Chapter 47: Nursing Assessment: Urinary System

MULTIPLE CHOICE 1. The nurse is reviewing a client’s chart and notes that the client has dysuria. To assess whether there is any improvement, which of the following questions should the nurse ask? a. “Do you have any blood in your urine?” b. “Do you have to urinate very frequently?” c. “Do you have any pain when you urinate?” d. “Do you have to get up at night to urinate?” ANS: C Dysuria is painful urination. The alternate responses are used to assess other urinary tract symptoms: hematuria, nocturia, and frequency. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 2. A client’s urine dipstick indicates a small amount of protein in the urine. Which of the following actions should the nurse take next? a. Check which medications the client is currently taking. b. Obtain a clean-catch urine specimen for culture and sensitivity testing. c. Ask the client about any family history of chronic renal failure. d. Send a urine specimen to the laboratory to test for ketones and glucose. ANS: A 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: Application TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 3. A creatinine clearance test is ordered for a hospitalized client with possible renal insufficiency. Which of the following equipment will the nurse need to obtain? a. Sterile specimen cup b. Large container for urine c. Foley catheter and drainage bag d. Towelettes for perineal cleaning ANS: B Since 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: Application TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity NURSINGTB.COM Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank This study source was downloaded by from CourseH on :00:17 GMT -05:00 NURSING ASSESSMENT : URINARY SYSTEM NU RS IN GT B.CO M 4. The nurse is preparing to conduct an annual health and physical examination on a client who is employed as a hairdresser and has a 10 pack-year history of cigarette smoking. Which of the following conditions should the nurse plan to teach the client about the increased risk for based upon the client history? a. Renal failure b. Kidney stones c. Pyelonephritis d. 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 client understands this risk. The client is not at increased risk for renal failure, pyelonephritis, or kidney stones. DIF: Cognitive Level: Application TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 5. During assessment of a client with decreased renal function, which of the following medications taken by the client at home is of most concern to the nurse? a. Ibuprofen b. Warfarin c. Folic acid d. Penicillin ANS: A The nonsteroidal anti-inflammatory durgs (NSAIDs) are nephrotoxic and should be avoided in clients with impaired renal function. The nurse also should ask about reasons the client is taking the other medications, but the medication of most concern is the ibuprofen. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 6. The nurse is admitting an older-adult client with benign prostatic hyperplasia. Which of the following actions should be included in the nursing plan of care? a. Limit fluid intake to no more than 1 500 mL/day. b. Leave a light on in the bathroom during the night. c. Pad the client’s bed to accommodate overflow incontinence. d. Ask the client to use a urinal so that all urine can be measured. ANS: B The client’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 clients. The information in the question does not indicate that measurement of the client’s output is necessary or that the client has overflow incontinence. DIF: Cognitive Level: Application TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity NURSINGTB.COM Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank This study source was downloaded by from CourseH on :00:17 GMT -05:00 NU RS IN GT B.CO M 7. The nurse is assessing a client’s urinary system and is unable to palpate either kidney. Which of the following actions should the nurse take next? a. Obtain a urine specimen to check for hematuria. b. Document the information on the assessment form. c. Ask the client about any history of recent sore throat. d. 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 clients, but there is nothing in the question stem to indicate that they are appropriate for this client. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 8. Which of the following techniques should the nurse use to assess the flank area of a client with pyelonephritis for tenderness? a. Push gently into the two lowest intercostal spaces. b. Palpate along both sides of the lumbar vertebral column. c. Position one hand flat at the costovertebral angle (CVA) and strike it with the other fist. d. Use two fingers to percuss the area between the iliac crest and ribs along the