KAPLAN MEDSURG COMPREHENSIVE FINAL EXAM 2026 WITH RATIONALES|WELL
STRUCTURED|100% PASS
QUESTIONS ANSWERS
A client admitted for acute pyelonephritis is about to start
RATIONAL: 2) The client may complain of pain on the
antibiotic therapy. Which symptom would be expected in
attected side because the kidney is enlarged and might
this client?
have formed an abscess.
1) Hypertension
Hypertension is associated with chronic pyelonephritis.
2) Flank pain on the attected side
Pain may radiate down the ureters or to the epigastrium.
3) Pain that radiates toward the unattected side
The client would have tenderness with deep palpation
4) No tenderness with deep palpation over the
over the CVA.
CVA
Discharge instructions for a client treated for acute RATIONALE: 2) The client needs to return for follow-up
pyelonephritis should include which statement? urine cultures because bacteriuria may be present but
- 1. Avoid taking any dairy products. asymptomatic. Intake of dairy products won't contribute
- 2. Return for follow-up urine cultures. to pyelonephritis. Antibiotics need to be taken for the
- 3. Stop taking the prescribed antibiotics when the symp- full course of therapy regardless of the symptoms.
toms subside. Pyelonephritis typically recurs as a relapse or new infec-
- 4. Recurrence is unlikely because you've been tion and frequently recurs within 2 weeks of completing
treated with antibiotics. therapy.
A client is complaining of severe flank and abdominal
RATIONALE: 1) Urine should be strained for calculi and
pain. A flat plate of the abdomen shows urolithiasis. Which
sent to the laboratory for analysis. Fluid intake of 3 to
intervention is important?
4 qt. 3 to 4 L/day is encouraged to flush the urinary
- 1. Strain all urine
tract and prevent further calculi formation. Ambulation is
- 2. Limit fluid intake
encouraged to help pass the calculi through gravity. A
- 3. Enforce strict bed rest.
low-calcium formation of calcium calculi.
- 4. Encourage a high-calcium diet
A client is diagnosed with cystitis. Client teaching aimed RATIONALE: 2) Cotton underwear prevents infection be-
at preventing a recurrence should include which instruc- cause it allows for air to flow to the perineum. Women
tion? should shower instead of taking a tub bath to prevent
- 1. Bathe in a tub. infection. Feminine hygiene spray can act as an irritant.
- 2. Wear cotton underwear. Cranberry juice helps prevent cystitis because it increases
- 3. Use a feminine hygiene spray. urine acidity; alkaline urine supports bacterial growth, so
- 4. Limit your intake of cranberry juice. cranberry juice intake should be increased, not limited.
, KAPLAN MEDSURG COMPREHENSIVE FINAL EXAM 2026 WITH RATIONALES|WELL
STRUCTURED|100% PASS
QUESTIONS ANSWERS
When performing a physical assessment, the nurse dis-
covers a client's urinary drainage bag lying next RATIONALE: 1) The drainage bag shouldn't be placed
to him. Based on this finding, the nurse identifies which alongside the client or on the floor because of the in-
priority nursing diagnosis? creased risk of infection caused by microorganisms. It
- 1. Risk for infection should hang on the bed in a dependent position. The
- 2. Reflex urinary incontinence other nursing diagnoses are not appropriate for this as-
- 3. Impaired comfort sessment finding.
- 4. Risk for compromised human dignity
Which method should be used to collect a specimen for
RATIONALE: 4) Catching urine midstream reduces the
urine culture?
amount of contamination by microorganisms at the mea-
- 1. Have the client void in a clean container.
tus. Voiding in a clean container is done for a ran-
- 2. Clean the foreskin of the penis of uncircumcised men
dom specimen, not a clean-catch specimen for urine cul-
before specimen collection.
ture. When cleaning an uncircumcised male, the fore-
- 3. Have the client void into a urinal, and then pour the
skin should be retracted and the glands penis should be
urine into the specimen container.
cleaned to prevent specimen contamination. Voiding in a
- 4. Have the client begin the stream of urine in the toilet
specimen because the urinal isn't sterile.
and catch the urine in a sterile container midstream.
A client with renal insuflciency is admitted with a di-
agnosis of pneumonia. He's being treated with IV
RATIONALE: 1) BUN and creatinine levels should be mon-
antibiotics, which can be nephrotoxic. Which laboratory
itored closely to detect elevations due to nephrotoxicity.
value(s) should be monitored closely?
ABG determinations are inappropriate for this situation.
- 1. Blood Urea Nitrogen (BUN) and creatinine levels.
Platelets and potassium levels should be monitored ac-
- 2. Arterial Blood Gas (ABG) levels
cording to routine.
- 3. Platelet count
- 4. Potassium level
During a health history, which statement by a client indi-
RATIONALE: 4) Renal calculi are commonly composed of
cates a risk of renal calculi?
calcium. Diets high in calcium may predispose a person
- 1. "I've been drinking a lot of cola soft drinks lately."
to renal calculi. Milk and milk products are high in calci-
- 2. "I've been jogging more than usual."
um. Cola soft drinks don't contain ingredients that would
- 3. "I've had more stress since we adopted a child last
increase the risk of renal calculi. Jogging and increased
year."
, KAPLAN MEDSURG COMPREHENSIVE FINAL EXAM 2026 WITH RATIONALES|WELL
STRUCTURED|100% PASS
QUESTIONS ANSWERS
- 4. "I'm a vegetarian and eat cheese two or three times stress aren't considered risk factors for renal calculi for-
each day." mation.
The nurse is assessing a client who reports painful uri-
nation during and after voiding. The nurse suspects the
RATIONALE: 1) Pain during or after voiding indicates a
client may have a problem with which area of the client's
bladder problems, usually infection. Kidney and ureter
urinary system?
pain would be in the flank area, and problems or the
- 1. Bladder
urethra would cause pain at the external orifice that's
- 2. Kidneys
commonly felt at the start of voiding.
- 3. Ureters
- 4. Urethra
RATIONALE: 4) To reduce the formation of oxalate cal-
A nurse is instructing a client with oxalate renal calculi.
culi, urge the client to avoid foods high in oxalate, such
What foods should the nurse urge the client to eliminate
as spinach, rhubarb, and asparagus. Other oxalate- rich
from his diet?
foods to avoid include tomatoes, beets, chocolate, cocoa,
1) Citrus fruits, molasses, and dried apricots
celery, and parsley.
2) Milk, cheese, and ice cream
Citrus fruits, molasses, dried apricots, milk, cheese, ice
3) Sardines, liver and kidney
cream, sardines and organ meats do NOT produce oxalate
4) Spinach rhubarb and asparagus
and do NOT need to be omitted from the client's diet.
RATIONALE: 2) Costovertebral angle tenderness and chills
are symptoms of acute pyelonephritis (inflammation of
A nurse is assessing a client diagnosed with acute
the kidney and renal pelvis).
pyelonephritis. Which of the following symptoms does the
Jaundice indicates gallbladder or liver obstruction.
nurse expect to see?
A burning sensation on urination is a sign of lower urinary
1) Jaundice and flank pain
tract infection (UTI).
2) Costovertebral angle tenderness and chills
Nocturia is associated with a lower UTI or benign prostatic
3) Burning sensation on urination
hyperplasia.
4) Polyuria and nocturia
Polyuria is seen with diabetes mellitus, diabetes insipidus,
or the use of diuretics.
A nurse is caring for a client who has undergone surgery
to create an ileal conduit. Which expected outcome state-
, KAPLAN MEDSURG COMPREHENSIVE FINAL EXAM 2026 WITH RATIONALES|WELL
STRUCTURED|100% PASS
QUESTIONS ANSWERS
ment is appropriate for this client?
1) The client uses sterile gloves when changing the appli- RATIONALE: 4) A healthy stoma is pink and moist.
ance. Sterile gloves aren't necessary when changing the appli-
2) The client demonstrates the ability to irrigate the stoma ance.
correctly. The stoma isn't to be irrigated.
3) The client expresses understanding and acceptance of There's no physiologic reason why the client can't engage
the fact that he can no longer engage in sexual relations. in sexual relations.
4) The stoma remains pink and moist.
RATIONALE: 3) Recent sore throat. Typically, acute
A client is admitted with dark urine, fever, and flank pain
glomerulonephritis occurs 2 to 3 weeks after a strep throat
and is diagnosed with acute glomerulonephritis. What
infection. The Most Common form of acute glomeru-
finding is the nurse most likely to find in the client's his-
lonephritis is caused by group A beta-hemolytic strepto-
tory?
coccal infection elsewhere in the body.
1) Renal calculi
Renal calculi and renal trauma aren't known to cause acute
2) Renal trauma
glomerulonephritis.
3) Recent sore throat
A family history isn't associated with the development of
4) Family history of acute glomerulonephritis
acute glomerulonephritis.
RATIONALE: 2) Dysuria (painful urination) is a common
symptom of a UTI.
Voiding large amounts of urine isn't associated with UTI's;
A nurse is assessing a client who might have a UTI. What
clients with UTI's commonly report frequent voiding of
statement by the client suggests that a UTI is likely?
small amounts of urine.
1) I urinate large amounts.
A client with a UTI is unlikely to be able to go for hours
2) It burns when I urinate.
without urinating because UTI's increase feelings of ur-
3) I go for hours without the urge to urinate.
gency to void.
4) My urine has a sweet smell.
Urine with a sweet acetone odor is associated with diabet-
ic ketoacidosis.
Foul-smelling urine may be a sign of infection.
RATIONALE: 3) Because muscle cramps can occur when
While undergoing hemodialysis, a client complains of
sodium and water are removed too quickly during dialysis,
muscle cramps. What intervention is ettective in relieving
treatment includes administering normal saline or hyper-
STRUCTURED|100% PASS
QUESTIONS ANSWERS
A client admitted for acute pyelonephritis is about to start
RATIONAL: 2) The client may complain of pain on the
antibiotic therapy. Which symptom would be expected in
attected side because the kidney is enlarged and might
this client?
have formed an abscess.
1) Hypertension
Hypertension is associated with chronic pyelonephritis.
2) Flank pain on the attected side
Pain may radiate down the ureters or to the epigastrium.
3) Pain that radiates toward the unattected side
The client would have tenderness with deep palpation
4) No tenderness with deep palpation over the
over the CVA.
CVA
Discharge instructions for a client treated for acute RATIONALE: 2) The client needs to return for follow-up
pyelonephritis should include which statement? urine cultures because bacteriuria may be present but
- 1. Avoid taking any dairy products. asymptomatic. Intake of dairy products won't contribute
- 2. Return for follow-up urine cultures. to pyelonephritis. Antibiotics need to be taken for the
- 3. Stop taking the prescribed antibiotics when the symp- full course of therapy regardless of the symptoms.
toms subside. Pyelonephritis typically recurs as a relapse or new infec-
- 4. Recurrence is unlikely because you've been tion and frequently recurs within 2 weeks of completing
treated with antibiotics. therapy.
A client is complaining of severe flank and abdominal
RATIONALE: 1) Urine should be strained for calculi and
pain. A flat plate of the abdomen shows urolithiasis. Which
sent to the laboratory for analysis. Fluid intake of 3 to
intervention is important?
4 qt. 3 to 4 L/day is encouraged to flush the urinary
- 1. Strain all urine
tract and prevent further calculi formation. Ambulation is
- 2. Limit fluid intake
encouraged to help pass the calculi through gravity. A
- 3. Enforce strict bed rest.
low-calcium formation of calcium calculi.
- 4. Encourage a high-calcium diet
A client is diagnosed with cystitis. Client teaching aimed RATIONALE: 2) Cotton underwear prevents infection be-
at preventing a recurrence should include which instruc- cause it allows for air to flow to the perineum. Women
tion? should shower instead of taking a tub bath to prevent
- 1. Bathe in a tub. infection. Feminine hygiene spray can act as an irritant.
- 2. Wear cotton underwear. Cranberry juice helps prevent cystitis because it increases
- 3. Use a feminine hygiene spray. urine acidity; alkaline urine supports bacterial growth, so
- 4. Limit your intake of cranberry juice. cranberry juice intake should be increased, not limited.
, KAPLAN MEDSURG COMPREHENSIVE FINAL EXAM 2026 WITH RATIONALES|WELL
STRUCTURED|100% PASS
QUESTIONS ANSWERS
When performing a physical assessment, the nurse dis-
covers a client's urinary drainage bag lying next RATIONALE: 1) The drainage bag shouldn't be placed
to him. Based on this finding, the nurse identifies which alongside the client or on the floor because of the in-
priority nursing diagnosis? creased risk of infection caused by microorganisms. It
- 1. Risk for infection should hang on the bed in a dependent position. The
- 2. Reflex urinary incontinence other nursing diagnoses are not appropriate for this as-
- 3. Impaired comfort sessment finding.
- 4. Risk for compromised human dignity
Which method should be used to collect a specimen for
RATIONALE: 4) Catching urine midstream reduces the
urine culture?
amount of contamination by microorganisms at the mea-
- 1. Have the client void in a clean container.
tus. Voiding in a clean container is done for a ran-
- 2. Clean the foreskin of the penis of uncircumcised men
dom specimen, not a clean-catch specimen for urine cul-
before specimen collection.
ture. When cleaning an uncircumcised male, the fore-
- 3. Have the client void into a urinal, and then pour the
skin should be retracted and the glands penis should be
urine into the specimen container.
cleaned to prevent specimen contamination. Voiding in a
- 4. Have the client begin the stream of urine in the toilet
specimen because the urinal isn't sterile.
and catch the urine in a sterile container midstream.
A client with renal insuflciency is admitted with a di-
agnosis of pneumonia. He's being treated with IV
RATIONALE: 1) BUN and creatinine levels should be mon-
antibiotics, which can be nephrotoxic. Which laboratory
itored closely to detect elevations due to nephrotoxicity.
value(s) should be monitored closely?
ABG determinations are inappropriate for this situation.
- 1. Blood Urea Nitrogen (BUN) and creatinine levels.
Platelets and potassium levels should be monitored ac-
- 2. Arterial Blood Gas (ABG) levels
cording to routine.
- 3. Platelet count
- 4. Potassium level
During a health history, which statement by a client indi-
RATIONALE: 4) Renal calculi are commonly composed of
cates a risk of renal calculi?
calcium. Diets high in calcium may predispose a person
- 1. "I've been drinking a lot of cola soft drinks lately."
to renal calculi. Milk and milk products are high in calci-
- 2. "I've been jogging more than usual."
um. Cola soft drinks don't contain ingredients that would
- 3. "I've had more stress since we adopted a child last
increase the risk of renal calculi. Jogging and increased
year."
, KAPLAN MEDSURG COMPREHENSIVE FINAL EXAM 2026 WITH RATIONALES|WELL
STRUCTURED|100% PASS
QUESTIONS ANSWERS
- 4. "I'm a vegetarian and eat cheese two or three times stress aren't considered risk factors for renal calculi for-
each day." mation.
The nurse is assessing a client who reports painful uri-
nation during and after voiding. The nurse suspects the
RATIONALE: 1) Pain during or after voiding indicates a
client may have a problem with which area of the client's
bladder problems, usually infection. Kidney and ureter
urinary system?
pain would be in the flank area, and problems or the
- 1. Bladder
urethra would cause pain at the external orifice that's
- 2. Kidneys
commonly felt at the start of voiding.
- 3. Ureters
- 4. Urethra
RATIONALE: 4) To reduce the formation of oxalate cal-
A nurse is instructing a client with oxalate renal calculi.
culi, urge the client to avoid foods high in oxalate, such
What foods should the nurse urge the client to eliminate
as spinach, rhubarb, and asparagus. Other oxalate- rich
from his diet?
foods to avoid include tomatoes, beets, chocolate, cocoa,
1) Citrus fruits, molasses, and dried apricots
celery, and parsley.
2) Milk, cheese, and ice cream
Citrus fruits, molasses, dried apricots, milk, cheese, ice
3) Sardines, liver and kidney
cream, sardines and organ meats do NOT produce oxalate
4) Spinach rhubarb and asparagus
and do NOT need to be omitted from the client's diet.
RATIONALE: 2) Costovertebral angle tenderness and chills
are symptoms of acute pyelonephritis (inflammation of
A nurse is assessing a client diagnosed with acute
the kidney and renal pelvis).
pyelonephritis. Which of the following symptoms does the
Jaundice indicates gallbladder or liver obstruction.
nurse expect to see?
A burning sensation on urination is a sign of lower urinary
1) Jaundice and flank pain
tract infection (UTI).
2) Costovertebral angle tenderness and chills
Nocturia is associated with a lower UTI or benign prostatic
3) Burning sensation on urination
hyperplasia.
4) Polyuria and nocturia
Polyuria is seen with diabetes mellitus, diabetes insipidus,
or the use of diuretics.
A nurse is caring for a client who has undergone surgery
to create an ileal conduit. Which expected outcome state-
, KAPLAN MEDSURG COMPREHENSIVE FINAL EXAM 2026 WITH RATIONALES|WELL
STRUCTURED|100% PASS
QUESTIONS ANSWERS
ment is appropriate for this client?
1) The client uses sterile gloves when changing the appli- RATIONALE: 4) A healthy stoma is pink and moist.
ance. Sterile gloves aren't necessary when changing the appli-
2) The client demonstrates the ability to irrigate the stoma ance.
correctly. The stoma isn't to be irrigated.
3) The client expresses understanding and acceptance of There's no physiologic reason why the client can't engage
the fact that he can no longer engage in sexual relations. in sexual relations.
4) The stoma remains pink and moist.
RATIONALE: 3) Recent sore throat. Typically, acute
A client is admitted with dark urine, fever, and flank pain
glomerulonephritis occurs 2 to 3 weeks after a strep throat
and is diagnosed with acute glomerulonephritis. What
infection. The Most Common form of acute glomeru-
finding is the nurse most likely to find in the client's his-
lonephritis is caused by group A beta-hemolytic strepto-
tory?
coccal infection elsewhere in the body.
1) Renal calculi
Renal calculi and renal trauma aren't known to cause acute
2) Renal trauma
glomerulonephritis.
3) Recent sore throat
A family history isn't associated with the development of
4) Family history of acute glomerulonephritis
acute glomerulonephritis.
RATIONALE: 2) Dysuria (painful urination) is a common
symptom of a UTI.
Voiding large amounts of urine isn't associated with UTI's;
A nurse is assessing a client who might have a UTI. What
clients with UTI's commonly report frequent voiding of
statement by the client suggests that a UTI is likely?
small amounts of urine.
1) I urinate large amounts.
A client with a UTI is unlikely to be able to go for hours
2) It burns when I urinate.
without urinating because UTI's increase feelings of ur-
3) I go for hours without the urge to urinate.
gency to void.
4) My urine has a sweet smell.
Urine with a sweet acetone odor is associated with diabet-
ic ketoacidosis.
Foul-smelling urine may be a sign of infection.
RATIONALE: 3) Because muscle cramps can occur when
While undergoing hemodialysis, a client complains of
sodium and water are removed too quickly during dialysis,
muscle cramps. What intervention is ettective in relieving
treatment includes administering normal saline or hyper-
