 mL B) 300 mL C) 500 mL D) 750 mL

Ans: A Feedback: The nerve reflex is triggered when approximately 150 mL of urine accumulates.

26. The nurse is encouraging the client with recurrent urinary tract infections to increase his fluid intake to 8 large glasses of fluids daily. The client states he frequently drinks water and all of the following. Which of the following would the nurse discourage for this client? A) Coffee in the morning B) Fruit juice midmorning C) Milk at lunch D) Ginger ale at dinner time

Ans: A Feedback: The nurse would discourage drinking coffee. Coffee, tea, alcohol, and colas are urinary tract irritants. Fruit juice, milk, and ginger ale are appropriate for drinking and countered toward the daily fluid total.

9. When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? A) Check for thrill or bruit over the access site. B) Inspect the catheter insertion site for infection. C) Add the prescribed drug to the dialysate. D) Warm the solution to body temperature.

Ans: A Feedback: When preparing a client for hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency. Inspecting the catheter insertion site for infection, adding the prescribed drug to the dialysate, and warming the solution to body temperature would be necessary when preparing a client for peritoneal dialysis.

33. The nurse is caring for a client diagnosed with bladder cancer and requiring a cystectomy. The nurse overhears the physician instructing the client on the presence of a stoma with temporary pouch. In gathering information for the client, which urinary diversion would the nurse select? A) Ileal conduit B) Kock Pouch C) Ureterosigmoidostomy D) Indiana Pouch

Ans: A Feedback: When the physician is discussing a stoma, the nurse recognizes that the client will have an ileal conduit which is a cutaneous urinary diversion. Both the Kock Pouch and Indiana Pouch are continent urinary diversions. The ureterosigmoidostomy connects

8. Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet? A) Low oxalate B) Low purine C) High protein D) High sodium

Ans: B Feedback: A low-purine diet is used for uric acid stones; although, the benefits are unknown. Clients with a history of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate. Only clients who have type II absorptive hypercalciuria—approximately half of the clients—need to limit calcium intake. Usually, clients are told to increase their fluid intake significantly, consume a moderate protein intake, and limit sodium. Avoiding excessive protein intake is associated with lower urinary oxalate and lower uric acid levels. Reducing sodium intake can lower urinary calcium levels.

Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys? A) Radiography B) Angiography C) Computed tomography (CT scan) D) Cystoscopy

Ans: B Feedback: Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the bladder.

20. A client, who has suffered with recurrent renal calculi, has learned that the stones were composed of calcium oxalate. In providing dietary education to this client, which food contains the highest levels of oxalate and should be limited? A) Bananas B) Chocolate C) Herbal teas D) Beef

Ans: B Feedback: Because as many as 80% of all renal calculi are composed of calcium oxalate, some believe limiting the amount of oxalate taken in via diet can be helpful. Milk, chocolate, and cocoa are highest in oxalate. Black tea is also high in oxalate. Bananas, herbal tea, and beef are not indicated as high oxalate foods.

22. A nephrostomy tube is inserted in a client with a large ureteral calculus. Which is the most important consideration in providing nursing care for this client? A) Clamp the tube for no longer than 2 hours at a time. B) Maintain free, continuous urine drainage. C) Leave nephrostomy site open to the air. D) Use only sterile NSS to irrigate the tube.

Ans: B Feedback: Clamping or kinking of the tube will create backup of urine into the renal pelvis, resulting in hydronephrosis and can contribute to renal damage. Always make sure the urine is allowed to flow continuously and freely and do not irrigate. The nephrostomy tube is inserted through a stab wound and enters the kidney. A sterile dressing should be used to prevent pathogen entry.

22. The nurse is caring for a client with cystitis. Which adjunct therapy is the nurse most correct to suggest to keep bacteria from adhering to the wall of the bladder? A) Douching with a vinegar solution B) Drinking cranberry juice C) Flushing the system with water D) Wiping from the urethra to rectum

Ans: B Feedback: Cranberry juice or vitamin C may be recommended to keep the bacteria from adhering to the wall of the bladder and thus promoting their excretion and enhancing the effectiveness of drug therapy. Douching is suggested for cleansing the female reproductive tract. It is always appropriate to flush the system with water; however, cranberry juice changes the pH of the urine to more acidic diminishing the number of bacteria in addition to the changes is the bladder wall. Wiping from the urethra to the rectum is helpful in prevent urinary tract infections.

9. A client has a full bladder. Which sound would the nurse expect to hear on percussion? A) Tympany B) Dullness C) Resonance D) Flatness

Ans: B Feedback: Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very dense tissue, such as the bone or muscle.

26. The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom? A) Azotemia B) Diminished erythropoietin production C) Impaired immunologic response D) Electrolyte imbalances

Ans: B Feedback: Erythropoietin is a hormone produced in the kidneys, and this production is inadequate in chronic renal failure, which results in anemia. Azotemia, impaired immune response, and electrolyte imbalance are associated with chronic renal failure but not indicated with anemia.

4. When assessing a client with chronic glomerulonephritis, the nurse notes that the client has generalized edema. The nurse documents this as which of the following? A) Periorbital edema B) Anasarca C) Uremic frost D) Hydronephrosis

Ans: B Feedback: Generalized edema known as anasarca is a common finding with chronic glomerulonephritis. Periorbital edema refers to puffiness around the eyes. Uremic frost is a precipitate that forms on the skin in clients with chronic renal failure. Hydronephrosis refers to a condition involving distention of the renal pelvis.

34. A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? A) Elevated urea levels B) Hyperkalemia C) Hypocalcemia D) Elevated white blood cells

Ans: B Feedback: Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.

31. The nurse is caring for a client with a urinary tract infection and a urethral stricture. Which complication of the condition is the primary cause of infection? A) The bladder mucosa attracts bacteria. B) There is a backflow of urine causing a diverticulum. C) Urine leakage occurs as urine passes through the stricture. D) Urine production is limited due to the urine remaining in the bladder.

Ans: B Feedback: It is common for a client with a stricture to have a urinary tract infection due to the backflow of urine and the stasis of the urine, causing an outpouching or diverticulum. Interstitial cystitis is an inflammatory disease where bacteria cling to the bladder mucosa. Urine leakage is characteristic in urinary incontinence. Urine production is impacted, urine excretion is impacted.

28. An investment banker, with chronic renal failure, informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? A) "The risk of peritonitis is greater with this type of dialysis." B) "This type of dialysis will provide more independence." C) "Peritoneal dialysis will require more work for you." D) "Peritoneal dialysis does not work well for every client."

Ans: B Feedback: Once a treatment choice has been selected by the client, the nurse should support the client in that decision. Continuous cyclic peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients.

The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client? A) Suprapubic cystostomy tube B) Permanent drainage with a urethral catheter C) Clean intermittent catheterization D) Credé voiding procedure

Ans: B Feedback: Permanent drainage with a urethral catheter carries the greatest risk. It may also increase the risk for bladder stones; renal diseases; bladder infections; and urosepsis, a severe systemic infection by microorganisms in the urinary tract invading the bloodstream. Clean intermittent catheterization has the fewest complications and is the preferred treatment for urinary retention. The Credé voiding procedure is used in the case of clients who have lost control over their nervous systems, secondary to injury or disease.

28. The nurse is caring for several clients on a urinary medical unit. Which client is at an increased risk for bladder stones? A) The client with frequent urinary tract infections B) The client who is paraplegic C) The client with difficulty ambulating D) The client with abdominal surgery

Ans: B Feedback: The client who is immobile or who is paraplegic may also tend to form bladder stones. Clients with incomplete urinary elimination, urinary stasis, or concentrated urine are at higher risk for stone formation. There is not as strong correlation between infections, difficulty ambulating, and surgery.

35. The nurse is assisting the physician in completing a cystoscopy. In which position would the nurse place the client when preparing for the procedure? A) On the client's back with knees to the side B) On the client's back with feet in the stirrups C) On the client's right side with a pillow behind the back D) On the client's left side with a pillow behind the back

Ans: B Feedback: The client who is undergoing a cystoscopy will be positioned on the back with the feet in stirrups. The client is also to have an empty bladder and may be sedated for the procedure.

10. After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? A) "It is important to use strict aseptic technique." B) "It is appropriate to warm the dialysate in a microwave." C) "The infusion clamp should be open during infusion." D) "The effluent should be allowed to drain by gravity."

Ans: B Feedback: The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.

29. The nurse discontinues a client's Foley catheter following diagnostic procedure. When assessing the client's voided urine, it is noted to be concentrated with red strings. Which nursing action is best? A) Ambulate the client in the hall. B) Instruct the client to increase fluid intake. C) Call the physician for further instructions. D) Wait to see the next voided specimen.

Ans: B Feedback: The nurse is correct to instruct the client to increase fluid intake and then will assess the next voided specimen. Concentrated urine can be a sign that fluids are needed and red strings within the urine can be from irritation of the Foley catheter. It is too early to call the physician unless the nurse has other documentation of an infection or urinary problem.

34. The nurse is instructing a 3-year-old's mother regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as normal finding for this age-group? A) Dysuria B) Enuresis C) Hematuria D) Anuria

Ans: B Feedback: The nurse would be most correct to document that enuresis, the involuntary voiding during sleep or commonly called "wetting the bed," is a normal finding in a pediatric client younger than 5 years old. Dysuria (pain on urination), hematuria (red blood cells in urine), and anuria (urine output less than 50 mL/day) are all abnormal findings

18. The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document? A) Urinary frequency B) Urinary urgency C) Urinary incontinence D) Urinary stasis

Ans: B Feedback: The nurse would document urinary urgency. Urinary frequency is urinating more frequently than normal often times due to inadequate emptying of the bladder. Urinary incontinence is the involuntary loss of urine. Urinary stasis is a stoppage or diminution of flow.

7. A nurse is describing the renal system to a client with a kidney disorder. Which structure would the nurse identify as emptying into the ureters? A) Nephron B) Renal pelvis C) Parenchyma D) Glomerulus

Ans: B Feedback: The renal pelvis empties into the ureter, which carries urine to the bladder for storage. The nephron consists of the glomerulus, afferent arteriole, efferent arteriole, Bowman's capsule, distal and proximal convoluted tubules, the loop of Henle, and collecting tubule. The nephron is located in the cortex and carries out the functions of the kidney. The parenchyma is made up of the cortex and medulla.

2. An older adult male client is participating in a bladder retraining program as part of the treatment for urinary incontinence. The nurse advises him to wear barrier garments such as liners and protective pants. Which suggestion would be most appropriate to help the client maintain skin integrity? A) Avoiding the application of moisture sealant B) Exposing the affected area to air C) Using scented sprays or perfumes D) Avoiding using an electric room deodorizer

Ans: B Feedback: To maintain skin integrity to avoid skin infections, the client should be advised to wash the perineum, change linens, and expose the affected area to air. These are important measures that help avoid skin infection or irritation. The application of moisture sealant will help protect the skin, and using an electric room deodorizer helps prevent urinary odors. The client should be advised not to use scented sprays or perfumes, which can be irritating.

4. A client who is suspected of urinary tract infection is asked to collect a 24-hour urine specimen for culture. Which of the following measures can the nurse suggest to the client that may help prevent the entire urine specimen from becoming contaminated? A) Collect the voided urine sample primarily before 5 AM. B) Refrigerate the specimen until it is taken to the laboratory. C) Use the same receptacle for voiding and defecation. D) Store the collected urine away from sunlight.

Ans: B Feedback: To prevent the entire urine specimen from becoming contaminated, the urine specimen should be refrigerated until it can be taken to the laboratory. The nurse should ask the client to use separate receptacles for voiding and defecation to prevent any part of the specimen from being lost or contaminated. Urinating and collecting the urine sample only before 5 AM and collecting and storing the urine away from sunlight will not help prevent the urine specimen from becoming contaminated.

3. A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate, I can't control it and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence? A) Stress B) Urge C) Overflow D) Functional

Ans: B Feedback: Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding in time to reach a toilet. Stress incontinence occurs when the client has an involuntary loss of urine that results from a sudden increase in intra-abdominal pressure. Overflow incontinence occurs when the client experiences an involuntary loss of urine related to an overdistended bladder; the client voids small amounts frequently and dribbles. Functional incontinence occurs when the client has function of the lower urinary tract but cannot identify the need to void or ambulate to the toilet.

6. A client is prescribed amitriptyline, an antidepressant for incontinence. The nurse understands which of the following reasons that this drug is an effective treatment? A) Increases contraction of the detrusor muscle B) Increases bladder neck resistance C) Reduces bladder spasticity D) Decreases involuntary bladder contractions

Ans: B, D Feedback: Some tricyclic antidepressant medications (amitriptyline, nortriptyline, and amoxapine) are useful in treating incontinence because they decrease bladder contractions and increase bladder neck resistance. Anticholinergic drugs such as oxybutynin chloride (Ditropan) reduce bladder spasticity and involuntary bladder contractions. Bethanechol (Urecholine) helps to increase contraction of the detrusor muscle, which assists with emptying of the bladder.

24. The nurse is caring for a client with chronic bladder infections and inflammation. The physician has ruled out several medical diagnoses and is considering interstitial cystitis. The nurse is most correct to anticipate which diagnostic test to confirm the disorder? A) A cystoscopy B) A voiding cystourethrogram C) A bladder biopsy D) A potassium sensitivity test

Ans: C Feedback: A bladder biopsy of the bladder mucosa reveals an inflammatory process with scarring and hemorrhagic areas and confirms the diagnosis. A cystoscopy reveals an inflamed bladder, bladder mucosa with pinpoint hemorrhages and a bladder capacity smaller than normal. A voiding cystourethrogram demonstrates a small bladder capacity. A potassium sensitivity test reveals pain from the potassium instilled and is used in suggesting the presence of bladder inflammation and irritation.

15. The nurse is completing a full exam of the renal system. Which assessment finding best documents the need to offer the use of the bathroom? A) Tenderness over the kidneys B) Bruits noted over the abdominal area C) A dull sound when percussing over the bladder D) The ingestion of 8 oz of water

Ans: C Feedback: A dull sound when percussing over the bladder indicates a full bladder. Because the bladder is full, the nurse would offer for the client to use the bathroom. Tenderness over the kidney can indicate an infection or stones. Bruits are an abnormal vascular sound that does not indicate the need to use the bathroom. Ingesting water does not mean that the client has to void at this time.

23. The nurse is caring for a 37-year-old female client with potential interstitial cystitis. Which question, asked by the nurse, is helpful in suggesting the disease? A) "Have you noted any unusual vaginal drainage?" B) "Have you experienced hematuria with cramping?" C) "When was your last menstrual period?" D) "Do you drink alcoholic beverages on a frequent basis?"

Ans: C Feedback: Although the cause of interstitial cystitis is unknown, there appears to be a connection with female hormones as a link between flare-ups prior to menstruation has been noted. Unusual vaginal drainage is a symptom of a sexually transmitted disease. Hematuria is a symptom of many urinary tract disorders and not helpful in specifically suggesting interstitial cystitis. Alcoholic beverage consumption is not an indicator.

31. The nurse evaluates the client as experiencing symptoms of disequilibrium syndrome, following an initial hemodialysis treatment. Which is the best action to be taken by the nurse? A) No action is needed. B) Hold the next scheduled treatment. C) Slow the dialysis process during future treatment. D) Notify the physician and manage the symptoms.

Ans: C Feedback: Disequilibrium syndrome is a neurologic condition believed to be caused by cerebral edema associated with rapid movement of water. The symptoms are self-limiting and disappear within several hours after dialysis but can be prevented by slowing the dialysis process to allow time for gradual equilibrium of water. The nurse should document the symptoms and notify the physician with repeated incidence.

10. Which of the following instructions would be appropriate to include when preparing a woman for an abdominal ultrasound? A) Restrict solid food intake for 2 hours before the test. B) Refrain from douching for at least 1 week before the test. C) Drink at least 1 quart of water an hour before the test. D) Empty the bladder immediately before the test.

Ans: C Feedback: Drinking at least 1 quart of water 45 minutes to 1 hour before the test and no voiding until after the test ensures a full bladder and facilitates transmission of the ultrasound waves. It also elevates the bowel away from the other pelvic organs. The client should restrict solid food intake for 6 to 8 hours before the test to avoid having images of her test obscured by gas and intestinal contents. There is no restriction on douching for this test. A full bladder, not an empty one, facilitates this test.

21. A client with several calculi in the ureter is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which teaching statement by the nurse best describes the procedure? A) A scope is passed through the urethra to visualize and destroy the stones with a laser. B) After locating the calculi, a small incision is made to remove the stones. C) The stone is identified via fluoroscopy and then shock waves are used to shatter the stones. D) Once the calculi are located, a fine wire delivers shock waves to pulverize the stones.

Ans: C Feedback: ESWL is a procedure that uses 800 to 2400 shock waves aimed from outside the body toward soft tissues to dense stones. The repetition of the shock waves helps to shatter the stones into smaller particles that can be passed from the urinary tract. No incision is needed for ESWL therapy. Laser lithotripsy uses a fine wire placement to allow the laser beam to pulverize the stones.

27. The nurse is caring for a client who is following a treatment plan to decrease urinary tract infections. Which of the following indicates the need to change the treatment plan? A) The client has history of repeated antibiotic therapy. B) The client has improved personal hygiene methods. C) The client exhibits continued symptoms. D) The client has diluted urine.

Ans: C Feedback: If the client exhibits continued symptoms, the treatment plan is ineffective and the plan needs revised. Having a history of antibiotic therapy indicates the need to establish a treatment plan. Having improved hygiene indicates that the client is following the treatment plan. Having diluted urine indicates that the client has increased fluids which are a part of typical treatment plans.

27. A chronic renal failure client complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? A) Elevated serum creatinine B) Hyperkalemia C) Hyperphosphatemia D) Elevated urea and nitrogen

Ans: C Feedback: Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.

18. A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching? A) "I inherited this disorder from one of my parents." B) "The cysts can get quite large in size." C) "As long as I have one normal kidney, I should be fine." D) "If renal failure develops, I may need to consider dialysis."

Ans: C Feedback: Polycystic kidney disease is characterized by the formation of multiple cysts on both kidneys. Polycystic kidney disease is inherited as an autosomal dominant trait. The fluid-filled cysts can cause great enlargement of the kidneys and interfere with kidney function, which can eventually lead to renal failure.

35. A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? A) "Squamous cell carcinomas do not present with detectable symptoms." B) "You should have sought treatment earlier." C) "Very few symptoms are associated with renal cancer." D) "Painless gross hematuria is the first symptom in renal cancer."

Ans: C Feedback: Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease. Adenocarcinomas are the most common renal cancer (about 80%), whereas squamous cell renal cancers are rare. It is not therapeutic to place doubt or blame for delayed diagnosis.

6. A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect? A) Acute glomerulonephritis B) Ureteral stricture C) Urinary calculi D) Renal cell carcinoma

Ans: C Feedback: Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.

33. The nurse is obtaining a history on a client stating nocturia. When evaluating the client's evening behaviors, which may be the cause of the problem? A) The client takes 8 oz of water after dinner with her evening medications. B) The client urinates for the evening while getting ready for bed. C) The client takes a furosemide (Lasix) with the evening medications. D) The client uses the Credé's maneuver when urinating at bedtime.

Ans: C Feedback: Taking a diuretic furosemide (Lasix) in the evening can produce nocturia when the therapeutic action of the medication is initiated. A diuretic should be administered in the morning or no later than early evening to avoid nocturia. Drinking water with medications after dinner, urinating before bed, and using the Credé's maneuver to remove urine from the bladder are acceptable methods to avoid large fluid intake before bedtime and eliminate urine from the bladder before the nighttime period.

35. The nurse is assessing a client brought to the emergency department for systemic complications after a traumatic event. Which assessment finding is most suggestive of an intact urinary tract? A) The nurse notes no abnormalities on abdominal inspection. B) The client states diffuse abdominal pain. C) Urine output is pink and noted at 300 mL. D) The physician notes urine leakage upon palpation.

Ans: C Feedback: The best evidence of an intact urinary tract is voiding in sufficient quantities. Even though the client's urine contains blood, the tract could be intact. Inspection and palpation provide data but not specific enough. The client stating pain also provides data.

15. The nurse is caring for a male client who has a significant urinary narrowing secondary to an enlarged prostate. Which nursing action is best to relieve his urinary retention? A) Use a 22 French catheter to remove urine from bladder. B) Teach the Credé's maneuver to remove urine from the bladder. C) Insert a coudé catheter to remove urine from the bladder. D) Use a straight-tipped catheter to remove urine from the bladder.

Ans: C Feedback: The best nursing action to remove urine from the bladder is to use a curve-tipped coudé catheter. The coudé catheter has a curved tip to slide over the obstruction. Using a large catheter such as a 22 French would meet resistance and trauma to the urethral lining. A straight-tipped catheter also would meet the obstruction and not advance. The Credé's maneuver may eliminate a small amount of urine but does nothing to allow urine flow around the narrowing.

16. The licensed practical nurse is employed as a charge nurse at a long-term care facility. A resident is ordered a catheterization schedule of every 6 hours due to chronic urinary retention. The LPN reports daily catheterization amounts from the previous day ranging from 450 mL to 800 mL. Which nursing action is most correct? A) Continue the same order. B) Obtain an order to decrease the frequency of the catheterizations. C) Obtain an order to increase the frequency of the catheterizations. D) Leave the catheter in if obtaining a urine amount over 500 mL.

Ans: C Feedback: The charge nurse realizes that if the volume of urine obtained via catheterization is more than 400 mL, the client should be catheterized more often. The LPN would call for a change in orders citing the urine volume as the rationale. Leaving the catheter in place is only completed if necessary.

32. The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder? A) Incontinence B) Dysuria C) Hematuria D) Frequency

Ans: C Feedback: The most common first symptom of a malignant tumor is hematuria. Most malignant tumors are vascular; thus, abnormal bleeding can be a first sign of abnormality. The client then has symptoms of incontinence (a later sign), dysuria and frequency.

21. The nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client's symptoms and urine specific gravity is anticipated? A) The specific gravity will be inversely proportional. B) The specific gravity will equal to one. C) The specific gravity will be high. D) The specific gravity will be low.

Ans: C Feedback: The nurse assesses all of the data to make an informed decision on client status. On a hot day, the client found outside will be perspiring. When dehydration occurs, a client will have low urine output and increased specific gravity of urine. Normal specific gravity is inversely proportional. The density of distilled water is one. A low specific gravity is noted in a client with high fluid intake and who is not losing systemic fluid.

23. The nurse has received morning lab work on a client with chronic renal disease. Which finding indicates renal disease? A) Urine pH of 6.5 B) Urine nitrate: negative C) Protein level of 400 mg/dL D) Specific gravity: 1.002

Ans: C Feedback: The nurse must analyze components of a urinalysis to determine abnormal results. Protein at a level of 400 mg/dL is high and indicates renal disease. The other results are

20. The nurse is completing a plan of care for a client with chronic urinary incontinence. Which of the following outcomes is a priority? A) The client will decrease fluid intake to 1000 mL/day. B) The client will use the bathroom every 30 minutes while awake. C) The client will maintain perineal skin integrity. D) The client will express feelings of acceptance related to condition.

Ans: C Feedback: The nurse planning care would identify the priority outcome being to maintain skin integrity. Due to the urinary incontinence, perineal skin breakdown may occur due to the warm, moist environment. A skin barrier or moisture sealant is suggested. The nurse would not decrease fluid intake dramatically or use the bathroom every 30 minutes in a

6. A group of students is reviewing for a test on the urinary and renal system. The students demonstrate understanding of the information when they identify which of the following as part of the upper urinary tract? A) Bladder B) Urethra C) Ureters D) Pelvic floor muscles

Ans: C Feedback: The upper urinary tract is composed of the kidneys, renal pelvis, and ureters. The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.

15. Which assessment finding is most important in determining nursing care for a client with acute glomerulonephritis? A) Presence of albumin in the urine B) Dark smoky colored urine C) Blurred vision D) Peripheral edema

Ans: C Feedback: Visual disturbances can be indicative of rising blood pressure in a client with acute glomerulonephritis. Severe hypertension needs prompt treatment to prevent convulsions. Presence of albumin (protein) and RBCs in the urine, along with periorbital and

20. The nurse is reviewing urine tests to obtain client baseline information. Which of the following urine tests is preferred to identify characteristics of normal and abnormal urine? A) A 24-hour urine kept in the bathroom on ice B) A catheterized specimen obtained at no particular time C) A clean-catch midstream specimen from the first voiding of the morning D) A specimen obtained from an indwelling Foley catheter's bag

Ans: C Feedback: When obtaining urine for baseline information, the preferred test is a clean-catch midstream specimen obtained from the first voiding of the morning. Specialized testing is not done until a baseline test is completed to identify abnormal readings. It is best to obtain data from the least invasive method. Specimens from a Foley catheter are

2. During the physical examination of a client, the nurse monitors for signs that may indicate a urinary tract disorder. Which of the following would suggest that the client may have a urinary tract disorder? A) Light-headedness B) Malaise C) Periorbital edema D) Flank pain

Ans: C, D Feedback: Periorbital edema, among other signs, such as edema of the extremities, cardiac failure, and mental changes may indicate a urinary tract disorder. Light-headedness and flank pain may suggest urinary bleeding. Malaise is a sign of systemic infection. Flank pain and malaise could occur after a biopsy, and if they occur, the physician is to be notified immediately.

19. The nurse is caring for clients on a medical urinary unit. Which client, scheduled for a urinary procedure, will be prescribed antibiotics following the procedure? A) The client scheduled for a voiding cystourethrography B) The client scheduled for a cystoscopy C) The client scheduled for a retrograde pyelography D) The client scheduled for a cystometrography

Ans: D Feedback: A cystometrography evaluates bladder tone and capacity. Because solution is instilled into the client's bladder, antibiotics may be prescribed for a day or two. The other options do not regularly have antibiotics prescribed.

11. The nurse is caring for a client with a cystoscopy tube draining urine from the bladder. When reviewing the client's history prior to administering care, which is of most concern? A) Diagnostic studies reporting bladder stones B) Crusted drainage around the cystoscopy tube C) A white blood count of 12,000 cells/mm3 D) New diagnosis of urosepsis

Ans: D Feedback: All of the options are typical risk factors for a client with a cystoscopy tube. The most concerning risk factor is of urosepsis, which is a serious systemic infection from microorganisms in the urinary tract invading the bloodstream.

32. The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable? A) Clients have frequent urinary tract infections. B) Clients develop a neurogenic bladder. C) Clients have urinary frequency. D) Clients have chronic renal failure.

Ans: D Feedback: Although all of the options may occur in the client with diabetes mellitus, the option which is most notable, and potentially life threatening, is chronic renal failure.

22. Which pharmacologic agents pose the greatest risk for urinary retention in a client with benign prostatic hyperplasia (BPH)? A) Muscle relaxers B) Antihypertensives C) Nitrates D) Antihistamines

Ans: D Feedback: Antihistamines and over-the-counter cold medications should be avoided in clients with BPH due to the increase in urinary retention properties. Muscle relaxers are commonly prescribed for treatment of urinary retention. Nitrates and antihypertensive medications do not cause significant risk in the management of BPH.

29. The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? A) Pats skin dry after bathing B) Uses moisturizing creams C) Keeps nails trimmed short D) Brief, hot daily showers

Ans: D Feedback: Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.

13. The nurse is caring for a client who has a history of urine reflux. To assess the client for this urinary complication, which nursing action is best? A) Ask the client if voiding sufficient quantities has been a problem. B) Monitor the client's intake and output for inconsistency. C) Have the client void into a collection device. D) Palpate the client's bladder for distension.

Ans: D Feedback: Normally, urine flows in one direction because of peristaltic action and because the ureters enter the bladder at an oblique angle. The reflux of urine (urine that flows backward) can occur secondary to a distended bladder. By palpating for bladder distension, the nurse is able to determine that reflux urine traveled back to the bladder instead of traveling from the bladder down the urethra. All of the other options provide data that can be helpful, but actually feeling for the distension is best. Using a bladder scanner would also provide an amount of urine in the bladder.

8. A client has undergone a renal transplant and returns to the healthcare agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? A) Hypotension B) Weight loss C) Polyuria D) Abdominal pain

Ans: D Feedback: Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.

3. The nurse is caring for several older clients. Which client would the nurse be especially alert for signs and symptoms of pyelonephritis? A) A client with acute renal failure B) A client with a urinary tumor C) A female client with preexisting chronic glomerulonephritis D) A client with urinary obstruction

Ans: D Feedback: The client with urinary obstruction is at the highest risk of developing pyelonephritis because a urinary obstruction is the most common cause of pyelonephritis in older adults. Acute glomerulonephritis usually occurs in older adults with preexisting chronic glomerulonephritis. Older clients with acute renal failure or urinary tumor are not at high risk for developing pyelonephritis.

9. A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom? A) Urinary retention B) Fever C) Frequency D) Painless hematuria

Ans: D Feedback: The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency. Later symptoms are related to metastases and include pelvic pain, urinary retention (if the tumor blocks the bladder outlet), and urinary frequency from the tumor occupying bladder space.

5. The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important? A) Set up a routine schedule of every 4 hours to check for residual urine. B) Check for residual after the client reports the urge to void. C) Record the volume of urine obtained. D) Catheterize the client immediately after the client voids.

Ans: D Feedback: To obtain accurate residual volumes, it is important that clients void first and that catheterization occur immediately after the attempt. The nurse should record both the volume voided (even if it is zero) and the volume obtained by catheterization. Intermittent catheterizations are performed based on a schedule, usually 3 to 4 times per day. Residual urine refers to the amount remaining in the bladder after voiding. It is essential that the client voids.

11. An elderly client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? A) Shows damage to the kidneys B) If risk for chronic pyelonephritis is likely C) Reveals causative microorganisms D) Detects calculi, cysts, or tumors

Ans: D Feedback: Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.

14. The nurse is caring for a client who has chronic urinary retention and discussing the options. When discussing care, which intervention is considered first? A) Completing clean intermittent catheterization B) Inserting a cystostomy tube C) Applying a condom catheter D) Using the Credé's maneuver

Ans: D Feedback: When considering interventions, begin with the least invasive. The Credé's maneuver or manual voiding is completed by pressing on the bladder to further expel urine. This procedure requires no invasive measures that would increase the risk of infection. Intermittent catheterization is an invasive procedure but would remove all urine from the bladder. The most invasive is placing an indwelling catheter surgically through the abdominal wall. A condom catheter is used for males who are incontinent.