NR 325 Exam 1 - will the nurse ask? a."Do you have to urinate a...

NR 325 Exam 1 To assess whether there is any improvement in a patient's dysuria, which question will the nurse ask?a."Do you have to urinate at night?" b."Do you have blood in your urine?" c."Do you have to urinate frequently?" d."Do you have pain when you urinate?" (Answer)- D. Dysuria is painful urination.When a patient's urine dipstick test indicates a small amount of protein, the nurse's

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. (Answer)- ANS:

C Normally the urinalysis will show zero to trace amounts of protein, but some medications may give false-positive readings.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

d. Sterile urine specimen cup (Answer)- ANS: C

Because creatinine clearance testing involves a 24-hour urine specimen, the nurse should obtain a large container for the urine collection. 1 / 4

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 the increased risk for

• renal failure.
• kidney stones.
• pyelonephritis.

d. bladder cancer. (Answer)- 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.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)

d. penicillin (Bicillin LA) (Answer)- ANS: A

The nonsteroidal antiinflammatory medications (NSAIDs) are nephrotoxic and should be avoided in patients with impaired renal function.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 in the bathroom during the night.
• Ask the patient to use a urinal so that urine can be measured.

d. Pad the patient's bed to accommodate overflow incontinence. (Answer)- ANS: B

The patient's 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 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. 2 / 4

• 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. (Answer)-

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.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. (Answer)-

ANS: B

Checking for flank pain is best performed by percussion of the CVA and asking about pain.What glomerular filtration rate (GFR) would the nurse estimate for a 30-year-old patient with a creatinine clearance result of 60 mL/min?

• 60 mL/min
• 90 mL/min
• 120 mL/min

d. 180 mL/min (Answer)- ANS: A

The creatinine clearance approximates the GFR.The nurse assessing the urinary system of a 45-year-old female would use auscultation to

• determine kidney position.
• identify renal artery bruits.
• check for ureteral peristalsis. 3 / 4

d. assess for bladder distention. (Answer)- ANS: B

The presence of a bruit may indicate problems such as renal artery tortuosity or abdominal aortic aneurysm.A patient gives the nurse health information before a scheduled intravenous pyelogram (IVP). Which item has the most immediate implications for the patient's care?

• The patient has not had food or drink for 8 hours.
• The patient lists allergies to shellfish and penicillin.
• The patient complains of costovertebral angle (CVA) tenderness.
• The patient used a bisacodyl (Dulcolax) tablet the previous night. (Answer)-

ANS: B

Iodine-based contrast dye is used during IVP and for many computed tomography (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.A patient passing bloody urine is scheduled for a cystoscopy with cystogram.Which description of the procedure by the nurse is accurate?

• "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."

• "Your doctor will insert a lighted tube into the bladder, and little catheters will

be inserted through the tube into your kidney."

• "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."

• "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." (Answer)-

ANS: C

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.

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