Question 1

The nurse caring for a patient after cystoscopy plans that the patient

Accepted Answer

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

Question 2

A patient gives the admitting nurse health information before a scheduled intravenous pyelogram (IVP). Which item requires the nurse to intervene before the procedure?

Accepted Answer

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.

Question 3

A patient who has elevated blood urea nitrogen (BUN)and serum creatinine levels is scheduled for a renal arteriogram. Which bowel preparation order would the nurse question for this patient?

Accepted Answer

High-phosphate enemas,such as Fleet enemas,should be avoided in patients with elevated BUN and creatinine because phosphate cannot be excreted by patients with renal failure. The other medications for bowel evacuation are more appropriate.

Question 4

A female patient with a suspected urinary tract infection (UTI)is to provide a clean-catch urine specimen for culture and sensitivity testing. To obtain the specimen,the nurse will

Accepted Answer

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. The technique described in the answer beginning "have the patient empty the bladder completely" would not result in a sterile specimen.

Question 5

A hospitalized patient with possible renal insufficiency after coronary artery bypass surgery is scheduled for a creatinine clearance test. Which item will the nurse need to obtain?

Accepted Answer

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.

Question 6

What glomerular filtration rate (GFR)would the nurse estimate for a 30-yr-old patient with a creatinine clearance result of 60 mL/min?

Accepted Answer

The creatinine clearance approximates the GFR. The other responses are not accurate.

Question 7

How will the nurse assess for flank tenderness in a patient with suspected pyelonephritis?

Accepted Answer

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.

Question 8

A male patient in the clinic provides a urine sample that is red-orange in color. Which action should the nurse take?

Accepted Answer

A red-orange color in the urine is normal with some over-the-counter (OTC)medications such as phenazopyridine . The color would not be expected with urinary tract infection,is not a sign that poor technique was used in obtaining the specimen,and does not need to be communicated to the health care provider until further assessment is done.

Question 9

A female patient being admitted with pneumonia has a history of neurogenic bladder as a result of a spinal cord injury. Which action will the nurse plan to take first?

Accepted Answer

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.

Question 10

When a patient's urine dipstick test indicates a small amount of protein,the nurse's next action should be to

Accepted Answer

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.

Question 11

Which medication taken at home by a patient with decreased renal function will be of most concern to the nurse?

Accepted Answer

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

Question 12

A young adult 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

Accepted Answer

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 is not at increased risk for renal failure,pyelonephritis,or kidney stones.

Question 13

A patient passing bloody urine is scheduled for a cystoscopy with cystogram. Which description of the procedure by the nurse is accurate?

Accepted Answer

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 a nuclear scan. The response beginning,"Your doctor will insert a lighted tube into the bladder,and little catheters will be inserted" describes a retrograde pyelogram.

Question 14

Which information from a patient's urinalysis requires that the nurse notify the health care provider?

Accepted Answer

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

Question 15

A 79-yr-old patient has been admitted with benign prostatic hyperplasia. What is most appropriate to include in the nursing plan of care?

Accepted Answer

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 information in the question does not indicate that measurement of the patient's output is necessary or that the patient has overflow incontinence.

Question 16

Which nursing action is essential for a patient immediately after a renal biopsy?

Accepted Answer

A pressure dressing is applied,and the patient is kept on the affected side for 30 to 60 minutes 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. Although monitoring for hematuria is needed,there is no need for catheterization.

Question 17

The nurse assessing the urinary system of a 45-yr-old patient would use palpation to

Accepted Answer

A distended bladder may be palpable above the symphysis pubis. Palpation would not be helpful in assessing for the other listed urinary tract information.

Question 18

The nurse completing a physical assessment for a newly admitted patient is unable to feel either kidney on palpation. Which action should the nurse take?

Accepted Answer

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.

Question 19

To assess whether there is any improvement in a patient's dysuria,which question will the nurse ask?

Accepted Answer

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

Question 20

The nurse is caring for a hospitalized patient with a decreased glomerular filtration rate who is scheduled for an intravenous pyelogram (IVP). Which action will be included in the plan of care?

Accepted Answer

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. MAC sedation and retention catheterization are not required for the procedure. The contrast medium is given IV,not orally.

Quiz 44: Assessment of Urinary System