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1. When reading a patient's chart, the nurse notes that the patient has had dysuria. To assess whether there is any improvement, which question will the nurse ask?
a. "Do you have any blood in your urine?"
b. "Do you have to get up at night to urinate?"
c. "Do you have any pain when you urinate?"
d. "Do you have to urinate very frequently?"

Answer: C
Rationale: Dysuria is painful urination. The alternate responses are used to assess other urinary tract symptoms: hematuria, nocturia, and frequency.

Cognitive Level: Application Text Reference: pp. 1143, 1145
Nursing Process: Assessment NCLEX: Physiological Integrity

2. When admitting a patient who has a history of paraplegia as a result of a spinal cord injury, the nurse will plan to
a. check the patient for urinary incontinence every 2 hours to maintain skin integrity.
b. assist the patient to the toilet on a scheduled basis to help ensure bladder emptying.
c. use intermittent catheterization on a regular schedule to avoid the risk of infection.
d. ask the patient about the usual urinary pattern and measures used for bladder control.

Answer: D
Rationale: Before planning any interventions, the nurse should complete the assessment and determine the patient's normal bladder pattern and the usual measures used by the patient at home. All the other responses may be appropriate, but until the assessment is complete, an individualized plan for the patient cannot be developed.

Cognitive Level: Application Text Reference: pp. 1143-1144
Nursing Process: Planning NCLEX: Physiological Integrity

3. A patient's urine dipstick indicates a large amount of protein in the urine. The next action by the nurse should be to
a. check which medications the patient is currently taking.
b. ask the patient about any family history of chronic renal failure.
c. send a urine specimen to the laboratory to test for ketones and glucose.

d. obtain a clean-catch urine for culture and sensitivity testing.

Answer: A
Rationale: Normally the urinalysis will show zero to trace amounts of protein, but some medications may give false-positive readings. The other actions by the nurse may be appropriate, but checking for medications that may affect the dipstick accuracy should be done first.

Cognitive Level: Application Text Reference: p. 1146
Nursing Process: Assessment NCLEX: Physiological Integrity

4. A creatinine clearance test is ordered for a hospitalized patient with possible renal insufficiency. Which equipment will the nurse need to obtain?
a. Foley catheter and drainage bag
b. Towelettes for perineal cleaning
c. Basin of ice
d. Sterile specimen cup

Answer: C
Rationale: Creatinine clearance testing involves a 24-hour urine specimen collection. The urine should be refrigerated or cooled, or a preservative should be used. Catheterization, cleaning of the perineum with antiseptic towelettes, and a sterile specimen cup are not needed for this test.

Cognitive Level: Application Text Reference: p. 1146
Nursing Process: Implementation NCLEX: Physiological Integrity

5. A 20-year-old patient who is employed as a hairdresser and has a 10 pack-year history of cigarette smoking is scheduled for an annual physical examination. The nurse will plan to teach the patient about the increased risk for
a. bladder cancer.
b. renal failure.
c. pyelonephritis.
d. kidney stones.

Answer: A
Rationale: Exposure to the chemicals involved in when working as a hairdresser and smoking both increase the risk of bladder cancer, and the nurse should assess whether the patient understands this risk. The patient is not at increased risk for renal failure, pyelonephritis, or kidney stones.

Cognitive Level: Application Text Reference: p. 1142
Nursing Process: Planning NCLEX: Physiological Integrity

6. During assessment of a patient with a possible renal insufficiency, which of these medications taken by the patient at home will be of most concern to the nurse?
a. Warfarin (Coumadin)
b. Folic acid (vitamin B9)
c. Ibuprofen (Motrin)
d. Penicillin (Bicillin LA)

Answer: C
Rationale: The nonsteroidal antiinflammatory medications (NSAIDs) are nephrotoxic and should be avoided in patients with renal insufficiency. The nurse should also ask about reasons the patient is taking the other medications, but the medication of most concern is the ibuprofen.

Cognitive Level: Application Text Reference: p. 1142
Nursing Process: Assessment NCLEX: Physiological Integrity

7. When the nurse is planning care for an 82-year-old man, an appropriate intervention based on an understanding of age-related changes of the urinary system is for the nurse to
a. limit fluid intake to no more than 1500 ml/day.
b. leave a light on in the bathroom at night.
c. ask the patient to use a urinal so that all urine can be measured.
d. pad the patient's bed to accommodate overflow incontinence.

Answer: B
Rationale: Because of a decrease in the ability of the kidney to concentrate urine, nocturia is common in older patients. Fluids should be encouraged because dehydration is more common in older patients. The information in the question does not indicate that measurement of the patient's output is necessary or that the patient has overflow incontinence.

Cognitive Level: Application Text Reference: pp. 1141, 1144
Nursing Process: Planning NCLEX: Physiological Integrity

8. While assessing a patient's urinary system, the nurse cannot palpate either kidney. Which action should the nurse take next?
a. Ask the patient about any history of recent sore throat.
b. Obtain a urine specimen to check for hematuria.
c. Ask the health care provider about scheduling a renal ultrasound.
d. Document the information on the assessment form.

Answer: D
Rationale: The kidneys are protected by the abdominal organs, ribs, and muscles of the back and may not be palpable under normal circumstances, so no action except to document the assessment information is needed. Asking about a recent sore throat, checking for hematuria, or obtaining a renal ultrasound may be appropriate when assessing for renal problems for some patients, but there is nothing in the stem to indicate that they are appropriate for this patient.

Cognitive Level: Application Text Reference: p. 1144
Nursing Process: Assessment NCLEX: Physiological Integrity

9. How will the nurse assess the flank area for tenderness?
a. Percuss the area between the iliac crest and ribs along the midaxillary line.
b. Palpate along both sides of the lumbar vertebral column.
c. Place one hand flat at the costovertebral angle (CVA) and strike it with the other fist.
d. Push gently into the two lowest intercostal spaces.

Answer: C
Rationale: Checking for flank pain is best performed by percussion of the CVA and asking about pain. The other techniques would not assess for flank pain.

Cognitive Level: Comprehension Text Reference: pp. 1144-1145
Nursing Process: Assessment NCLEX: Physiological Integrity

10. The result of a patient's creatinine clearance test is 60 ml/min. The nurse equates this finding to a glomerular filtration rate (GFR) of _____ ml/min.
a. 30
b. 60
c. 120
d. 240

Answer: B
Rationale: The creatinine clearance approximates the GFR. The other responses are not accurate.

Cognitive Level: Comprehension Text Reference: p. 1146
Nursing Process: Assessment NCLEX: Physiological Integrity

11. The nurse uses auscultation during assessment of the urinary system to
a. determine the position of the kidneys.
b. assess for bladder distension.
c. check for ureteral peristalsis.
d. identify renal artery or aortic bruits.

Answer: D
Rationale: The presence of a bruit may indicate problems such as renal artery tortuosity or abdominal aortic aneurysm. Auscultation would not be helpful in assessing for the other listed urinary tract information.

Cognitive Level: Comprehension Text Reference: p. 1145
Nursing Process: Assessment NCLEX: Physiological Integrity

12. When reviewing the results of a patient's urinalysis, which information indicates that the nurse should notify the health care provider?
a. pH 6.2
b. Protein: 6 mg/dl
c. WBC: 20-26/hpf
d. Specific gravity: 1.021

Answer: C
Rationale: The increased number of white blood cells (WBCs) indicates the presence of urinary tract infection or inflammation. The other findings are normal.

Cognitive Level: Comprehension Text Reference: p. 1152
Nursing Process: Assessment NCLEX: Physiological Integrity

13. A patient with a possible renal cell tumor who is scheduled for an intravenous pyelogram (IVP) and computed tomography (CT) scanning of the abdomen gives the nurse all the following data. Which information has the most immediate implications for the patient's care?
a. The patient has not had anything to eat or drink for 8 hours.
b. The patient used a bisacodyl (Dulcolax) tablet the previous night.
c. The patient describes allergies to shellfish and penicillin.
d. The patient complains of costovertebral angle (CVA) tenderness.

Answer: C
Rationale: Iodine-based contrast dye is used during IVP and for many CT scans. The nurse will need to notify the health care provider before the procedures so that the patient can receive medications such as antihistamines or corticosteroids before the procedures are started. The other information is also important to note and document but does not have immediate implications for the patient's care during the procedures.

Cognitive Level: Application Text Reference: pp. 1147-1148
Nursing Process: Assessment NCLEX: Physiological Integrity

14. When teaching a patient scheduled for a cystogram via a cystoscope about the procedure, the nurse tells the patient,
a. "Your doctor will place a catheter into an artery in your groin and inject a dye that will visualize the blood supply to the kidneys."
b. "Your doctor will inject a radioactive solution into a vein in your arm and the distribution of the isotope in your kidneys and bladder will be checked."
c. "Your doctor will insert a lighted tube into the bladder through your urethra, inspect the bladder, and instill a dye that will outline your bladder on x-ray."
d. "Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidney."

Answer: C
Rationale: In a cystoscope and cystogram procedure, a cystoscope is inserted into the bladder for direct visualization, and then contrast solution is injected through the scope so that x-rays can be taken. The response beginning, "Your doctor will place a catheter" describes a renal arteriogram procedure. The response beginning, "Your doctor will inject a radioactive solution" describes an IVP. And the response beginning, "Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted" describes a retrograde pyelogram.

Cognitive Level: Application Text Reference: pp. 1148-1149
Nursing Process: Implementation NCLEX: Physiological Integrity

15. The nurse informs the patient undergoing cystoscopy that following the procedure, the patient
a. should ask for the ordered narcotics as necessary for pain.
b. will be NPO for 8 hours to prevent nausea and vomiting.
c. may experience blood-tinged urine and urinary frequency.
d. is expected to be on strict bed rest for about 4 to 6 hours.

Answer: C
Rationale: Pink-tinged urine and urinary frequency are expected after cystoscopy. Burning on urination is common, but pain that requires narcotics for relief is not expected. A good fluid intake is encouraged after this procedure. Bed rest is not required following cystoscopy.

Cognitive Level: Application Text Reference: p. 1149
Nursing Process: Implementation NCLEX: Physiological Integrity

16. A patient with an elevated blood urea nitrogen (BUN) and serum creatinine is scheduled for a renal arteriogram. The nurse should question an order from radiology for bowel preparation with the use of
a. senna/docusate (Sennakot-S).
b. Fleet enema.
c. tap-water enema.
d. bisacodyl (Dulcolax) tablets.

Answer: B
Rationale: High-phosphate enemas, such as Fleet enemas, should be avoided in patients with renal insufficiency (as evidenced by an increased BUN and creatinine). The other medications for bowel evacuation are more appropriate.

Cognitive Level: Application Text Reference: p. 1149
Nursing Process: Implementation NCLEX: Physiological Integrity

17. The health care provider orders a clean-catch urine specimen for culture and sensitivity testing for a patient with a suspected urinary tract infection (UTI). To obtain the specimen, the nurse will plan to
a. teach the patient to clean the urethral area, void a small amount into the toilet, then void into a sterile specimen cup.
b. insert a short, small "mini" catheter attached to a collecting container into the urethra and bladder to obtain the specimen.
c. clean the area around the meatus with a povidone-iodine (Betadine) swab, and then have the patient void into a sterile container.
d. have the patient empty the bladder completely, and then obtain the next urine specimen that the patient is able to void.

Answer: A
Rationale: This answer describes the technique for obtaining a clean-catch specimen. The answer beginning, "insert a short, small, 'mini' catheter attached to a collecting container" describes a technique that would result in a sterile specimen, but a health care provider's order for a catheterized specimen would be required. Using Betadine before obtaining the specimen is not necessary and might result in suppressing the growth of some bacteria. And the technique described in the answer beginning "have the patient empty the bladder completely" would not result in a sterile specimen.

Cognitive Level: Application Text Reference: p. 1146
Nursing Process: Implementation NCLEX: Physiological Integrity

18. A patient who had a cystoscopy the previous day calls the urology clinic and gives the nurse all the following information. Which statement by the patient should be reported immediately to the health care provider?
a. "My urine still looks pink."
b. "I did not sleep well last night."
c. "I have a temperature of 101."
d. "My IV site is still bruised."

Answer: C
Rationale: The patient's elevated temperature may indicate a bladder infection, a possible complication of cystoscopy. The health care provider should be notified so that antibiotic therapy can be started. Pink-tinged urine is expected after a cystoscopy. The insomnia and bruising should be discussed further with the patient but do not indicate a need to notify the health care provider.

Cognitive Level: Application Text Reference: p. 1149
Nursing Process: Assessment NCLEX: Physiological Integrity

19. A hospitalized patient with renal insufficiency is scheduled to have an IVP. Which nursing action will be needed during this procedure?
a. Assist with monitoring for conscious sedation.
b. Insert a large size urinary catheter prior to the IVP.
c. Monitor the urine output after the procedure.
d. Give oral contrast solution before the procedure.

Answer: C
Rationale: Patients with impaired renal function are at risk for decreased renal function after IVP because the contrast medium used is nephrotoxic, so the nurse should monitor the patient's urine output. Conscious sedation and retention catheterization are not required for the procedure. The contrast medium is given intravenously, not orally.

Cognitive Level: Application Text Reference: p. 1147
Nursing Process: Implementation NCLEX: Physiological Integrity

20. Following an intravenous pyelogram (IVP), all of these assessment data are obtained. Which one requires immediate action by the nurse?
a. The urine output is 400 ml in the first 2 hours.
b. The patient complains of a dry mouth.
c. The heart rate is 58 beats/min.
d. The respiratory rate is 38 breaths/min.

Answer: D
Rationale: The increased respiratory rate indicates that the patient may be experiencing an allergic reaction to the contrast medium used during the procedure. The nurse should immediately assess the patient's oxygen saturation and breath sounds. The other data are not unusual findings following an IVP.

Cognitive Level: Application Text Reference: p. 1147
Nursing Process: Assessment NCLEX: Physiological Integrity

21. A patient with diabetic nephropathy is admitted for a right renal biopsy. Immediately after the biopsy, which of these is an essential nursing action?
a. Check blood glucose to assess for hyperglycemia or hypoglycemia.
b. Obtain a urine specimen to check for hematuria.
c. Monitor the BUN and creatinine to assess renal function.
d. Place the patient on the right side to put pressure on the site.

Answer: D
Rationale: The patient is placed in a supine position to put pressure on the biopsy side and decrease the risk for bleeding. The blood glucose and BUN/creatinine will not be affected by the biopsy. Hematuria is a common finding immediately after a renal biopsy.

Cognitive Level: Application Text Reference: p. 1149
Nursing Process: Implementation NCLEX: Physiological Integrity

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