Urinary System

Front 1

A renal stone in the pelvis of the kidney will alter the function of the kidney by interfering with:

A. the structural support of the kidney.
B. regulation of the concentration of urine.
C. the entry and exit of blood vessels at the kidney.
D. collection and drainage of urine from the kidney.

Back 1

D. collection and drainage of urine from the kidney.

Front 2

A patient with renal disease has oliguria and a creatinine clearance of 40 ml per minute. The nurse recognizes that these findings most directly reflect abnormal function of

A. tubular secretion.
B. glomerular filtration.
C. capillary permeability.
D. concentration of filtrate.

Back 2

B. glomerular filtration.

Front 3

The nurse identifies a risk for urinary calculi in a patient who relates a past health history that includes

A. measles.
B. gastric ulcer.
C. diabetes mellitus.
D. hyperparathyroidism.

Back 3

D. hyperparathyroidism.

Front 4

Normal changes associated with aging of the urinary system that the nurse expects to find include

A. decreased levels of BUN.
B. urine postvoiding residual.
C. increased bladder capacity.
D. more easily palpable kidneys.

Back 4

B. urine postvoiding residual.

Front 5

During physical assessment of the urinary system, the nurse

A. percusses the flank area with a firm blow.
B. palpates an empty bladder as a small nodule.
C. positions the patient prone to palpate the kidneys.
D. uses auscultation to determine the level of urine in the bladder.

Back 5

A. percusses the flank area with a firm blow.

Front 6

Normal findings expected by the nurse on physical assessment of the urinary system include

A. nonpalpable left kidney.
B. auscultation of renal artery bruit.
C. CVA tenderness elicited by a kidney punch.
D. palpable bladder to the level of the pubic symphysis.

Back 6

A. nonpalpable left kidney.

Front 7

An important nursing responsibility after an IVP is to

A. assess the patient for flank pain.
B. encourage extra oral fluid intake.
C. observe urine for remaining contrast material.
D. encourage ambulation 2 to 3 hours after the study.

Back 7

B. encourage extra oral fluid intake.

Front 8

On reading the urinalysis results of a dehydrated patient, the nurse would expect to find

A. a pH of 8.4.
B. RBC of 4/hpf.
C. color: yellow, cloudy.
D. specific gravity of 1.035.

Back 8

D. specific gravity of 1.035.

Front 9

A female client reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-voided urine specimen is markedly cloudy. The probable cause of these symptoms and findings is:

A. Cystitis
B. Renal stone
C. Hemorrhage
D. Incontinence

Back 9

A. Cystitis

Cystitis is usually marked by urinary frequency and irritation. The cloudiness is usually indicative of bacterial presence. A renal stone presents with pain and hematuria. Hemorrhage and incontinence are not correct options for this presentation.

Front 10

Hospital-acquired urinary tract infections (UTIs) are often related to poor hand washing and:

A. Poor urinary output
B. Poor perineal hygiene
C. Use of urinary drainage bags
D. Improper catheter care

Back 10

D. Improper catheter care

Although all the answers may be causes of UTIs, in the hospital, urinary catheterization has the highest potential for causing UTIs, and improper catheter care can increase the chance of these infections. Poor perineal hygiene can also increase the risk of UTIs, both in and out of the hospital. Poor urinary output does increase the chance of UTIs, in and out of the hospital.

Front 11

Some medications change the color of the urine. Pyridium colors the urine:

A. Blue
B. Brown
C. Yellow
D. Bright orange to rust

Back 11

D. Bright orange to rust

Front 12

To minimize nocturia, clients should avoid fluids:

A. After lunch
B. In the late afternoon
C. For 2 hours before bedtime
D. For 4 hours before bedtime

Back 12

C. For 2 hours before bedtime

Front 13

Maintaining a Foley catheter drainage bag in the dependent position prevents:

A. Urinary reflux
B. Urinary retention
C. Reflex incontinence
D. Urinary incontinence

Back 13

A. Urinary reflux

Front 14

When a condom catheter is applied, the catheter should be secured on the penile shaft in such a manner that the catheter is:

A. Tight and draining well
B. Dependent and draining well
C. Secured with adhesive tape applied in a circular pattern
D. Snug and secure but without causing constriction that impedes blood flow

Back 14

D. Snug and secure but without causing constriction that impedes blood flow

Front 15

A client undergoes ultrasonography of a kidney. The nurse providing postprocedure care remembers that:

A. There are no special precautions that must be taken.
B. Each urine specimen must be assessed for blood for 24 hours.
C. All urine must be saved in a radiation-safe container for 12 hours.
D. Contact with the client must be limited to 10 minutes each hour for 6 hours.

Back 15

A. There are no special precautions that must be taken.

Front 16

As a result of the adaptation response to surgery, the nurse expects that for the first 1 to 2 days after the client's surgery the client's urine output will:

A. Increase
B. Decrease

Back 16

B. Decrease

The stress response releases an increased amount of antidiuretic hormone, which increases water reabsorption. Stress also elevates aldosterone levels, which causes sodium and water retention. Both of these physiological responses reduce urine output.

Front 17

A client underwent total knee replacement and was placed on patient-controlled analgesia (PCA). The client has been activating the drug button an average of 4 times per hour. The nurse has assisted the client on and off the bedpan 2 or 3 times an hour for the past 2 hours. Urine output was about 50 ml with each void. The nurse now begins to suspect:

A. Fluid overload
B. Urge incontinence
C. Retention overflow
D. Urinary tract infection (UTI)

Back 17

C. Retention overflow

Urinary retention may cause increased pressure in the bladder to the point that the external urethral sphincter is unable to hold back urine. The sphincter temporarily opens to allow a small volume of urine to escape. Bladder pressure then falls, and the sphincter closes again. The nurse should also assess the lower abdomen for bladder distention. The symptom described does not justify the selection of the other options. There is no sense of urgency. Fluid overload would more likely present as lung congestion. A UTI would have additional symptoms.

Front 18

The nurse recognizes that the organism that most frequently causes urinary tract infections (UTIs) in women is:

A. Aspergillus
B. Streptococcus
C. Escherichia coli
D. Staphylococcus aureus

Back 18

C. Escherichia coli

Because the female urethra is positioned close to the anus, most UTIs are a result of contamination of the urethra with organisms from the gastrointestinal (GI) tract.

Front 19

The nurse is about to insert a urinary catheter into an uncircumcised client. After retracting the foreskin and inserting and securing the catheter, the nurse must be sure to:

A. Secure the catheter to the client's leg.
B. Clean the urinary meatus with povidone-iodine.
C. Return the foreskin over the glans penis.
D. Culture the first urine to drain into the collection bag.

Back 19

C. Return the foreskin over the glans penis.

If the nurse does not pull the foreskin back over the glans penis, it could act as a tourniquet. The glans penis could become extremely swollen and require an emergency circumcision. The insertion of the urinary catheter already required cleansing of the meatus. Securing the catheter to the leg or to the abdomen is important, but it is not essential. Cultures are not performed on urine that has drained into the collection bag.

Front 20

A client is scheduled for an intravenous pyelogram (IVP). Before the test the most important assessment the nurse performs is asking about:

A. Allergies to shellfish
B. Previous experience with IVP
C. Family history of a reaction to IVP
D. Ability to remain still during the procedure

Back 20

A. Allergies to shellfish

Front 21

Elimination changes that result from obstruction to the flow of urine in the urinary collecting system may cause which of the following? (Select all that apply.)

A. Blood clots
B. Dehydration
C. Renal damage
D. Urinary retention
E. Urinary tract infection

Back 21

C. Renal damage
D. Urinary retention
E. Urinary tract infection

Obstruction can cause renal damage, urinary retention, and urinary tract infections.

Front 22

A female client is having difficulty voiding after childbirth. The nurse implements which of the following interventions to promote voiding? (Select all that apply.)

A. Turning the water tap on
B. Ambulating the client to the bathroom
C. Trickling warm water over the mons pubis
D. Offering the client a large glass of cranberry juice
E. Positioning the client on a fracture bedpan flat in bed

Back 22

A. Turning the water tap on
B. Ambulating the client to the bathroom
C. Trickling warm water over the mons pubis

Front 23

A client reports to the nurse that he wakes up early because of a need to urinate. The nurse recommends that the client avoid which of the following liquids after 8 PM? (Select all that apply.)

A. Tea
B. Cola
C. Wine
D. Coffee

Back 23

A. Tea
B. Cola
C. Wine
D. Coffee

All of the beverages listed are diuretics. In addition, alcohol inhibits the release of antidiuretic hormone, thus increasing water loss in urine.

Front 24

A client with multiple sclerosis is being taught how to perform self-catheterization. As part of this teaching the nurse instructs the client to do which of the following? (Select all that apply.)

A. Increase intake of fluids.
B. Always use clean technique.
C. Always use sterile technique.
D. Use petroleum jelly to lubricate the catheter tip.

Back 24

A. Increase intake of fluids.
B. Always use clean technique.

Sterile technique is required for urinary catheter insertion in the hospital, but when catheterization is performed at home by the client only clean technique is required. The hospital is populated by a wide variety of microorganisms that could become pathogenic to the client. The client's own organisms do not generally cause disease. Intake of fluids is important to minimize the occurrence of urinary tract infections. Use of an oil-based lubricant is not recommended and may increase urinary tract infections. Water-based lubricants, which can be expelled from the urethra during voiding, should be used.

Front 25

The nurse is teaching a group of young (20- to 25-year-old) women how to prevent urinary tract infections (UTIs). Which of the following foods does the nurse recommend consuming to reduce the incidence of UTIs? (Select all that apply.)

A. Prunes
B. Cranberry juice
C. Grapefruit juice
D. Whole-grain breads

Back 25

A. Prunes
B. Cranberry juice
D. Whole-grain breads

Prunes, cranberry juice, and whole-grain breads acidify the urine, which creates an inhospitable environment for pathogens. In addition, cranberry juice has been shown to decrease the adherence of bacteria to the bladder wall. Grapefruit juice has not demonstrated any value in preventing UTIs.

Front 26

The urine appears concentrated and cloudy because of the presence of white blood cells or ___________.

Back 26

Bacteria

Front 27

After undergoing transurethral prostatectomy a client returns to his room with a triple-lumen indwelling catheter for continuous bladder irrigation. The irrigation fluid is normal saline delivered at a rate of 150 ml/hr. After 8 hours the nurse empties the drainage bag, which contains a total of 2520 ml. Of the total, _____ ml is urine output.

Back 27

1320

Front 28

What test is performed to differentiate renal cysts from renal tumors?

Back 28

Renal Angiography

Front 29

In teaching a patient with pyelonephritis about the disorder, the nurse informs the patient that the organisms that cause pyelonephritis most commonly reach the kidneys through

A. the bloodstream.
B. the lymphatic system.
C. a descending infection.
D. an ascending infection.

Back 29

D. an ascending infection.

Front 30

The nurse teaches the female patient who has frequent UTIs that she should

A. urinate after sexual intercourse.
B. take tub baths with bubble bath.
C. take prophylactic sulfonamides for the rest of her life.
D. restrict fluid intake to prevent the need for frequent voiding.

Back 30

A. urinate after sexual intercourse.

Front 31

The immunologic mechanisms involved in glomerulonephritis include

A. tubular blocking by precipitates of bacteria and antibody reactions.
B. deposition of immune complexes and complement along the GBM.
C. thickening of the GBM from autoimmune microangiopathic changes.
D. destruction of glomeruli by proteolytic enzymes contained in the GBM.

Back 31

B. deposition of immune complexes and complement along the GBM.

Front 32

One of the most important roles of the nurse in relation to acute poststreptococcal glomerulonephritis is to

A. promote early diagnosis and treatment of sore throats and skin lesions.
B. encourage patients to request antibiotic therapy for all upper respiratory infections.
C. teach patients with APSGN that long-term prophylactic antibiotic therapy is necessary to prevent recurrence.
D. monitor patients for respiratory symptoms that indicate that the disease is affecting the alveolar basement membrane.

Back 32

A. promote early diagnosis and treatment of sore throats and skin lesions.

Front 33

The edema that occurs in nephrotic syndrome is due to

A. decreased aldosterone secretion from adrenal insufficiency.
B. increased hydrostatic pressure caused by sodium retention.
C. increased fluid retention caused by decreased glomerular filtration.
D. decreased colloidal osmotic pressure caused by loss of serum albumin.

Back 33

D. decreased colloidal osmotic pressure caused by loss of serum albumin.

Front 34

A patient is admitted to the hospital with severe renal colic caused by renal lithiasis. The nurse’s first priority in management of the patient is to

A. administer narcotics as prescribed.
B. obtain supplies for straining all urine.
C. encourage fluid intake of 3 to 4 L per day.
D. keep the patient NPO in preparation for surgery.

Back 34

A. administer narcotics as prescribed.

Front 35

The nurse recommends genetic counseling for the children of a patient with

A. nephrotic syndrome.
B. chronic pyelonephritis.
C. malignant nephrosclerosis.
D. adult-onset polycystic renal disease.

Back 35

D. adult-onset polycystic renal disease.

Front 36

The nurse encourages strict diabetic control in the patient prone to diabetic nephropathy knowing that the renal tissue changes that may occur in this condition include

A. uric acid calculi and nephrolithiasis.
B. renal sugar-crystal calculi and cysts.
C. lipid deposits in the glomeruli and nephrons.
D. thickening of the GBM and glomerulosclerosis.

Back 36

D. thickening of the GBM and glomerulosclerosis.

Front 37

In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes

A. restricting fluids to diminish the risk of urinary leakage.
B. counseling the patient concerning choice of incontinence containment device.
C. clamping and releasing a catheter to increase bladder tone.
D. teaching the patient biofeedback mechanisms to suppress the urge to void.

Back 37

A. restricting fluids to diminish the risk of urinary leakage.

Front 38

A patient with a ureterolithotomy returns from surgery with a nephrostomy tube in place. Postoperative nursing care of the patient includes

A. encouraging the patient to drink fruit juices and milk.
B. forcing fluids of at least 2 to 3 L per day after nausea has subsided.
C. notifying the physician if nephrostomy tube drainage is more than 30 ml per hour.
D. irrigating the nephrostomy tube with 10 ml of normal saline solution as needed.

Back 38

B. forcing fluids of at least 2 to 3 L per day after nausea has subsided.