Medical Surgical Nursing Final Exam
Test Banks 1300 Questions with Correct
Answers and Expert Verified
Explanations
1. A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding
should alert the nurse to immediately contact the health care provider?
a. Flank pain
b. Periorbital edema
c. Bloody and cloudy urine
d. Enlarged abdomen
ANS: B
Periorbital edema would not be a finding related to PKD and should be investigated further.
Flank pain and a distended or enlarged abdomen occur in PKD because the kidneys enlarge
and displace other organs. Urine can be bloody or cloudy as a result of cyst rupture or
infection.
2. A nurse cares for a client with autosomal dominant polycystic kidney disease (ADPKD). The
client asks, "Will my children develop this disease?" How should the nurse respond?
a. "No genetic link is known, so your children are not at increased risk."
b. "Your sons will develop this disease because it has a sex-linked gene."
c. "Only if both you and your spouse are carriers of this disease."
d. "Each of your children has a 50% risk of having ADPKD."
ANS: D
Children whose parent has the autosomal dominant form of PKD have a 50% chance of
inheriting the gene that causes the disease. ADPKD is transmitted as an autosomal dominant
trait and therefore is not gender specific. Both parents do not need to have this disorder.
3. After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy,
the nurse assesses the client's understanding. Which statement made by the client indicates a
correct understanding of the teaching?
a. "I will take a laxative every night before going to bed."
b. "I must increase my intake of dietary fiber and fluids."
c. "I shall only use salt when I am cooking my own food."
d. "I'll eat white bread to minimize gastrointestinal gas."
ANS: B
Clients with PKD often have constipation, which can be managed with increased fiber,
exercise, and drinking plenty of water. Laxatives should be used cautiously. Clients with PKD
,should be on a restricted salt diet, which includes not cooking with salt. White bread has a low
fiber count and would not be included in a high-fiber diet.
4. A nurse cares for a middle-aged female client with diabetes mellitus who is being treated
for the third episode of acute pyelonephritis in the past year. The client asks, "What can I do to
help prevent these infections?" How should the nurse respond?
a. "Test your urine daily for the presence of ketone bodies and proteins."
b. "Use tampons rather than sanitary napkins during your menstrual period."
c. "Drink more water and empty your bladder more frequently during the day."
d. "Keep your hemoglobin A1c under 9% by keeping your blood sugar controlled."
ANS: C
Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons.
Chronically elevated blood glucose levels spill glucose into the urine, changing the pH and
providing a favorable climate for bacterial growth. The neuropathy associated with diabetes
reduces bladder tone and reduces the client's sensation of bladder fullness. Thus, even with
large amounts of urine, the client voids less frequently, allowing stasis and overgrowth of
microorganisms. Increasing fluid intake (specifically water) and voiding frequently prevent
stasis and bacterial overgrowth. Testing urine and using tampons will not help prevent
pyelonephritis. A hemoglobin A1c of 9% is too high.
5. A nurse evaluates a client with acute glomerulonephritis (GN). Which manifestation should
the nurse recognize as a positive response to the prescribed treatment?
a. The client has lost 11 pounds in the past 10 days.
b. The client's urine specific gravity is 1.048.
c. No blood is observed in the client's urine.
d. The client's blood pressure is 152/88 mm Hg.
ANS: A
Fluid retention is a major feature of acute GN. This weight loss represents fluid loss, indicating
that the glomeruli are performing the function of filtration. A urine specific gravity of 1.048 is
high. Blood is not usually seen in GN, so this finding would be expected. A blood pressure of
152/88 mm Hg is too high; this may indicate kidney damage or fluid overload.
6. After teaching a client with nephrotic syndrome and a normal glomerular filtration, the
nurse assesses the client's understanding. Which statement made by the client indicates a
correct understanding of the nutritional therapy for this condition?
a. "I must decrease my intake of fat."
b. "I will increase my intake of protein."
c. "A decreased intake of carbohydrates will be required."
d. "An increased intake of vitamin C is necessary."
ANS: B
In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and
edema formation. If glomerular filtration is normal or near normal, increased protein loss
should be matched by increased intake of protein. The client would not need to adjust fat,
carbohydrates, or vitamins based on this disorder.
,7. A nurse assesses a client who is recovering from a radical nephrectomy for renal cell
carcinoma. The nurse notes that the client's blood pressure has decreased from 134/90 to
100/56 mm Hg and urine output is 20 mL for this past hour. Which action should the nurse
take?
a. Position the client to lay on the surgical incision.
b. Measure the specific gravity of the client's urine.
c. Administer intravenous pain medications.
d. Assess the rate and quality of the client's pulse.
ANS: D
The nurse should first fully assess the client for signs of volume depletion and shock, and then
notify the provider. The radical nature of the surgery and the proximity of the surgery to the
adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypotension is a
clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypotension
is particularly dangerous for the remaining kidney, which must receive adequate perfusion to
function effectively. Re-positioning the client, measuring specific gravity, and administering
pain medication would not provide data necessary to make an appropriate clinical decision, nor
are they appropriate interventions at this time.
8. An emergency department nurse assesses a client with kidney trauma and notes that the
client's abdomen is tender and distended and blood is visible at the urinary meatus. Which
prescription should the nurse consult the provider about before implementation?
a. Assessing vital signs every 15 minutes
b. Inserting an indwelling urinary catheter
c. Administering intravenous fluids at 125 mL/hr
d. Typing and crossmatching for blood products
ANS: B
Clients with blood at the urinary meatus should not have a urinary catheter inserted via the
urethra before additional diagnostic studies are done. The urethra could be torn. The nurse
should question the provider about the need for a catheter; if one is needed, the provider can
insert a suprapubic catheter. The nurse should monitor the client's vital signs closely, send
blood for type and crossmatch in case the client needs blood products, and administer
intravenous fluids.
9. After teaching a client with hypertension secondary to renal disease, the nurse assesses the
client's understanding. Which statement made by the client indicates a need for additional
teaching?
a. "I can prevent more damage to my kidneys by managing my blood pressure."
b. "If I have increased urination at night, I need to drink less fluid during the day."
c. "I need to see the registered dietitian to discuss limiting my protein intake."
d. "It is important that I take my antihypertensive medications as directed."
ANS: B
The client should not restrict fluids during the day due to increased urination at night. Clients
with renal disease may be prescribed fluid restrictions. These clients should be assessed
thoroughly for potential dehydration. Increased nocturnal voiding can be decreased by
, consuming fluids earlier in the day. Blood pressure control is needed to slow the progression
of renal dysfunction. When dietary protein is restricted, refer the client to the registered
dietitian as needed.
10. A nurse cares for a client who is recovering after a nephrostomy tube was placed 6 hours
ago. The nurse notes drainage in the tube has decreased from 40 mL/hr to 12 mL over the last
hour. Which action should the nurse take?
a. Document the finding in the client's record.
b. Evaluate the tube as working in the hand-off report.
c. Clamp the tube in preparation for removing it.
d. Assess the client's abdomen and vital signs.
ANS: D
The nephrostomy tube should continue to have a consistent amount of drainage. If the drainage
slows or stops, it may be obstructed. The nurse must notify the provider, but first should
carefully assess the client's abdomen for pain and distention and check vital signs so that this
information can be reported as well. The other interventions are not appropriate.
11. A nurse teaches a client who is recovering from a nephrectomy secondary to kidney trauma.
Which statement should the nurse include in this client's teaching?
a. "Since you only have one kidney, a salt and fluid restriction is required."
b. "Your therapy will include hemodialysis while you recover."
c. "Medication will be prescribed to control your high blood pressure."
d. "You need to avoid participating in contact sports like football."
ANS: D
Clients with one kidney need to avoid contact sports because the kidneys are easily injured.
The client will not be required to restrict salt and fluids, end up on dialysis, or have new
hypertension because of the nephrectomy.
12. A nurse provides health screening for a community health center with a large population of
African-American clients. Which priority assessment should the nurse include when working
with this population?
a. Measure height and weight.
b. Assess blood pressure.
c. Observe for any signs of abuse.
d. Ask about medications.
ANS: B
All interventions are important for the visiting nurse to accomplish. However, African
Americans have a high rate of hypertension leading to end-stage renal disease. Each
encounter that the nurse has with an African-American client provides a chance to detect
hypertension and treat it. If the client is already on antihypertensive medication, assessing
blood pressure monitors therapy.
13. After teaching a client with renal cancer who is prescribed temsirolimus (Torisel), the
nurse assesses the client's understanding. Which statement made by the client indicates a
correct understanding of the teaching?
Test Banks 1300 Questions with Correct
Answers and Expert Verified
Explanations
1. A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding
should alert the nurse to immediately contact the health care provider?
a. Flank pain
b. Periorbital edema
c. Bloody and cloudy urine
d. Enlarged abdomen
ANS: B
Periorbital edema would not be a finding related to PKD and should be investigated further.
Flank pain and a distended or enlarged abdomen occur in PKD because the kidneys enlarge
and displace other organs. Urine can be bloody or cloudy as a result of cyst rupture or
infection.
2. A nurse cares for a client with autosomal dominant polycystic kidney disease (ADPKD). The
client asks, "Will my children develop this disease?" How should the nurse respond?
a. "No genetic link is known, so your children are not at increased risk."
b. "Your sons will develop this disease because it has a sex-linked gene."
c. "Only if both you and your spouse are carriers of this disease."
d. "Each of your children has a 50% risk of having ADPKD."
ANS: D
Children whose parent has the autosomal dominant form of PKD have a 50% chance of
inheriting the gene that causes the disease. ADPKD is transmitted as an autosomal dominant
trait and therefore is not gender specific. Both parents do not need to have this disorder.
3. After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy,
the nurse assesses the client's understanding. Which statement made by the client indicates a
correct understanding of the teaching?
a. "I will take a laxative every night before going to bed."
b. "I must increase my intake of dietary fiber and fluids."
c. "I shall only use salt when I am cooking my own food."
d. "I'll eat white bread to minimize gastrointestinal gas."
ANS: B
Clients with PKD often have constipation, which can be managed with increased fiber,
exercise, and drinking plenty of water. Laxatives should be used cautiously. Clients with PKD
,should be on a restricted salt diet, which includes not cooking with salt. White bread has a low
fiber count and would not be included in a high-fiber diet.
4. A nurse cares for a middle-aged female client with diabetes mellitus who is being treated
for the third episode of acute pyelonephritis in the past year. The client asks, "What can I do to
help prevent these infections?" How should the nurse respond?
a. "Test your urine daily for the presence of ketone bodies and proteins."
b. "Use tampons rather than sanitary napkins during your menstrual period."
c. "Drink more water and empty your bladder more frequently during the day."
d. "Keep your hemoglobin A1c under 9% by keeping your blood sugar controlled."
ANS: C
Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons.
Chronically elevated blood glucose levels spill glucose into the urine, changing the pH and
providing a favorable climate for bacterial growth. The neuropathy associated with diabetes
reduces bladder tone and reduces the client's sensation of bladder fullness. Thus, even with
large amounts of urine, the client voids less frequently, allowing stasis and overgrowth of
microorganisms. Increasing fluid intake (specifically water) and voiding frequently prevent
stasis and bacterial overgrowth. Testing urine and using tampons will not help prevent
pyelonephritis. A hemoglobin A1c of 9% is too high.
5. A nurse evaluates a client with acute glomerulonephritis (GN). Which manifestation should
the nurse recognize as a positive response to the prescribed treatment?
a. The client has lost 11 pounds in the past 10 days.
b. The client's urine specific gravity is 1.048.
c. No blood is observed in the client's urine.
d. The client's blood pressure is 152/88 mm Hg.
ANS: A
Fluid retention is a major feature of acute GN. This weight loss represents fluid loss, indicating
that the glomeruli are performing the function of filtration. A urine specific gravity of 1.048 is
high. Blood is not usually seen in GN, so this finding would be expected. A blood pressure of
152/88 mm Hg is too high; this may indicate kidney damage or fluid overload.
6. After teaching a client with nephrotic syndrome and a normal glomerular filtration, the
nurse assesses the client's understanding. Which statement made by the client indicates a
correct understanding of the nutritional therapy for this condition?
a. "I must decrease my intake of fat."
b. "I will increase my intake of protein."
c. "A decreased intake of carbohydrates will be required."
d. "An increased intake of vitamin C is necessary."
ANS: B
In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and
edema formation. If glomerular filtration is normal or near normal, increased protein loss
should be matched by increased intake of protein. The client would not need to adjust fat,
carbohydrates, or vitamins based on this disorder.
,7. A nurse assesses a client who is recovering from a radical nephrectomy for renal cell
carcinoma. The nurse notes that the client's blood pressure has decreased from 134/90 to
100/56 mm Hg and urine output is 20 mL for this past hour. Which action should the nurse
take?
a. Position the client to lay on the surgical incision.
b. Measure the specific gravity of the client's urine.
c. Administer intravenous pain medications.
d. Assess the rate and quality of the client's pulse.
ANS: D
The nurse should first fully assess the client for signs of volume depletion and shock, and then
notify the provider. The radical nature of the surgery and the proximity of the surgery to the
adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypotension is a
clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypotension
is particularly dangerous for the remaining kidney, which must receive adequate perfusion to
function effectively. Re-positioning the client, measuring specific gravity, and administering
pain medication would not provide data necessary to make an appropriate clinical decision, nor
are they appropriate interventions at this time.
8. An emergency department nurse assesses a client with kidney trauma and notes that the
client's abdomen is tender and distended and blood is visible at the urinary meatus. Which
prescription should the nurse consult the provider about before implementation?
a. Assessing vital signs every 15 minutes
b. Inserting an indwelling urinary catheter
c. Administering intravenous fluids at 125 mL/hr
d. Typing and crossmatching for blood products
ANS: B
Clients with blood at the urinary meatus should not have a urinary catheter inserted via the
urethra before additional diagnostic studies are done. The urethra could be torn. The nurse
should question the provider about the need for a catheter; if one is needed, the provider can
insert a suprapubic catheter. The nurse should monitor the client's vital signs closely, send
blood for type and crossmatch in case the client needs blood products, and administer
intravenous fluids.
9. After teaching a client with hypertension secondary to renal disease, the nurse assesses the
client's understanding. Which statement made by the client indicates a need for additional
teaching?
a. "I can prevent more damage to my kidneys by managing my blood pressure."
b. "If I have increased urination at night, I need to drink less fluid during the day."
c. "I need to see the registered dietitian to discuss limiting my protein intake."
d. "It is important that I take my antihypertensive medications as directed."
ANS: B
The client should not restrict fluids during the day due to increased urination at night. Clients
with renal disease may be prescribed fluid restrictions. These clients should be assessed
thoroughly for potential dehydration. Increased nocturnal voiding can be decreased by
, consuming fluids earlier in the day. Blood pressure control is needed to slow the progression
of renal dysfunction. When dietary protein is restricted, refer the client to the registered
dietitian as needed.
10. A nurse cares for a client who is recovering after a nephrostomy tube was placed 6 hours
ago. The nurse notes drainage in the tube has decreased from 40 mL/hr to 12 mL over the last
hour. Which action should the nurse take?
a. Document the finding in the client's record.
b. Evaluate the tube as working in the hand-off report.
c. Clamp the tube in preparation for removing it.
d. Assess the client's abdomen and vital signs.
ANS: D
The nephrostomy tube should continue to have a consistent amount of drainage. If the drainage
slows or stops, it may be obstructed. The nurse must notify the provider, but first should
carefully assess the client's abdomen for pain and distention and check vital signs so that this
information can be reported as well. The other interventions are not appropriate.
11. A nurse teaches a client who is recovering from a nephrectomy secondary to kidney trauma.
Which statement should the nurse include in this client's teaching?
a. "Since you only have one kidney, a salt and fluid restriction is required."
b. "Your therapy will include hemodialysis while you recover."
c. "Medication will be prescribed to control your high blood pressure."
d. "You need to avoid participating in contact sports like football."
ANS: D
Clients with one kidney need to avoid contact sports because the kidneys are easily injured.
The client will not be required to restrict salt and fluids, end up on dialysis, or have new
hypertension because of the nephrectomy.
12. A nurse provides health screening for a community health center with a large population of
African-American clients. Which priority assessment should the nurse include when working
with this population?
a. Measure height and weight.
b. Assess blood pressure.
c. Observe for any signs of abuse.
d. Ask about medications.
ANS: B
All interventions are important for the visiting nurse to accomplish. However, African
Americans have a high rate of hypertension leading to end-stage renal disease. Each
encounter that the nurse has with an African-American client provides a chance to detect
hypertension and treat it. If the client is already on antihypertensive medication, assessing
blood pressure monitors therapy.
13. After teaching a client with renal cancer who is prescribed temsirolimus (Torisel), the
nurse assesses the client's understanding. Which statement made by the client indicates a
correct understanding of the teaching?
