Lewis's Medical Surgical Nursing Test Bank 11th Edition [Harding]
Chapter 45 - Renal and Urologic Problems
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.
Answer: C
Explanation: Because uncomplicated urinary tract infections (UTIs) are usually successfully
treated with 3 days of antibiotic therapy, this patient will need a urine culture and sensitivity
to determine appropriate antibiotic therapy. Acetaminophen would not be as effective as
other over-the-counter (OTC) medications such as phenazopyridine (Pyridium) in treating
dysuria. The fluid intake should be increased to at least 1800 mL/day. Because the UTI has
persisted after treatment with Bactrim, the patient is likely to need a different antibiotic.
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.
Answer: D
Explanation: Voiding every 3 to 4 hours is recommended to prevent UTIs. Use of vaginal
sprays is discouraged. The bladder should be emptied before and after intercourse, but
cleaning with soap and water is not necessary. A quart of fluids is insufficient to provide
adequate urine output to decrease risk for UTI.
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.
,Answer: B
Explanation: Patients should be taught that Pyridium will color the urine deep orange.
Urinary analgesics should only be needed for a few days until the prescribed antibiotics
decrease the bacterial count. Pyridium does not cause photosensitivity. Taking Pyridium
before intercourse will not be helpful in reducing the risk for UTI.
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
Answer: D
Explanation: Costovertebral tenderness is characteristic of pyelonephritis. Bladder distention,
foul-smelling urine, and suprapubic discomfort are characteristic of lower UTI and are likely
to be present if the patient also has an upper UTI.
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.
Answer: C
Explanation: High-potency multiple vitamins may irritate the bladder and increase symptoms.
The other patient statements indicate good understanding of the teaching.
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.
Answer: B
,Explanation: Acute glomerulonephritis frequently occurs after a streptococcal infection such
as strep throat. It is not caused by kidney stones, hypertension, or urinary tract infection
(UTI).
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.
Answer: D
Explanation: Because edema is a common clinical manifestation of glomerulonephritis,
resolution of the edema indicates that the prescribed therapies have been effective. Nitrites
will be negative and the patient will not experience dysuria because the patient does not have
a urinary tract infection. Antibodies to streptococcus will persist after a streptococcal
infection.
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.
Answer: C
Explanation: Flank pain in a patient with nephrotic syndrome suggests a renal vein
thrombosis, and anticoagulation is needed. Antibiotics are used to treat a patient with flank
pain caused by pyelonephritis. Fungal pyelonephritis is uncommon and is treated with
antifungals. Antihypertensives are used if the patient has high blood pressure.
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
Answer: B
, Explanation: The patient with a nephrotic syndrome will have weight gain associated with
edema. Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal
because of the edema. Urine protein is high.
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.
Answer: B
Explanation: Organ meats and fish such as sardines increase purine levels and uric acid.
Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones.
Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-
containing stones.
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.
Answer: D
Explanation: A fluid intake of 2000 to 3000 mL daily is recommended to help flush out
minerals before stones can form. Avoidance of calcium is not usually recommended for
patients with renal calculi. Coffee tends to increase stone recurrence. There is no need for a
patient to strain all urine routinely after a stone has passed, and this will not prevent stones.
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.
Answer: B
Chapter 45 - Renal and Urologic Problems
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.
Answer: C
Explanation: Because uncomplicated urinary tract infections (UTIs) are usually successfully
treated with 3 days of antibiotic therapy, this patient will need a urine culture and sensitivity
to determine appropriate antibiotic therapy. Acetaminophen would not be as effective as
other over-the-counter (OTC) medications such as phenazopyridine (Pyridium) in treating
dysuria. The fluid intake should be increased to at least 1800 mL/day. Because the UTI has
persisted after treatment with Bactrim, the patient is likely to need a different antibiotic.
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.
Answer: D
Explanation: Voiding every 3 to 4 hours is recommended to prevent UTIs. Use of vaginal
sprays is discouraged. The bladder should be emptied before and after intercourse, but
cleaning with soap and water is not necessary. A quart of fluids is insufficient to provide
adequate urine output to decrease risk for UTI.
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.
,Answer: B
Explanation: Patients should be taught that Pyridium will color the urine deep orange.
Urinary analgesics should only be needed for a few days until the prescribed antibiotics
decrease the bacterial count. Pyridium does not cause photosensitivity. Taking Pyridium
before intercourse will not be helpful in reducing the risk for UTI.
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
Answer: D
Explanation: Costovertebral tenderness is characteristic of pyelonephritis. Bladder distention,
foul-smelling urine, and suprapubic discomfort are characteristic of lower UTI and are likely
to be present if the patient also has an upper UTI.
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.
Answer: C
Explanation: High-potency multiple vitamins may irritate the bladder and increase symptoms.
The other patient statements indicate good understanding of the teaching.
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.
Answer: B
,Explanation: Acute glomerulonephritis frequently occurs after a streptococcal infection such
as strep throat. It is not caused by kidney stones, hypertension, or urinary tract infection
(UTI).
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.
Answer: D
Explanation: Because edema is a common clinical manifestation of glomerulonephritis,
resolution of the edema indicates that the prescribed therapies have been effective. Nitrites
will be negative and the patient will not experience dysuria because the patient does not have
a urinary tract infection. Antibodies to streptococcus will persist after a streptococcal
infection.
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.
Answer: C
Explanation: Flank pain in a patient with nephrotic syndrome suggests a renal vein
thrombosis, and anticoagulation is needed. Antibiotics are used to treat a patient with flank
pain caused by pyelonephritis. Fungal pyelonephritis is uncommon and is treated with
antifungals. Antihypertensives are used if the patient has high blood pressure.
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
Answer: B
, Explanation: The patient with a nephrotic syndrome will have weight gain associated with
edema. Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal
because of the edema. Urine protein is high.
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.
Answer: B
Explanation: Organ meats and fish such as sardines increase purine levels and uric acid.
Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones.
Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-
containing stones.
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.
Answer: D
Explanation: A fluid intake of 2000 to 3000 mL daily is recommended to help flush out
minerals before stones can form. Avoidance of calcium is not usually recommended for
patients with renal calculi. Coffee tends to increase stone recurrence. There is no need for a
patient to strain all urine routinely after a stone has passed, and this will not prevent stones.
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.
Answer: B
