Exam with Detailed Ansers 2024-2025

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Medical Surgical Nursing CH 44, 45, 46 Lewis's (11th Edition by Harding) Real Exam with Detailed Ansers 2024-2025

Chapter 44 Assessment: Urinary System

Test Bank MULTIPLE CHOICE

• To assess whether there is any improvement in a patients dysuria, which question will the nurse

ask?

• Do you have to urinate at night?
• Do you have blood in your urine?
• Do you have to urinate frequently?
• Do you have pain when you urinate?

ANS: D

Dysuria is painful urination. The alternate responses are used to assess other urinary tract

symptoms: hematuria, nocturia, and frequency.

DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

• When a patients urine dipstick test indicates a small amount of protein, the nurses next action

should be to

• send a urine specimen to the laboratory to test for ketones.
• Obtain a clean-catch urine for culture and sensitivity testing.
• Inquire about which medications the patient is currently taking.
• ask the patient about any family history of chronic renal failure. 1 / 4

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ANS: C

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.DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

• A hospitalized patient with possible renal insufficiency after coronary artery

bypass surgery is scheduled for a creatinine clearance test. Which equipment will the nurse need to obtain?

• Urinary catheter
• Cleaning towelettes
• Large container for urine
• Sterile urine specimen cup

ANS: C

Because creatinine clearance testing involves a 24-hour urine specimen, the nurse should obtain a large container for the urine collection. Catheterization, cleaning of the perineum with antiseptic towelettes, and a sterile specimen cup are not needed for this test.DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

• A 32-year-old patient who is employed as a hairdresser and has a 15 pack-year history of

cigarette smoking is scheduled for an annual physical examination. The nurse will plan to teach the patient about then increased risk for

• renal failure.
• Kidney stones.
• pyelonephritis.
• Bladder cancer.

ANS: D

Exposure to the chemicals involved with working as a hairdresser and in smoking both increase the risk of bladder cancer, and the nurse should assess whether the patient understands this risk. The patient I not at increased risk for renal failure, pyelonephritis, or kidney stones. 2 / 4

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DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

• Which medication taken at home by a 47-year-old patient with decreased renal function will

be of most concern to the nurse?

• Ibuprofen (Motrin)
• Warfarin (Coumadin)
• folic acid (vitamin B9)
• penicillin (Bicillin LA)

ANS: A

The nonsteroidal antiinflammatory medications (NSAIDs) are nephrotoxic and should be avoided in patients with impaired renal function. The nurse also should ask about reasons the patient is taking the other medications, but the medication of most concern is the ibuprofen.DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

• A 79-year-old man has been admitted with benign prostatic

hyperplasia. What is most appropriate to include in the nursing plan of care?

• Limit fluid intake to no more than 1000 mL/day.
• Leave a light on I the bathroom during the night.
• Ask the patient to use a urinal so that urine can be measured.
• Pad the patients bed to accommodate overflow incontinence.

ANS: B

The patients age and diagnosis indicate a likelihood of nocturia, so leaving the light on in the bathroom is appropriate. Fluids should be encouraged because dehydration is more common in older patients. The information in the question does not indicate that measurement of the patients output is necessary or that the patient has overflow incontinence.DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 3 / 4

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• The nurse completing a physical assessment for a newly

admitted male patient is unable to feel either kidney on palpation.Which action should the nurse take next?

• Obtain a urine specimen to check for hematuria.
• Document the information on the assessment form.
• Ask the patient about any history of recent sore throat.
• Ask the health care provider about scheduling a renal

ultrasound.

ANS: B

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 question stem to indicate that they are appropriate for this patient.DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

• How will the nurse assess for flank tenderness in a 30-year-

old female patient with suspected pyelonephritis?

• Palpate along both sides of the lumbar vertebral column.
• Strike a flat hand covering the costovertebral angle (CVA).
• Push fingers upward into the two lowest intercostal spaces.
• Percuss between the iliac crest and ribs along the

midaxillary line.

ANS: B

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.DIF: Cognitive Level: Understand (comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

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