Latest bstrandable NCLEX Urinary/Renal System
(Answered) Grade A+
The nurse assesses a patient admitted to the medical-surgical unit who has a diagnosis
of type I diabetes mellitus. The nurse notes that the patient's urine is cloudy and foul-
smelling. Which of the following diagnostic tests does the nurse anticipate will be
ordered based on this finding?
1. urine culture and sensitivity (C&S)
2. blood urea nitrogen (BUN)
3. creatinine clearance
4. residual urine
{{ANS}}Correct Answer: 1
Rationale: Urine culture and sensitivity (C&S) is correct because cloudy and foul-
smelling urine indicates a urinary tract infection. The diagnostic test to identify the
organism responsible is a urine C&S. Blood urea nitrogen (BUN) measures the amount
of urea (end product of protein metabolism) in the blood plasma. It does not identify
infection. Creatinine clearance is a 24-hour urine test used to identify renal function; it
will not identify an infection. Residual urine measures the amount of urine left in the
bladder after voiding, and does not identify an infection.
When preparing a patient for an intravenous pyelogram (IVP), the nurse reviews
diagnostic data, noting all of the following. Which of these findings requires notification
of the physician before proceeding with the test?
1. blood urea nitrogen (BUN) 55 mg/dLdl
2. serum creatinine 1.3 mg/dL
3. urine culture <10,000 organisms/mL
4. residual urine of 80 mL
{{ANS}}Correct Answer: 1
Rationale: Blood urea nitrogen (BUN) 55 mg/dL is correct because this level is
elevated, indicating that there might be a problem of renal function. The physician will
need to be notified because an IVP involves the injection of dye that must eventually
cleared by the kidney, and if there is already compromised renal function, the test may
not be administered. Serum creatinine 1.3 mg/dL, urine culture <10,000 organisms/mL,
and residual urine of 80 mL are all incorrect because these values are all within the
normal range, and therefore will not require physician notification
A nurse working in a postoperative unit is caring for a patient who states, "I voided a
small amount of urine, but I feel as if I need to void more and am unable to do so." The
patient receives a prescription for a post-voiding residual urine test. The nurse correctly
prepares to perform the procedure by gathering supplies that include which of the
following?
,1. a urine collecting device and a straight urinary catheter
2. a urine collecting device and a voiding diary
3. an indwelling urinary catheter and an insertion kit
4. a peripheral IV insertion kit and a urine collecting device
{{ANS}}Correct Answer: 1
Rationale: To evaluate the amount of urine in bladder post-voiding is correct. This
diagnostic test is ordered to determine urinary retention or incomplete bladder emptying,
which could be a consequence of the operative experience. To correctly perform the
procedure, the nurse gathers a urinary collecting device and asks the patient to void. A
straight urinary catheter is inserted and removed and the amount of urine obtained from
the bladder is measured. Voiding diaries, indwelling urinary catheters, and peripheral
IVs are not required for this procedure.
Because of normal changes due to aging, the nurse anticipates that a 75-year-old
patient's serum creatinine level might be which of the following?
1. 0.3 mg/dL
2. 2.4 mg/dL
3. 4.8 mg/dL
4. 6.4 mg/dL
{{ANS}}Correct Answer: 1
Rationale: Lower than normal is correct because serum creatinine level reflects the by-
product of muscle breakdown, and an older adult with less muscle mass can be
expected to have a lower-than-normal level. 0.5-1.5 mg/dL is the normal creatinine
range for adults. Higher than normal, variable with fluid status, and within normal range
are all incorrect because the question is asking for the expected change due to the
aging process, and that is less muscle mass, and therefore less serum creatinine.
When assessing a patient who is scheduled to have a CT scan of the kidneys, which of
these findings would prompt the nurse to notify the primary healthcare provider?
1. allergy to iodine and seafood
2. . urinary output of 1,200 mL in 24 hours
3. last bowel movement one day ago
4. height 5'8" and weight 160 pounds
{{ANS}}Correct Answer: 1
Rationale: Allergy to iodine and seafood is correct because a CT scan of the kidneys
requires the injection of a radiopaque dye that contains iodine. A patient who is allergic
to iodine or seafood will be unable to have this test. Urinary output of 1,200 mL in 24
hours, last bowel movement one day ago, and height 5'8" and weight 160 pounds are
all incorrect because these are all normal findings, and therefore do not require that the
physician be notified.
,A nurse is assessing a 68-year-old female patient who states, "I am having episodes of
urinary incontinence." The nurse should recognize this statement as indicating which of
the following?
1. an abnormal finding requiring further testing
2. an indication of the presence of a urinary infection
3. a normal outcome of the aging process
4. the result of having several children
{{ANS}}Correct Answer: 1
Rationale: An abnormal finding requiring further testing is correct because
incontinence is not a normal part of the aging process, and therefore will require further
investigation to identify the cause. An indication of the presence of a urinary infection is
incorrect because although frequency and urgency can be symptoms of a urinary tract
infection, a culture and sensitivity test is necessary in order to determine infection. A
normal outcome of the aging process and a result of having several children are
incorrect because incontinence is not normal, and is it not necessarily the result of
having had several children.
A nurse is caring for a patient who has a diagnosis of peritonitis related to a ruptured
appendix. The patient states, "I hope I don't get a kidney infection from this with my
kidneys being so close to my appendix. I had a kidney infection before and I felt
terrible." Which explanation would be most appropriate for the nurse to give the patient?
1. "Your kidneys are located outside the peritoneum, the sack that encloses the
appendix."
2. "Good thinking. Infections in the abdomen can spread to other organs."
3. "You need to speak with your primary healthcare provider about your concern."
4. "We can check your urine daily to assure the infection is not spreading."
{{ANS}}Correct Answer: 1
The nurse is caring for patient who has been diagnosed with an altered mycogenic
mechanism of the renal blood vessels. The patient asks, "Why is it so important that I
treat my hypertension and keep my blood pressure within normal limits?" The nurse's
best response is which of the following?
1. "Your kidneys may have difficulty protecting themselves from high blood
pressure."
2. "Your blood pressure medication is toxic to your kidneys in high doses."
3. "If not controlled, the condition will require an indwelling urinary catheter."
4. "High blood pressure increases your risk for kidney stones."
{{ANS}}Correct Answer: 1
Rationale: The myogenic mechanism, which responds to pressure changes in the renal
blood vessels, controls the diameter of the afferent arterioles to achieve autoregulation.
, An increase in systemic blood pressure causes the renal vessels to constrict, whereas a
decrease in blood pressure causes the afferent arterioles to dilate. These changes
adjust the glomerular hydrostatic pressure and, indirectly, maintain the GFR. An
alteration in this system exposes the kidneys to pressures that are too high for proper
long term kidney function. Option 2 does not address the patient's question. Option 3
and 4 are incorrect.
A nurse is teaching a nursing student about the effects of a sustained drop in systemic
blood pressure on the juxtaglomerular cells of the distal tubules in the kidneys. The
nurse knows teaching has been effective when the student states, "This juxtaglomerular
cell response to low blood pressure is utilized with the medication
1. captopril (Capoten)."
2. digoxin (Lanoxin)."
3. furosemide (Lasix)."
4. adenosine (Adenocard)."
{{ANS}}Correct Answer: 1
Rationale: A sustained drop in systemic blood pressure triggers the juxtaglomerular
cells to release renin. Renin acts on a plasma globulin, angiotensinogen, to release
angiotensin I, which is in turn converted to angiotensin II. As a vasoconstrictor,
angiotensin II activates vascular smooth muscle throughout the body, causing systemic
blood pressure to rise. Captopril (Capoten) is an ACE inhibitor, which blocks the
conversion of angiotensin I to the vasodilator angiotensin II. The other drugs are not
ACE inhibitors.
A nurse is teaching a nursing student about kidney function. The nurse states, "In
healthy kidneys, almost all organic nutrients such as glucose and amino acids are
reabsorbed." The nurse knows the student understands teaching when the student
states, "Your comment means that
1. the nutrients move from blood to filtrate to blood, then back to the blood."
2. the nutrients move from filtrate to blood, then back to the filtrate."
3. the nutrients remain in the kidneys at all times."
4. the nutrients are large molecules and remain in the blood at all times."
{{ANS}}Correct Answer: 1
Rationale: Reabsorption may be active or passive. Substances move from the blood
into the filtrate, then are reclaimed into the blood.
The nurse is caring for a patient who states, "I need to micturate." The nurse's best
response is which of the following?
1. "There is a restroom at the end of the hallway."
2. "Have you been taking your medication on a daily basis?"
3. "Do you have a supply of sterile catheters?"
(Answered) Grade A+
The nurse assesses a patient admitted to the medical-surgical unit who has a diagnosis
of type I diabetes mellitus. The nurse notes that the patient's urine is cloudy and foul-
smelling. Which of the following diagnostic tests does the nurse anticipate will be
ordered based on this finding?
1. urine culture and sensitivity (C&S)
2. blood urea nitrogen (BUN)
3. creatinine clearance
4. residual urine
{{ANS}}Correct Answer: 1
Rationale: Urine culture and sensitivity (C&S) is correct because cloudy and foul-
smelling urine indicates a urinary tract infection. The diagnostic test to identify the
organism responsible is a urine C&S. Blood urea nitrogen (BUN) measures the amount
of urea (end product of protein metabolism) in the blood plasma. It does not identify
infection. Creatinine clearance is a 24-hour urine test used to identify renal function; it
will not identify an infection. Residual urine measures the amount of urine left in the
bladder after voiding, and does not identify an infection.
When preparing a patient for an intravenous pyelogram (IVP), the nurse reviews
diagnostic data, noting all of the following. Which of these findings requires notification
of the physician before proceeding with the test?
1. blood urea nitrogen (BUN) 55 mg/dLdl
2. serum creatinine 1.3 mg/dL
3. urine culture <10,000 organisms/mL
4. residual urine of 80 mL
{{ANS}}Correct Answer: 1
Rationale: Blood urea nitrogen (BUN) 55 mg/dL is correct because this level is
elevated, indicating that there might be a problem of renal function. The physician will
need to be notified because an IVP involves the injection of dye that must eventually
cleared by the kidney, and if there is already compromised renal function, the test may
not be administered. Serum creatinine 1.3 mg/dL, urine culture <10,000 organisms/mL,
and residual urine of 80 mL are all incorrect because these values are all within the
normal range, and therefore will not require physician notification
A nurse working in a postoperative unit is caring for a patient who states, "I voided a
small amount of urine, but I feel as if I need to void more and am unable to do so." The
patient receives a prescription for a post-voiding residual urine test. The nurse correctly
prepares to perform the procedure by gathering supplies that include which of the
following?
,1. a urine collecting device and a straight urinary catheter
2. a urine collecting device and a voiding diary
3. an indwelling urinary catheter and an insertion kit
4. a peripheral IV insertion kit and a urine collecting device
{{ANS}}Correct Answer: 1
Rationale: To evaluate the amount of urine in bladder post-voiding is correct. This
diagnostic test is ordered to determine urinary retention or incomplete bladder emptying,
which could be a consequence of the operative experience. To correctly perform the
procedure, the nurse gathers a urinary collecting device and asks the patient to void. A
straight urinary catheter is inserted and removed and the amount of urine obtained from
the bladder is measured. Voiding diaries, indwelling urinary catheters, and peripheral
IVs are not required for this procedure.
Because of normal changes due to aging, the nurse anticipates that a 75-year-old
patient's serum creatinine level might be which of the following?
1. 0.3 mg/dL
2. 2.4 mg/dL
3. 4.8 mg/dL
4. 6.4 mg/dL
{{ANS}}Correct Answer: 1
Rationale: Lower than normal is correct because serum creatinine level reflects the by-
product of muscle breakdown, and an older adult with less muscle mass can be
expected to have a lower-than-normal level. 0.5-1.5 mg/dL is the normal creatinine
range for adults. Higher than normal, variable with fluid status, and within normal range
are all incorrect because the question is asking for the expected change due to the
aging process, and that is less muscle mass, and therefore less serum creatinine.
When assessing a patient who is scheduled to have a CT scan of the kidneys, which of
these findings would prompt the nurse to notify the primary healthcare provider?
1. allergy to iodine and seafood
2. . urinary output of 1,200 mL in 24 hours
3. last bowel movement one day ago
4. height 5'8" and weight 160 pounds
{{ANS}}Correct Answer: 1
Rationale: Allergy to iodine and seafood is correct because a CT scan of the kidneys
requires the injection of a radiopaque dye that contains iodine. A patient who is allergic
to iodine or seafood will be unable to have this test. Urinary output of 1,200 mL in 24
hours, last bowel movement one day ago, and height 5'8" and weight 160 pounds are
all incorrect because these are all normal findings, and therefore do not require that the
physician be notified.
,A nurse is assessing a 68-year-old female patient who states, "I am having episodes of
urinary incontinence." The nurse should recognize this statement as indicating which of
the following?
1. an abnormal finding requiring further testing
2. an indication of the presence of a urinary infection
3. a normal outcome of the aging process
4. the result of having several children
{{ANS}}Correct Answer: 1
Rationale: An abnormal finding requiring further testing is correct because
incontinence is not a normal part of the aging process, and therefore will require further
investigation to identify the cause. An indication of the presence of a urinary infection is
incorrect because although frequency and urgency can be symptoms of a urinary tract
infection, a culture and sensitivity test is necessary in order to determine infection. A
normal outcome of the aging process and a result of having several children are
incorrect because incontinence is not normal, and is it not necessarily the result of
having had several children.
A nurse is caring for a patient who has a diagnosis of peritonitis related to a ruptured
appendix. The patient states, "I hope I don't get a kidney infection from this with my
kidneys being so close to my appendix. I had a kidney infection before and I felt
terrible." Which explanation would be most appropriate for the nurse to give the patient?
1. "Your kidneys are located outside the peritoneum, the sack that encloses the
appendix."
2. "Good thinking. Infections in the abdomen can spread to other organs."
3. "You need to speak with your primary healthcare provider about your concern."
4. "We can check your urine daily to assure the infection is not spreading."
{{ANS}}Correct Answer: 1
The nurse is caring for patient who has been diagnosed with an altered mycogenic
mechanism of the renal blood vessels. The patient asks, "Why is it so important that I
treat my hypertension and keep my blood pressure within normal limits?" The nurse's
best response is which of the following?
1. "Your kidneys may have difficulty protecting themselves from high blood
pressure."
2. "Your blood pressure medication is toxic to your kidneys in high doses."
3. "If not controlled, the condition will require an indwelling urinary catheter."
4. "High blood pressure increases your risk for kidney stones."
{{ANS}}Correct Answer: 1
Rationale: The myogenic mechanism, which responds to pressure changes in the renal
blood vessels, controls the diameter of the afferent arterioles to achieve autoregulation.
, An increase in systemic blood pressure causes the renal vessels to constrict, whereas a
decrease in blood pressure causes the afferent arterioles to dilate. These changes
adjust the glomerular hydrostatic pressure and, indirectly, maintain the GFR. An
alteration in this system exposes the kidneys to pressures that are too high for proper
long term kidney function. Option 2 does not address the patient's question. Option 3
and 4 are incorrect.
A nurse is teaching a nursing student about the effects of a sustained drop in systemic
blood pressure on the juxtaglomerular cells of the distal tubules in the kidneys. The
nurse knows teaching has been effective when the student states, "This juxtaglomerular
cell response to low blood pressure is utilized with the medication
1. captopril (Capoten)."
2. digoxin (Lanoxin)."
3. furosemide (Lasix)."
4. adenosine (Adenocard)."
{{ANS}}Correct Answer: 1
Rationale: A sustained drop in systemic blood pressure triggers the juxtaglomerular
cells to release renin. Renin acts on a plasma globulin, angiotensinogen, to release
angiotensin I, which is in turn converted to angiotensin II. As a vasoconstrictor,
angiotensin II activates vascular smooth muscle throughout the body, causing systemic
blood pressure to rise. Captopril (Capoten) is an ACE inhibitor, which blocks the
conversion of angiotensin I to the vasodilator angiotensin II. The other drugs are not
ACE inhibitors.
A nurse is teaching a nursing student about kidney function. The nurse states, "In
healthy kidneys, almost all organic nutrients such as glucose and amino acids are
reabsorbed." The nurse knows the student understands teaching when the student
states, "Your comment means that
1. the nutrients move from blood to filtrate to blood, then back to the blood."
2. the nutrients move from filtrate to blood, then back to the filtrate."
3. the nutrients remain in the kidneys at all times."
4. the nutrients are large molecules and remain in the blood at all times."
{{ANS}}Correct Answer: 1
Rationale: Reabsorption may be active or passive. Substances move from the blood
into the filtrate, then are reclaimed into the blood.
The nurse is caring for a patient who states, "I need to micturate." The nurse's best
response is which of the following?
1. "There is a restroom at the end of the hallway."
2. "Have you been taking your medication on a daily basis?"
3. "Do you have a supply of sterile catheters?"
