MSP2

1.
A 46-year-old female patient returns to the clinic with recurrent dysuria after being treated with
trimethoprim and sulfamethoxazole (Bactrim) for 3 days. Which action will the nurse plan to take?
a. Teach the patient to take the prescribed Bactrim for 3 more days.
b. Remind the patient about the need to drink 1000 mL of fluids daily.
c. Obtain a midstream urine specimen for culture and sensitivity testing.
d. Suggest that the patient use acetaminophen (Tylenol) to treat the symptoms.
2. The nurse determines that instruction regarding prevention of future urinary tract infections (UTIs)
has been effective for a 22-year-old female patient with cystitis when the patient states which of the
following?
a. I can use vaginal antiseptic sprays to reduce bacteria.
b. I will drink a quart of water or other fluids every day.
c. I will wash with soap and water before sexual intercourse.
d. I will empty my bladder every 3 to 4 hours during the day.
3. Which information will the nurse include when teaching the patient with a urinary tract infection (UTI)
about the use of phenazopyridine (Pyridium)?
a. Pyridium may cause photosensitivity
b. Pyridium may change the urine color.
c. Take the Pyridium for at least 7 days.
d. Take Pyridium before sexual intercourse
4. Which finding by the nurse will be most helpful in determining whether a 67-year-old patient with
benign prostatic hyperplasia has an upper urinary tract infection (UTI)?
a. Bladder distention
b. Foul-smelling urine
c. Suprapubic discomfort
d. Costovertebral tenderness
5. The nurse determines that further instruction is needed for a patient with interstitial cystitis when the
patient says which of the following?
a. I should stop having coffee and orange juice for breakfast.
b. I will buy calcium glycerophosphate (Prelief) at the pharmacy.
c. I will start taking high potency multiple vitamins every morning.
d. I should call the doctor about increased bladder pain or odorous urine.
6. It is most important that the nurse ask a patient admitted with acute glomerulonephritis about
a. history of kidney stones.
b. recent sore throat and fever.
c. history of high blood pressure.
d. frequency of bladder infections.
7. Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment
has been effective?
a. The patient denies pain with voiding.
b. The urine dipstick is negative for nitrites.
c. The antistreptolysin-O (ASO) titer is decreased.

d. The periorbital and peripheral edema is resolved.
8. The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about
treatment with
a. antibiotics.
b. antifungals.
c. anticoagulants.
d. antihypertensives.
9. A 56-year-old female patient is admitted to the hospital with new onset nephrotic syndrome. Which
assessment data will the nurse expect?
a. Poor skin turgor
b. Recent weight gain
c. Elevated urine ketones
d. Decreased blood pressure
10. To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating
a. milk and cheese.
b. sardines and liver.
c. legumes and dried fruit.
d. spinach, chocolate, and tea.
11. The nurse teaches a 64-year-old woman to prevent the recurrence of renal calculi by
a. using a filter to strain all urine.
b. avoiding dietary sources of calcium.
c. choosing diuretic fluids such as coffee.
d. drinking 2000 to 3000 mL of fluid a day.
12.
When planning teaching for a 59-year-old male patient with benign nephrosclerosis the nurse should
include instructions regarding
a.
preventing bleeding with anticoagulants.
b.
monitoring and recording blood pressure.
c.
obtaining and documenting daily weights.
d.
measuring daily intake and output volumes.
ANS: B
Hypertension is the major symptom of nephrosclerosis. Measurements of intake and output and daily
weights
are not necessary unless the patient develops renal insufficiency. Anticoagulants are not used to treat
nephrosclerosis.
DIF: Cognitive Level: Apply (application) REF: 1082
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
Test Bank - Medical-Surgical Nursing: Assessment and Management of Clinical Problems 10e
563
13.
A 28-year-old male patient is diagnosed with polycystic kidney disease. Which information is most
appropriate for the nurse to include in teaching at this time?
a.
Complications of renal transplantation
b.
Methods for treating severe chronic pain
c.
Discussion of options for genetic counseling
d.
Differences between hemodialysis and peritoneal dialysis
ANS: C
Because a 28-year-old patient may be considering having children, the nurse should include information
about
genetic counseling when teaching the patient. The well-managed patient will not need to choose
between
hemodialysis and peritoneal dialysis or know about the effects of transplantation for many years. There
is no
indication that the patient has chronic pain.
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
14.
A 34-year-old male patient seen at the primary care clinic complains of feeling continued fullness after
voiding and a split, spraying urine stream. The nurse will ask about a history of
a.
recent kidney trauma.
b.
gonococcal urethritis.
c.
recurrent bladder infection.
d.
benign prostatic hyperplasia.
ANS: B
The patients clinical manifestations are consistent with urethral strictures, a possible complication of
gonococcal urethritis. These symptoms are not consistent with benign prostatic hyperplasia, kidney
trauma, or
bladder infection.
DIF: Cognitive Level: Apply (application) REF: 1071 | 1081
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
15.
The nurse will plan to teach a 27-year-old female who smokes 2 packs of cigarettes daily about the
increased risk for
a.
kidney stones.
b.
bladder cancer.
564
c.
bladder infection.
d.
interstitial cystitis.
ANS: B
Cigarette smoking is a risk factor for bladder cancer. The patients risk for developing interstitial cystitis,
urinary tract infection (UTI), or kidney stones will not be reduced by quitting smoking.
DIF: Cognitive Level: Apply (application) REF: 1085-1086
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
16.
A 68-year-old female patient admitted to the hospital with dehydration is confused and incontinent of
urine. Which nursing action will be best to include in the plan of care?
a.
Restrict fluids between meals and after the evening meal.
b.
Apply absorbent incontinent pads liberally over the bed linens.
c.
Insert an indwelling catheter until the symptoms have resolved.
d.
Assist the patient to the bathroom every 2 hours during the day.
ANS: D
In older or confused patients, incontinence may be avoided by using scheduled toileting times.
Indwelling
catheters increase the risk for urinary tract infection (UTI). Incontinent pads increase the risk for skin
breakdown. Restricting fluids is not appropriate in a patient with dehydration.

17.
A 55-year-old woman admitted for shoulder surgery asks the nurse for a perineal pad, stating that
laughing
or coughing causes leakage of urine. Which intervention is most appropriate to include in the care plan?
a.
Assist the patient to the bathroom q3hr.
b.
Place a commode at the patients bedside.
c.
Demonstrate how to perform the Cred maneuver.
d.
Teach the patient how to perform Kegel exercises.
ANS: D
Kegel exercises to strengthen the pelvic floor muscles will help reduce stress incontinence. The Cred
maneuver
is used to help empty the bladder for patients with overflow incontinence. Placing the commode close
to the
bedside and assisting the patient to the bathroom are helpful for functional incontinence.
565
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
18.
Following rectal surgery, a patient voids about 50 mL of urine every 30 to 60 minutes for the first 4
hours.
Which nursing action is
most
appropriate?
a.
Monitor the patients intake and output over night.
b.
Have the patient drink small amounts of fluid frequently.
c.
Use an ultrasound scanner to check the postvoiding residual volume.
d.
Reassure the patient that this is normal after rectal surgery because of anesthesia.
ANS: C
An ultrasound scanner can be used to check for residual urine after the patient voids. Because the
patients
history and clinical manifestations are consistent with overflow incontinence, it is not appropriate to
have the
patient drink small amounts. Although overflow incontinence is not unusual after surgery, the nurse
should
intervene to correct the physiologic problem, not just reassure the patient. The patient may develop
reflux into
the renal pelvis and discomfort from a full bladder if the nurse waits to address the problem for several
hours.
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
19.
A patient admitted to the hospital with pneumonia has a history of functional urinary incontinence.
Which
nursing action will be included in the plan of care?
a.
Demonstrate the use of the Cred maneuver.
b.
Teach exercises to strengthen the pelvic floor.
c.
Place a bedside commode close to the patients bed.
d.
Use an ultrasound scanner to check postvoiding residuals.
ANS: C
Modifications in the environment make it easier to avoid functional incontinence. Checking for residual
urine
and performing the Cred maneuver are interventions for overflow incontinence. Kegel exercises are
useful for
stress incontinence.
20.
The home health nurse teaches a patient with a neurogenic bladder how to use intermittent
catheterization
for bladder emptying. Which patient statement indicates that the teaching has been effective?
a.
I will buy seven new catheters weekly and use a new one every day.
566
b.
I will use a sterile catheter and gloves for each time I self-catheterize.
c.
I will clean the catheter carefully before and after each catheterization.
d.
I will need to take prophylactic antibiotics to prevent any urinary tract infections.
ANS: C
Patients who are at home can use a clean technique for intermittent self-catheterization and change the
catheter
every 7 days. There is no need to use a new catheter every day, to use sterile catheters, or to take
prophylactic
antibiotics.
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
21.
After a ureterolithotomy, a female patient has a left ureteral catheter and a urethral catheter in place.
Which
action will the nurse include in the plan of care?
a.
Provide teaching about home care for both catheters.
b.
Apply continuous steady tension to the ureteral catheter.
c.
Call the health care provider if the ureteral catheter output drops suddenly.
d.
Clamp the ureteral catheter off when output from the urethral catheter stops.
ANS: C
The health care provider should be notified if the ureteral catheter output decreases because
obstruction of this
catheter may result in an increase in pressure in the renal pelvis. Tension on the ureteral catheter
should be
avoided in order to prevent catheter displacement. To avoid pressure in the renal pelvis, the catheter is
not
clamped. Because the patient is not usually discharged with a ureteral catheter in place, patient
teaching about
both catheters is not needed.
DIF: Cognitive Level: Apply (application) REF: 1093-1095
22.
A 68-year-old male patient who has bladder cancer had a cystectomy with creation of an Indiana pouch.
Which topic will be included in patient teaching?
a.
Application of ostomy appliances
b.
Barrier products for skin protection
c.
Catheterization technique and schedule
d.
Analgesic use before emptying the pouch
567
ANS: C
The Indiana pouch enables the patient to self-catheterize every 4 to 6 hours. There is no need for an
ostomy
device or barrier products. Catheterization of the pouch is not painful.
23.
A patient who had surgery for creation of an ileal conduit 3 days ago will not look at the stoma and
requests that only the ostomy nurse specialist does the stoma care. The nurse identifies a nursing
diagnosis of
a.
anxiety related to effects of procedure on lifestyle.
b.
disturbed body image related to change in function.
c.
readiness for enhanced coping related to need for information.
d.
self-care deficit, toileting, related to denial of altered body function.
ANS: B
The patients unwillingness to look at the stoma or participate in care indicates that disturbed body
image is the
best diagnosis. No data suggest that the impact on lifestyle is a concern for the patient. The patient does
not
appear to be ready for enhanced coping. The patients insistence that only the ostomy nurse care for the
stoma
indicates that denial is not present.
TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity
24.
Which information from a patient who had a transurethral resection with fulguration for bladder cancer
3
days ago is
most
important to report to the health care provider?
a.
The patient is voiding every 4 hours.
b.
The patient is using opioids for pain.
c.
The patient has seen clots in the urine.
d.
The patient is anxious about the cancer.
ANS: C
Clots in the urine are not expected and require further follow-up. Voiding every 4 hours, use of opioids
for
pain, and anxiety are typical after this procedure.
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
568
MSC: NCLEX: Physiological Integrity
25.
When preparing a female patient with bladder cancer for intravesical chemotherapy, the nurse will
teach
about
a.
premedicating to prevent nausea.
b.
obtaining wigs and scarves to wear.
c.
emptying the bladder before the medication.
d.
maintaining oral care during the treatments.
ANS: C
The patient will be asked to empty the bladder before instillation of the chemotherapy. Systemic side
effects
are not usually experienced with intravesical chemotherapy.
26. Nursing staff on a hospital unit are reviewing rates of hospital-acquired infections (HAI) of the
urinary tract. Which nursing action will be most helpful in decreasing the risk for HAI in patients
admitted to the hospital?
a. Encouraging adequate oral fluid intake

b. Testing urine with a dipstick daily for nitrites
c. Avoiding unnecessary urinary catheterizations
d. Providing frequent perineal hygiene to patients
27. Which assessment data reported by a 28-year-old male patient is consistent with a lower urinary
tract
infection (UTI)?
a. Poor urine output
b. Bilateral flank pain
c. Nausea and vomiting
d. Burning on urination
28. Which assessment finding for a patient who has just been admitted with acute pyelonephritis is
Most important for the nurse to report to the health care provider?
a. Complaint of flank pain
b. Blood pressure 90/48 mm Hg
c. Cloudy and foul-smelling urine
d. Temperature 100.1 F (57.8 C)
29. A 58-year-old male patient who is diagnosed with nephrotic syndrome has ascites and 4+ leg
edema. Which nursing diagnosis is a Priority for the patient?
a. Activity intolerance related to rapidly increased weight
b. Excess fluid volume related to low serum protein levels
c. Disturbed body image related to peripheral edema and ascites
d. Altered nutrition: less than required related to protein restriction
30. A 76-year-old with benign prostatic hyperplasia (BPH) is agitated and confused, with a markedly
distended bladder. Which intervention prescribed by the health care provider should the nurse
implement FirsT?
a. Insert a urinary retention catheter.
b. Schedule an intravenous pyelogram (IVP).
c. Draw blood for a serum creatinine level.
d. Administer lorazepam (Ativan) 0.5 mg PO.
31. Which nursing action is of highest Priority for a 68-year-old patient with renal calculi who is being
admitted to the hospital with gross hematuria and severe colicky left flank pain?
a. Administer prescribed analgesics.
b. Monitor temperature every 4 hours.
c. Encourage increased oral fluid intake.
d. Give antiemetics as needed for nausea.
32. The nurse is caring for a patient who has had an ileal conduit for several years. Which nursing action
could be delegated to unlicensed assistive personnel (UAP)?
a. Change the ostomy appliance.
b. Choose the appropriate ostomy bag.
c. Monitor the appearance of the stoma.
d. Assess for possible urinary tract infection (UTI).

33. Which assessment finding is Most important to report to the health care provider regarding a
patient who has had left-sided extracorporeal shock wave lithotripsy?
a. Blood in urine
b. Left flank bruising
c. Left flank discomfort
d. Decreased urine output
34. A 44-year-old patient is unable to void after having an open loop resection and fulguration of the
bladder. Which nursing action should be implemented first?
a. Assist the patient to soak in a 15-minute sitz bath.
b. Insert a straight urethral catheter and drain the bladder.
c. Encourage the patient to drink several glasses of water.
d. Teach the patient how to do isometric perineal exercises.
35. The nurse observes unlicensed assistive personnel (UAP) taking the following actions when caring for
a female patient with a urethral catheter. Which action requires that the nurse intervene?
a. Taping the catheter to the skin on the patients upper inner thigh
b. Cleaning around the patients urinary meatus with soap and water
c. Disconnecting the catheter from the drainage tube to obtain a specimen
d. Using an alcohol-based gel hand cleaner before performing catheter care
36. A 58-year-old male patient who weighs 242 lb (110 kg) undergoes a nephrectomy for massive kidney
trauma due to a motor vehicle crash. Which postoperative assessment finding is most important to
communicate to the surgeon?
a. Blood pressure is 102/58.
b. Urine output is 20 mL/hr for 2 hours.
c. Incisional pain level is reported as 9/10.
d. Crackles are heard at bilateral lung bases.
37. A 63-year-old male patient had a cystectomy with an ileal conduit yesterday. Which new assessment
data is Most important for the nurse to communicate to the physician?
a. Cloudy appearing urine
b. Hypotonic bowel sounds
c. Heart rate 102 beats/minute
d. Continuous stoma drainage
38. A 32-year-old patient with a history of polycystic kidney disease is admitted to the surgical unit after
having shoulder surgery. Which of the routine postoperative orders is most important for the nurse to
discuss with the health care provider?
a. Infuse 5% dextrose in normal saline at 75 mL/hr.
b. Order regular diet after patient is awake and alert.
c. Give ketorolac (Toradol) 10 mg PO PRN for pain.
d. Draw blood urea nitrogen (BUN) and creatinine in 2 hours.
ANS: C
The nonsteroidal antiinflammatory drugs (NSAIDs) should be avoided in patients with decreased renal
function because nephrotoxicity is a potential adverse effect. The other orders do not need any
clarification or change.
39. A 22-year-old female patient seen in the clinic for a bladder infection describes the following
symptoms. Which information is Most important for the nurse to report to the health care provider?
a. Urinary urgency
b. Left-sided flank pain
c. Intermittent hematuria
d. Burning with urination
ANS: B
Flank pain indicates that the patient may have developed pyelonephritis as a complication of the
bladder infection. The other clinical manifestations are consistent with a lower urinary tract infection
(UTI).
40. A patient in the urology clinic is diagnosed with monilial urethritis. Which action will the nurse
include in the plan of care?
a. Teach the patient about the use of antifungal medications.
b. Tell the patient to avoid tub baths until the symptoms resolve.
c. Instruct the patient to refer recent sexual partners for treatment.
d. Teach the patient to avoid nonsteroidal antiinflammatory drugs (NSAIDs).
ANS: A
Monilial urethritis is caused by a fungus and antifungal medications such as nystatin (Mycostatin) or
fluconazole (Diflucan) are usually used as treatment. Because monilial urethritis is not sexually
transmitted, there is no need to refer sexual partners. Warm baths and NSAIDS may be used to treat
symptoms.
41. Which action will the nurse anticipate taking for an otherwise healthy 50-year-old who has just been
diagnosed with Stage 1 renal cell carcinoma?
a. Prepare patient for a renal biopsy.
b. Provide preoperative teaching about nephrectomy.
c. Teach the patient about chemotherapy medications.
d. Schedule for a follow-up appointment in 3 months.
ANS: B
The treatment of choice in patients with localized renal tumors who have no co-morbid conditions is
partial ortotal nephrectomy. A renal biopsy will not be needed in a patient who has already been
diagnosed with renal cancer. Chemotherapy is used for metastatic renal cancer. Because renal cell
cancer frequently metastasizes, treatment will be started as soon as possible after the diagnosis.
42. Which information about a patient with Goodpasture syndrome requires the Most rapid action by
the nurse?
a. Blood urea nitrogen level is 70 mg/dL.
b. Urine output over the last 2 hours is 30 mL.
c. Audible crackles bilaterally over the posterior chest to the midscapular level.
d. Elevated level of antiglomerular basement membrane (anti-GBM) antibodies.
ANS: C
Crackles heard to a high level indicate a need for rapid actions such as assessment of oxygen saturation,
reporting the findings to the health care provider, initiating oxygen therapy, and dialysis. The other
findings will also be reported, but are typical of Goodpasture syndrome and do not require immediate
nursing action.
43. A patient is admitted to the emergency department with possible renal trauma after an automobile
accident. Which prescribed intervention will the nurse implement First?
a. Check blood pressure and heart rate.
b. Administer morphine sulfate 4 mg IV.
c. Transport to radiology for an intravenous pyelogram.
d. Insert a urethral catheter and obtain a urine specimen.
ANS: A
Because the kidney is very vascular, the initial action with renal trauma will be assessment for bleeding
and shock. The other actions are also important once the patients cardiovascular status has been
determined and stabilized.
44. After change-of-shift report, which patient should the nurse assess first?
a. Patient with a urethral stricture who has not voided for 12 hours
b. Patient who has cloudy urine after orthotopic bladder reconstruction
c. Patient with polycystic kidney disease whose blood pressure is 186/98 mm Hg
d. Patient who voided bright red urine immediately after returning from lithotripsy
ANS: A
The patient information suggests acute urinary retention, a medical emergency. The nurse will need to
assess the patient and consider whether to insert a retention catheter. The other patients will also be
assessed, but their findings are consistent with their diagnoses and do not require immediate
assessment or possible intervention.
MULTIPLE RESPONSE
1. A patient has been diagnosed with urinary tract calculi that are high in uric acid. Which foods will the
nurse teach the patient to avoid (select all that apply)?
a. Milk
b. Liver
c. Spinach
d. Chicken
e. Cabbage
f. Chocolate
ANS: B, D
Meats contain purines, which are metabolized to uric acid. The other foods might be restricted in
patients who have calcium or oxalate stones

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1.

c. Obtain a midstream urine specimen for culture and sensitivity testing.

a. I can use vaginal antiseptic sprays to reduce bacteria.

b. I will drink a quart of water or other fluids every day.

c. I will wash with soap and water before sexual intercourse.

d. I will empty my bladder every 3 to 4 hours during the day.

a. Pyridium may cause photosensitivity

b. Pyridium may change the urine color.

c. Take the Pyridium for at least 7 days.

d. Take Pyridium before sexual intercourse

a. I should stop having coffee and orange juice for breakfast.

b. I will buy calcium glycerophosphate (Prelief) at the pharmacy.

c. I will start taking high potency multiple vitamins every morning.

a. history of kidney stones.

b. recent sore throat and fever.

c. history of high blood pressure.

d. frequency of bladder infections.

a. The patient denies pain with voiding.

b. The urine dipstick is negative for nitrites.

c. The antistreptolysin-O (ASO) titer is decreased.

a. Poor skin turgor

b. Recent weight gain

c. Elevated urine ketones

d. Decreased blood pressure

a. milk and cheese.

b. sardines and liver.

c. legumes and dried fruit.

d. spinach, chocolate, and tea.

a. using a filter to strain all urine.

b. avoiding dietary sources of calcium.

c. choosing diuretic fluids such as coffee.

d. drinking 2000 to 3000 mL of fluid a day.

include instructions regarding

preventing bleeding with anticoagulants.

monitoring and recording blood pressure.

obtaining and documenting daily weights.

measuring daily intake and output volumes.

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

appropriate for the nurse to include in teaching at this time?

Complications of renal transplantation

Methods for treating severe chronic pain

Discussion of options for genetic counseling

Differences between hemodialysis and peritoneal dialysis

indication that the patient has chronic pain.

DIF: Cognitive Level: Apply (application) REF: 1083

recent kidney trauma.

recurrent bladder infection.

benign prostatic hyperplasia.

DIF: Cognitive Level: Apply (application) REF: 1071 | 1081

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

increased risk for

DIF: Cognitive Level: Apply (application) REF: 1085-1086

Restrict fluids between meals and after the evening meal.

Apply absorbent incontinent pads liberally over the bed linens.

Insert an indwelling catheter until the symptoms have resolved.

breakdown. Restricting fluids is not appropriate in a patient with dehydration.

DIF: Cognitive Level: Apply (application) REF: 1089

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

Assist the patient to the bathroom q3hr.

Place a commode at the patients bedside.

Demonstrate how to perform the Cred maneuver.

Teach the patient how to perform Kegel exercises.

DIF: Cognitive Level: Apply (application) REF: 1089