Chapter 42: Urologic Disorders
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. A nurse is assessing a patient with renal impairment. Which facial characteristic is a sign of
fluid retention?
a.
Broken blood vessels around the nose
b.
Periorbital edema
c.
Rash on cheeks and neck
d.
Facial twitching
2. What laboratory value change should indicate to a nurse that a patient with renal failure has
entered the oliguric stage?
a.
Blood urea nitrogen (BUN) level rises.
b.
Serum calcium increases.
c.
Blood volume decreases.
d.
Urine osmolality increases.
3. What should nursing care focus on when caring for a patient with a ureteral catheter in place
after the removal of a kidney stone?
a.
Irrigating the catheter regularly
b.
Assessing for patency
c.
Including ureteral output with the bladder output
d.
Early ambulation
4. What is true about the urine osmolality when the kidney is adequately functioning?
a.
Equal to the osmolality of the serum
b.
Approximately half of the serum
c.
In a ratio of 10:1 with the serum
d.
Equal to the excretion of urea
5. Which urine test provides the most accurate measurement of renal function?
a.
BUN
b.
Phosphates
c.
Specific gravity
d.
Creatinine
6. A nurse is caring for a patient after urinary diversion surgery. What postoperative nursing
assessment is the priority?
a.
Level of fluid intake
b.
Position on the left side
c.
Keep the bed flat
d.
Bowel sounds
7. A nurse is performing frequent catheterizations for residual urine. What causes the greatest
concern for the nurse?
a.
Introduction of pathogens into the bladder
b.
Frequent genital exposure of the patient
c.
Presence of the indwelling catheter
d.
Causing urethral erosion
8. A patient has a nephrostomy tube that has been inserted because of an obstruction in the
ureter. What special precautions in the care of the nephrostomy tube should the nurse
implement?
a.
Clamping every 2 hours to allow expansion of the kidney pelvis
b.
Instilling no more than 50 mL of sterile water if sterile irrigations are ordered
c.
Being certain the tube is connected, not kinked, or not clamped to ensure that it
continually drains
d.
Leaving the nephrostomy site open to air
9. A patient comes to the medical clinic with complaints of urgency, frequency, pain in the area
of the symphysis pubis, and dark cloudy urine. What should the nurse suspect that this patient
has?
a.
Urinary calculi, probably located in the ureter
b.
Kidney infection, most likely pyelonephritis
c.
Cystitis, probably from bacterial contamination
d.
Interstitial cystitis (although rare in a male patient)
10. A patient who has cystitis has been told to drink at least 30 mL for each kilogram of body
weight. Her weight is 154 lb. How many mL/day should the nurse instruct the patient to
drink?
a.
1500
b.
2100
c.
2700
d.
3100
11. A home health patient diagnosed with cystitis has been prescribed the medication
phenazopyridine (Pyridium). When providing patient teaching, what should the nurse caution
the patient about?
a.
Staying out of the heat
b.
Nausea
c.
Staining of clothing
d.
Skin rash
12. A nurse is collecting data from a hospital patient who has been admitted with pyelonephritis.
He is acutely ill with a high fever, chills, nausea, and vomiting. He also has severe pain in the
flank area. What is the primary goal of treatment?
a.
Provide adequate nutrition with a stable body weight.
b.
Provide adequate hydration with pulse and blood pressure within patient norms.
c.
Give pain relief with analgesics and antispasmodics.
d.
Prevent further damage to his kidneys that could lead to renal failure.
13. What is the usual cause of the autoimmune disease of acute glomerulonephritis?
a.
Frequent cystitis
b.
Streptococcal infection
c.
Childhood disease of mumps
d.
Recent wound infection
14. A nurse is caring for a patient with acute glomerulonephritis. What should the nurse be aware
that the inflammation of the capillary loops in the glomeruli will lead to?
a.
Moderate to high blood pressure
b.
Low blood volume with polyuria
c.
Irritability and hyperactivity
d.
Low levels of BUN and creatinine
15. A 16-year-old patient with acute glomerulonephritis complains of boredom with bed rest and
asks when he can become more active. He asks, “What has to happen for me to get off of bed
rest?” What is the most accurate statement by the nurse?
a.
Dialysis starts.
b.
The antibiotic protocol is completed.
c.
Potassium levels are normal.
d.
Blood pressure drops to normal levels.
16. What discharge teaching is appropriate for the nurse to provide to a patient who has had a
lithotripsy?
a.
Check for edema of the legs and ankles.
b.
Watch for stone debris in the urine in 1 to 4 weeks.
c.
Decrease fluid intake to 1000 mL/day.
d.
Remain on restricted activity for a week.
17. Which outcome is most necessary for a patient diagnosed with renal calculi?
a.
Patient states an awareness of signs and symptoms of kidney stones and knows
where to find pain relief.
b.
Patient will measure intake and output so that they will be approximately equal.
c.
Patient will avoid infections and situations that would increase stress.
d.
Patient is able to describe measures to prevent recurrence of calculi.
18. A nurse is caring for a patient with an atrioventricular (AV) fistula in the forearm and assesses
that a trill is absent when palpating the venous side of the fistula. What action should the
nurse implement?
a.
Inject the ordered amount of heparin into the fistula.
b.
Apply warm compresses and lower the arm below the heart level.
c.
Send the patient to dialysis for remedy.
d.
Report to the charge nurse that the fistula is occluded.
19. A patient on dialysis asks why he is receiving aluminum hydroxide gel (Amphojel), a
phosphate binder, for his renal disorder. What should the nurse explain regarding the action of
that Amphojel?
a.
Calms the frequent upset stomach experienced by patients on dialysis
b.
Binds with phosphorus to increase the serum calcium level
c.
Increases the appetite
d.
Corrects the pH of the bowel
20. Which statement by a patient on dialysis, taking gentamicin (Garamycin), should cause the
nurse the most concern?
a.
“I have a horrible headache.”
b.
“Speak up! I can’t hear you.”
c.
“I’ve had diarrhea once or twice today.”
d.
“I’m thirsty. I can’t get enough water.”
21. A family member of a patient who has returned to the special unit after renal transplantation is
alarmed by blood in the urine of the patient. What is the nurse’s best explanation when
explaining the reason for hematuria in this patient?
a.
“It is related to the immunosuppressant drugs taken before transplantation.”
b.
“It is a normal postoperative expectation.”
c.
“It is caused by dye injected during surgery.”
d.
“It is caused by a small vessel that may be bleeding but will coagulate as urine
flow increases.”
22. A 10-year-old boy tells a nurse that he wants to give his kidney to his grandfather. How many
years of age should the nurse explain that kidney donors must be?
a.
At least 14 years old
b.
At least 16 years old
c.
At least 18 years old
d.
At least 21 years old
23. Erythropoietin is a hormone produced by the kidney. What will a deficiency of erythropoietin
in a patient in chronic renal failure result in?
a.
Diminished immunologic function with fewer white blood cells
b.
Elevated lipid levels in the bloodstream, contributing to accelerated atherosclerosis
c.
Anemia as a result of the diminished number of red blood cells being produced
d.
Hypertension as a result of the increased, concentrated blood volume
24. A patient with chronic renal failure is to begin renal dialysis treatment and asks for advice
about which type of dialysis would be best. The patient is considering peritoneal dialysis
because it is less expensive and has fewer dietary and fluid restrictions. What is the most
accurate information for the nurse to provide about peritoneal dialysis?
a.
It has literally no drawbacks.
b.
It gives more independence and more closely resembles normal kidney function.
c.
It is a lot more work than hemodialysis, in which the health care staff takes care of
everything.
d.
It usually does not work very well and has many complications, such as a high
blood sugar level.
25. Why are patients diagnosed with chronic renal failure and on dialysis prone to injury?
a.
Bone demineralization and peripheral neuropathy
b.
Fatigue and drug side effects
c.
Impaired immune response and malnutrition
d.
Multiple life changes and hormone deficiencies
26. A nurse assesses a Grey Turner sign in a patient who was admitted 2 days earlier after an
automobile accident. What does this finding indicate?
a.
Retroperitoneal bleeding and bruising over the flank
b.
Hematuria with abdominal bruising
c.
Distended bladder with painful urination
d.
Bladder spasms on palpation of abdomen
MULTIPLE RESPONSE
27. A nurse is planning the care for an older adult patient. Which age-related changes in kidney
function should the nurse consider when providing care to this patient? (Select all that apply.)
a.
Thinning of nephron membranes
b.
Sclerosis of renal blood vessels
c.
Decreasing glomerular filtrations
d.
Decreasing ability to concentrate or dilute urine
e.
Decreasing erythropoietin
28. A nurse is caring for a patient with a Foley catheter. What actions should the nurse implement
to decrease this patient’s risk for infection? (Select all that apply.)
a.
Keep the bag below the level of the bed.
b.
Provide perineal care twice a day.
c.
Flushing the tubing as needed.
d.
Using standard precautions when handling urine and tubing.
e.
Keep the drainage system open.
29. A female patient reports very painful urethritis. What should the home health care nurse
question the patient about the use of? (Select all that apply.)
a.
Bubble bath
b.
Vitamin preparations
c.
Herbal remedies
d.
Vaginal sprays
e.
Exercise machines
30. A nurse reads the serum calcium laboratory report of a patient as 4.2 mEq/L. Which
symptoms should the nurse anticipate that the patient might exhibit? (Select all that apply.)
a.
Irritability
b.
Tingling sensations in limbs
c.
Tetany
d.
Nausea
e.
Visual disturbances
COMPLETION
31. The major risk of peritoneal dialysis is _____.
32. A nurse is aware that if a ureter is blocked by a kidney stone, the urine backs up into the
kidney, causing _____.