Tif26

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank
Chapter 26
Question 1
Type: MCSA
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 patients 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
Correct Answer: 1
Rationale 1: 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.
Rationale 2: Blood urea nitrogen (BUN) measures the amount of urea (end product of protein metabolism) in the
blood plasma. It does not identify infection.
Rationale 3: Creatinine clearance is a 24-hour urine test used to identify renal function; it will not identify an
infection.
Rationale 4: Residual urine measures the amount of urine left in the bladder after voiding, and does not identify
an infection.
Global 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.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2. Identify specific topics for consideration during a health history interview of the patient
with health problems involving the renal system.
Copyright 2011 by Pearson Education, Inc.
Question 2
Type: MCSA
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
Correct Answer: 1
Rationale 1: 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.
Rationale 2: Serum creatinine 1.3 mg/dL is within the normal range, and therefore will not require physician
notification.
Rationale 3: Urine culture <10,000 organisms/mL is within the normal range, and therefore will not require
physician notification.
Rationale 4: Residual urine of 80 mL is within the normal range, and therefore will not require physician
notification.
Global 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.
Cognitive Level: Analyzing
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 6. Identify abnormal findings that may indicate alterations in urinary elimination.
Question 3
Type: MCSA

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
Correct Answer: 1
Rationale 1:
Rationale 2: Voiding diaries are not required for this procedure.
Rationale 3: Indwelling urinary catheters are not required for this procedure.
Rationale 4: Peripheral IVs are not required for this procedure.
Global 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.
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 3. Describe techniques used to assess the integrity and function of the renal system.
Question 4
Type: MCSA
Because of normal changes due to aging, the nurse anticipates that a 75-year-old patients 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
Correct Answer: 1
Rationale 1: 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.
Rationale 2: 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.
Global 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.
Client Need: Health Promotion and Maintenance
Client Need Sub:
Question 5
Type: MCSA
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 58 and weight 160 pounds
Correct Answer: 1
Rationale 1: Allergy to iodine and seafood is correct because a CT scan of the kidneys requires the injection of a
radiopaque dye that contains iodine.
Rationale 2: Urinary output of 1,200 mL in 24 hours is incorrect because this is a normal finding, and therefore
does not require that the physician be notified.
Rationale 3: Last bowel movement one day ago is incorrect because this is a normal finding, and therefore do not
require that the physician be notified.
Rationale 4: Height 58 and weight 160 pounds are incorrect because these are normal findings, and therefore do
not require that the physician be notified.
Global 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 58 and
weight 160 pounds are all incorrect because these are all normal findings, and therefore do not require that the
physician be notified.
Nursing/Integrated Concepts: Nursing Process: Diagnosis
Question 6
Type: MCSA
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
Correct Answer: 1
Rationale 1: 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.

Rationale 2: 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.
Rationale 3: A normal outcome of the aging process is incorrect because incontinence is not normal.
Rationale 4: A result of having several children is incorrect because incontinence is not normal, and is it not
necessarily the result of having had several children.
Global 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.
Client Need Sub:
Learning Outcome: 5. Describe normal variations in assessment findings for the older adult.
Question 7
Type: MCSA
A nurse is caring for a patient who has a diagnosis of peritonitis related to a ruptured appendix. The patient states,
I hope I dont 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.
Correct Answer: 1
Rationale 1:
Rationale 2: Though infections can spread, this is not the best choice as it does not address the patients concern
and may unduly alarm the patient.
Rationale 3: There is no indication that the patient should speak with the primary healthcare provider at the
current time.
Rationale 4: There is no indication for daily urinalysis.

Global Rationale:
Client Need Sub: Physiological Adaptation
Learning Outcome: 1. Describe the anatomy, physiology, and functions of the renal system.
Question 8
Type: MCSA
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 nurses 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.
Correct Answer: 1
Rationale 1: 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.
Rationale 2: Option 2 does not address the patients question.
Rationale 3: Option 3 and 4 are incorrect.
Rationale 4: Option 3 and 4 are incorrect.
Global 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 patients question. Option 3 and 4 are incorrect.

Question 9
Type: MCSA
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).
Correct Answer: 1
Rationale 1: Captopril (Capoten) is an ACE inhibitor, which blocks the conversion of angiotensin I to the
vasodilator angiotensin II.
Rationale 2: The other drugs are not ACE inhibitors.
Global 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.
Client Need Sub: Pharmacological and Parenteral Therapies
Nursing/Integrated Concepts: Nursing Process: Evaluation
Question 10
Type: MCSA

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.
Correct Answer: 1
Rationale 1: Reabsorption may be active or passive. Substances move from the blood into the filtrate, then are
reclaimed into the blood.
Global Rationale: Reabsorption may be active or passive. Substances move from the blood into the filtrate, then
are reclaimed into the blood.
Client Need Sub:
Question 11
Type: MCHS
A nurse is teaching a patient who has a diagnosis of a kidney stone in the left ureter. The nurse knows the patient
understands teaching when the patient identifies the left ureter on the graphic.

Correct Answer:
Rationale : The ureters are bilateral tubes approximately 10 to 12 inches (26 to 30 cm) long. They transport urine
from the kidney to the bladder through peristaltic waves originating in the renal pelvis.
Global Rationale:
Client Need Sub:
Question 12
Type: MCSA
The nurse is caring for a patient who states, I need to micturate. The nurses 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?
4. Do you have someone who can drive you home?
Correct Answer: 1
Rationale 1: Micturation is the acting of urinating or voiding. The best response is to direct the patient to a
restroom.
Rationale 2: The best response is to direct the patient to a restroom.
Global Rationale: Micturation is the acting of urinating or voiding. The best response is to direct the patient to a
restroom.
Client Need Sub:
Question 13
Type: MCSA
A nurse is caring for a patient who asks the nurse why females are more likely than males to contract bladder
infections. The nurse knows teaching has been effective when the patient identifies which of the following as a
female risk factor for bladder infections?
1. The urinary meatus is closer to the bladder than in most males.
2. The urinary meatus is farther from the anus than most males.
3. The pH of the female urethra is more conducive to infection.
4. Females urinate more frequently than males, increasing risk.
Correct Answer: 1
Rationale 1: In females, the urethra is approximately 1.5 inches (3 to 5 cm) long, and the urinary meatus is
anterior to the vaginal orifice.

Rationale 2: The female urinary meatus is closer, not farther from the anus than in most males, also increasing
risk for bladder infections.
Rationale 3: The pH of the female urethra is not more conducive to infection.
Rationale 4: Frequent urination decreases the risk of bladder infection making this choice incorrect.
Global Rationale: In females, the urethra is approximately 1.5 inches (3 to 5 cm) long, and the urinary meatus is
anterior to the vaginal orifice. In males, the urethra is approximately 8 inches (20 cm) long. The shorter distance
of the female urethra creates a mechanism by which more females than males contract bladder infections. The
female urinary meatus is closer, not farther from the anus than in most males, also increasing risk for bladder
infections. The pH of the female urethra is not more conducive to infection. Frequent urination decreases the risk
of bladder infection making this choice incorrect.
Client Need Sub:
Question 14
Type: MCSA
The nurse working on a nephrology unit is providing telephone triage to a patient who states, I am worried that
my child may be genetically at risk for kidney problems in adulthood. The nurse should recognize that which of
these comments by the patient best indicates that the patients child may be at future risk for manifesting a genetic
kidney disorder?
1. My mother had lots of cysts on her kidneys.
2. I have a bladder infection at least once a year.
3. The childs father has Parkinsons disease.
4. My father had kidney cancer.
Correct Answer: 1
Rationale 1: When conducting a health assessment interview and physical assessment, it is important for the
nurse to consider genetic influences on health. During the health assessment interview, ask about family members
with health problems affecting kidney function, or of family members diagnosed with polycystic disease. A
grandmother with polycystic kidney disease increases the grandchilds risk for having the disorder.
Rationale 2: A yearly bladder infection in a mother is not the most important indicator of a genetic kidney
disorder.
Rationale 3: Parkinsons disease is not associated with kidney disease.

Rationale 4: Kidney cancer is not highly associated with heredity.
Global Rationale: When conducting a health assessment interview and physical assessment, it is important for
the nurse to consider genetic influences on health. During the health assessment interview, ask about family
members with health problems affecting kidney function, or of family members diagnosed with polycystic
disease. A grandmother with polycystic kidney disease increases the grandchilds risk for having the disorder. A
yearly bladder infection in a mother is not the most important indicator of a genetic kidney disorder. Parkinsons
disease is not associated with kidney disease. Kidney cancer is not highly associated with heredity.
Client Need Sub:
Learning Outcome: 4. Give examples of genetic disorders of the renal system.
Question 15
Type: MCSA
A nurse is assessing a patient. Which of the following patient statements best alerts the nurse to the likelihood of
the patient having a distended bladder?
1. I am in pain and it is worse when I press on my abdomen.
2. My back is killing me.
3. It feels like someone is stabbing me in the abdomen with a knife.
4. It hurt constantly with spasms once in a while.
Correct Answer: 1
Rationale 1: The patient with a distended bladder experiences constant pain increased by any pressure over the
bladder.
Rationale 2: Kidney pain is experienced in the back and the costovertebral angle (the angle between the lower
ribs and adjacent vertebrae) and may spread toward the umbilicus.
Rationale 3: Renal colic (pain in response to renal calculi moving through the ureter) is severe, sharp, stabbing,
and excruciating; often it is felt in the flank, bladder, urethra, testes, or ovaries.
Rationale 4: Bladder and urethral pain is usually dull and continuous but may be experienced as spasms.
Global Rationale: The patient with a distended bladder experiences constant pain increased by any pressure over
the bladder. Kidney pain is experienced in the back and the costovertebral angle (the angle between the lower ribs
and adjacent vertebrae) and may spread toward the umbilicus. Renal colic (pain in response to renal calculi
moving through the ureter) is severe, sharp, stabbing, and excruciating; often it is felt in the flank, bladder,
urethra, testes, or ovaries. Bladder and urethral pain is usually dull and continuous but may be experienced as
spasms.
Question 16
Type: MCSA
A nursing student is assessing a patient who is reporting constant dull pain over the lower abdomen. The student
inspects, palpates, and auscultates the patients abdomen. After leaving the patients room the nurse tells the
student, Your assessment findings may not be accurate because you
1. palpated prior to auscultating.
2. inspected prior to palpating.
3. inspected prior to auscultating.
4. auscultated after inspecting.
Correct Answer: 1
Rationale 1: Auscultate immediately after inspection because percussion or palpation may increase bowel
motility and interfere with sound transmission during auscultation.
Global Rationale: Auscultate immediately after inspection because percussion or palpation may increase bowel
Question 17
Type: MCSA
The nurse is caring for a patient who sustained a fall with a fractured femur and was unable to summon help or
receive healthcare treatment for 48 hours. On arrival at the emergency department, the patients blood urea
nitrogen level is 50 mg/dL. The serum creatinine level is 1.0 mg/dL. These findings would help substantiate a
nursing diagnosis of which of the following?
1. Deficient Fluid Volume
2. Anxiety related to crisis
3. Acute Pain
4. Impaired Nutrition
Correct Answer: 1
Rationale 1: To assess if the patients elevated blood urea nitrogen is caused by dehydration or renal failure, the
nurse assesses the serum creatinine value. The patients serum creatinine is normal, which does not indicate
kidney failure. A nursing diagnosis of Deficient Fluid Volume is appropriate for this patient.
Rationale 2: These laboratory values are not relevant to a diagnosis of Anxiety.
Rationale 3: These laboratory values are not relevant to a diagnosis of Impaired Nutrition.
Rationale 4: These laboratory values are not relevant to a diagnosis of Pain.
Global Rationale:
Question 18
Type: MCMA
The nurse is reviewing the serum creatinine laboratory results for a group of patients. The nurse identifies which
of the following patients as being at risk for having falsely elevated serum creatinine levels: A patient with a
diagnosis of which of the following?
Standard Text: Select all that apply.
1. rhinovirus taking 10,000 mg of vitamin C daily

2. Parkinsons disease and a prescription for methyldopa
3. bipolar disorder and a prescription for lithium carbonate
4. acne vulgaris and a prescription for tetracycline
5. insomnia taking over-the-counter melatonin
Correct Answer: 1,2,3
Rationale 1:
Rationale 2:
Rationale 3:
Rationale 4:
Rationale 5:
Global Rationale:
Question 19
Type: MCSA
A nurse is reviewing laboratory data for a patient who had a voiding cystogram that revealed an urge to void at
100 mL. Which of these nursing diagnoses should receive priority for this patient?
1. Risk for Urge Urinary Incontinence
2. Risk for Impaired Skin Integrity
3. Self-Care Deficit
4. Risk for Urinary Retention
Correct Answer: 1

Rationale 1: A patient who has a sensation of an urge to void at 100 mL is at greatest Risk for Urge Urinary
Incontinence.
Rationale 2: Risk for Impaired Skin Integrity, Self-Care Deficit, and Risk for Urinary Retention would not be
appropriate diagnoses for the patient with these test results.
Global Rationale: A voiding cystogram is conducted to evaluate bladder capacity and neuromuscular functions
of the bladder, urethral pressures, and causes of bladder dysfunction. A measured quantity of fluid is instilled into
the bladder, and the filling capacity and voiding pressures are measured. Normal values: urine stream strong and
uninterrupted, normal filling pattern, and sensation of fullness; bladder capacity: 300-600 mL; urge to void: >150
mL; fullness felt: 300 mL. A patient who has a sensation of an urge to void at 100 mL is at greatest Risk for Urge
Urinary Incontinence. Risk for Impaired Skin Integrity, Self-Care Deficit, and Risk for Urinary Retention would
not be appropriate diagnoses for the patient with these test results.
Question 20
Type: MCMA
A nurse is teaching a patient about a voiding cystogram procedure. Which of these statements, if made by the
patient, would indicate that the patient has the correct understanding of the instruction?
1. A urinary catheter will be placed in my bladder.
2. My bladder will be filled with fluid
3. I will describe when my bladder feels full.
4. A peripheral IV will be inserted in my arm.
5. I will be sedated for the procedure.
Rationale 1: During this procedure a urinary catheter will be placed in the bladder.
Rationale 2: During this procedure the bladder will be filled.

Rationale 3: During this procedure when the bladder is being filled the patient will be asked to describe the first
urge to void, and the sensation of being unable to delay urination any longer.
Rationale 4: A peripheral IV is not needed for this procedure.
Rationale 5: The patient is not sedated as the patient must report when the sensation of bladder filling is
occurring.
Global Rationale: During this procedure a urinary catheter will be placed in the bladder, then the bladder will be
filled and during filling the patient will be asked to describe the first urge to void, and the sensation of being
unable to delay urination any longer. A peripheral IV is not needed for this procedure and the patient is not sedated
as the patient must report when the sensation of bladder filling is occurring.
Question 21
Type: MCMA
When assessing a patient who is scheduled for a cystogram and at risk for complications directly related to the
procedure, a nurse should alert the primary healthcare provider if the patient has which of these clinical
manifestations? Select all that apply.
1. cystitis
2. prostatitis
3. neuroleptic malignant syndrome
4. right-sided hemiplegia
5. chronic pain
Rationale 1: When caring for a patient undergoing a cystogram, the nurse will assess history of cystitis (this
disorder could result in sepsis after the procedure).
Rationale 2: When caring for a patient undergoing a cystogram, the nurse will assess history of prostatitis (this
disorder could result in sepsis after the procedure).
Rationale 3: When caring for a patient undergoing a cystogram, the nurse will assess history of hypersensitivity
to anesthetics.
Rationale 4: Right-sided hemiplegia and chronic pain are not issues for this patient.
Rationale 5: Right-sided hemiplegia and chronic pain are not issues for this patient.
Global Rationale: When caring for a patient undergoing a cystogram, the nurse will assess history of cystitis or
prostatitis (these disorders could result in sepsis after the procedure), hypersensitivity to anesthetics, and urinary
patterns (amount, color, odor). Right-sided hemiplegia and chronic pain are not issues for this patient.
Question 22
Type: MCSA
The nurse is providing preoperative teaching for a patient scheduled for a cystogram. The nurse knows follow-up
is needed when the patient states, After the procedure, I need to contact my primary healthcare provider if I
experience
1. bloody urine.
2. low urine output.
3. abdominal pain.
4. chills or fever.
Correct Answer: 1
Rationale 1: Some blood is expected in the urine following the procedure. The nurse should provide more
information regarding the monitoring of blood in the urine. The nurse should instruct the patient to immediately
notify the physician if the urine remains bloody for more than three voidings after the procedure, or if bright
bleeding develops.
Rationale 2: Low urine output, abdominal or flank pain, chills, or fever do not identify blood in the urine
although these complications can occur.

Global Rationale: Some blood is expected in the urine following the procedure. The nurse should provide more
information regarding the monitoring of blood in the urine. The nurse should instruct the patient to immediately
notify the physician if the urine remains bloody for more than three voidings after the procedure, or if bright
bleeding develops. Low urine output, abdominal or flank pain, chills, or fever do not identify blood in the urine
Question 23
Type: MCMA
A nurse is performing discharge teaching with a patient who had a cystogram. The nurse should instruct the
patient to use which of the following techniques to promote comfort? Select all that apply.
1. Take a sitz bath.
2. Increase oral fluid intake.
3. Take acetaminophen for minor pain.
4. Apply heat to the lower back.
5. Drink one ounce of brandy or rum with warm water.
Rationale 1: Appropriate techniques for relieving pain after a cystogram include taking a sitz bath.
Rationale 2: Appropriate techniques for relieving pain after a cystogram include increasing oral fluid intake.
Rationale 3: Appropriate techniques for relieving pain after a cystogram include using over-the-counter
analgesics that do not promote bleeding.
Rationale 4: Apply heat to the lower abdomen, not the lower back.
Rationale 5: Tell the patient to avoid alcoholic drinks for two days and that a slight burning sensation with
voiding may occur for a day or two.
Global Rationale: Appropriate techniques for relieving pain after a cystogram include taking a sitz bath,
increasing oral fluid intake, and using over-the-counter analgesics that do not promote bleeding. Apply heat to the
lower abdomen, not the lower back. Tell the patient to avoid alcoholic drinks for two days and that a slight
burning sensation with voiding may occur for a day or two.
Question 24
Type: MCMA
The nurse is reviewing the laboratory results for a patient who has a prescription for an estimated glomerular
filtration rate (EGFR). The nurse knows that which of the following factors may be utilized to determine the
estimated glomerular filtration rate?
1. serum creatinine
2. patients age
3. patients gender
4. patients racial origin
5. serum blood urea nitrogen
Correct Answer: 1,2,3,4
Rationale 1: The EGFR is calculated based on the serum creatinine, age, gender, and (in some instances) racial
origin.
origin.
origin.
origin.
Rationale 5: Serum blood urea nitrogen is not utilized.

Global Rationale: The EGFR is calculated based on the serum creatinine, age, gender, and (in some instances)
racial origin. Serum blood urea nitrogen results is not utilized.
Question 25
Type: MCSA
In formulating the teaching plan for a patient who is taking metformin (Glucophage), the nurse should include
which of these priority instructions? Notify your healthcare provider if
1. you need a diagnostic test that uses iodinated contrast.
2. your urine becomes orange or red-tinted.
3. your urine becomes more concentrated.
4. you need an intermittent or indwelling urinary catheterization.
Correct Answer: 1
Rationale 1: Oral hypoglycemic agents are contraindicated for use with iodinated contrast, as the combination of
the two can precipitate renal failure. Patients should be taught to inform all healthcare providers if they have a
prescription for an oral hypoglycemic agent.
Rationale 2: Orange or red-tinted urine has no interaction with metformin.
Rationale 3: Concentrated urine has no interaction with metformin.
Rationale 4: Needing urinary catheterizations has no interaction with metformin.
Global Rationale: Oral hypoglycemic agents are contraindicated for use with iodinated contrast, as the
combination of the two can precipitate renal failure. Patients should be taught to inform all healthcare providers if
they have a prescription for an oral hypoglycemic agent. Orange or red-tinted urine, concentrated urine, or
needing urinary catheterizations have no interaction with metformin.
Question 26
Type: MCSA
A patient who has prescriptions for both an intravenous pyelogram and a barium enema tells the nurse, I will
schedule the intravenous pyelogram to be done before the barium enema. Which of these responses by the nurse
is most appropriate?
1. Please make your appointments, as you have indicated.
2. Please clarify with your primary healthcare provider which should be completed first.
3. Please reverse the order of your planned appointments.
4. The order of the tests is irrelevant. You may change the order to meet your needs.
Correct Answer: 1
Rationale 1: Schedule an IVP prior to any ordered barium test or gallbladder studies using contrast material, as
residual contrast material from the barium enema or gallbladder studies may interfere with the IVP results.
Global Rationale: Schedule an IVP prior to any ordered barium test or gallbladder studies using contrast
material, as residual contrast material from the barium enema or gallbladder studies may interfere with the IVP
results.
Question 27
Type: MCSA
Which of these findings, if identified in an adult patient who is scheduled for an intravenous pyelogram, should a
nurse report to the primary healthcare provider immediately?
1. serum osmolality of 1500 mOsm/kg/H2O
2. serum creatinine of 1.30 mg/dL

3. blood urea nitrogen of 20 mg/dL
4. hourly urine output of 45 mL/hour
Correct Answer: 1
Rationale 1: Prior to the IVP the nurse should assess renal and fluid status, including serum osmolality,
creatinine, and blood urea nitrogen (BUN) levels. Notify the physician of any abnormal values. This patients
serum osmolality is elevated. Normal findings are 50-1200 mOsm/kg/H2O. Elevated serum osmolality may
indicate a high-protein diet, SIADH, Addisons disease, dehydration, or hyperglycemia.
Rationale 2: The creatinine finding is within normal limits for this patient.
Rationale 3: The BUN finding is within normal limits for this patient.
Rationale 4: The hourly urine output findings are within normal limits for this patient.
Global Rationale: Prior to the IVP the nurse should assess renal and fluid status, including serum osmolality,
creatinine, and blood urea nitrogen (BUN) levels. Notify the physician of any abnormal values. This patients
serum osmolality is elevated. Normal findings are 50-1200 mOsm/kg/H2O. Elevated serum osmolality may
indicate a high-protein diet, SIADH, Addisons disease, dehydration, or hyperglycemia. The creatinine, BUN, and
hourly urine output findings are within normal limits for this patient.
Question 28
Type: MCSA
The nurse is reviewing teaching with a patient who has a prescription for an intravenous pyelogram. The nurse
recognizes that further teaching is needed when the patient states, I will
1. not drink any fluids for at least 12 hours before the procedure.
2. start the bowel prep with a suppository the night before the procedure
3. take the prescribed laxative the morning of the procedure.
4. not eat solid food for at least 8 hours before the procedure.
Correct Answer: 1
Rationale 1: Clear liquids are allowed.

Rationale 2: Instruct the patient to complete ordered pretest bowel preparation, including prescribed laxative or
cathartic the evening before the test, and an enema or suppository the morning of the test.
Rationale 3: Instruct the patient to complete ordered pretest bowel preparation, including prescribed laxative or
cathartic the evening before the test, and an enema or suppository the morning of the test.
Rationale 4: Tell the patient not to eat food for 8 to 12 hours prior to the test.
Global Rationale: Tell the patient not to eat food for 8 to 12 hours prior to the test; clear liquids are allowed.
Instruct the patient to complete ordered pretest bowel preparation, including prescribed laxative or cathartic the
evening before the test, and an enema or suppository the morning of the test.
Question 29
Type: MCSA
A nurse on the postoperative unit should assign which of these staff members to perform a follow-up assessment
for a patient who has returned home after having an intravenous pyelogram 24 hours ago?
1. RN floating from the immunology unit
2. LPN floating from the nephrology unit
3. LPN floating from the pulmonology unit
4. RN floating from the orthopedic unit
Correct Answer: 1
Rationale 1: Delayed reactions to contrast dyes containing iodine can occur. The most appropriate staff member
to follow up with the patient is the RN from the immunology unit. This RN will have extensive experience with
hypersentitivity reactions and is best prepared to meet the needs of the patient. Prior to discharge the nurse should
instruct the patient to contact the healthcare provider for any delayed reactions to the dye (breathing difficulty,
rash, itching, rapid heartbeat).
Rationale 2: The most appropriate staff member to follow up with the patient is the RN from the immunology
unit.

unit.
unit.
Global Rationale: Delayed reactions to contrast dyes containing iodine can occur. The most appropriate staff
member to follow up with the patient is the RN from the immunology unit. This RN will have extensive
experience with hypersentitivity reactions and is best prepared to meet the needs of the patient. Prior to discharge
the nurse should instruct the patient to contact the healthcare provider for any delayed reactions to the dye
(breathing difficulty, rash, itching, rapid heartbeat).
Client Need: Safe Effective Care Environment
Client Need Sub:
Question 30
Type: MCSA
A nursing student asks all of the following questions when assessing a patient who is scheduled to have an MRI of
the kidneys. Which of these questions would require the nurse to intervene?
1. When did you last have anything to eat or drink?
2. Have you ever been treated for chest pain?
3. Do you have any tattoos?
4. Is there any possibility you could be pregnant?
Correct Answer: 1
Rationale 1: There are no restrictions regarding food or fluids for this test.
Rationale 2: Patients with a history of chest pain should be asked if they have a prescription for transdermal
nitroglycerin patches, which must be removed prior to the test.
Rationale 3: The nurse should assess for any metallic implants (such as pacemakers, clips on brain aneurysms,
body piercings, tattoos, and shrapnel). If present, the nurse should notify the imaging physician.
Rationale 4: Ask if patient is pregnant; if so the test is not performed.
Global Rationale: There are no restrictions regarding food or fluids for this test. Patients with a history of chest
pain should be asked if they have a prescription for transdermal nitroglycerin patches, which must be removed
prior to the test. The nurse should assess for any metallic implants (such as pacemakers, clips on brain aneurysms,
body piercings, tattoos, and shrapnel). If present, the nurse should notify the imaging physician. Ask if patient is
pregnant; if so the test is not performed.
Question 31
Type: MCSA
Which of these outcomes would be most appropriate for a nurse to establish with a patient who has just voided
and who is scheduled to have a portable ultrasonic bladder scan immediatly? The scan will indicate which of the
following?
1. less than 100 mL of urine in the bladder
2. between 100 and 150 mL of urine in the bladder
3. between 150 and 200 mL of urine in the bladder
4. more than 200 mL of urine in the bladder
Correct Answer: 1
Rationale 1: A normal ultrasonic bladder scan finding is less than 100 mL for a residual voiding.
Rationale 2: A normal ultrasonic bladder scan finding is less than 100 mLfor a residual voiding.
Global Rationale: A normal ultrasonic bladder scan finding is less than 100 mL for a residual voiding.
Question 32
Type: MCSA

Which of these explanations would be most appropriate for a nurse to give to a patient who is scheduled to have a
portable ultrasonic bladder scan to measure residual urine?
1. You will have more than one reading taken.
2. You will have an intermittent urinary catheter inserted and removed.
3. You will have to delay the urge to void as long as possible.
4. You will have the scan one hour after voiding in the toilet.
Correct Answer: 1
Rationale 1: When performing a portable ultrasonic bladder scan the nurse obtains several readings and uses the
largest (the most accurate). The nurse should print the information, place it on the patients chart, and document
the residual urine amount.
Rationale 2: The patient is not asked to delay voiding.
Rationale 3: No catheterization is performed as part of this test.
Rationale 4: The scan is performed immediately after the patient voids.
Global Rationale: When performing a portable ultrasonic bladder scan the nurse obtains several readings and
uses the largest (the most accurate). The nurse should print the information, place it on the patients chart, and
document the residual urine amount. The patient is not asked to delay voiding. No catheterization is performed as
part of this test. The scan is performed immediately after the patient voids.
Question 33
Type: MCSA
A 12-year-old patient who is scheduled to have a renal angiogram asks why the nurse has touched the patients
feet and marked an X on the top of both feet. Which of these responses would be most appropriate for the nurse
to make?
1. I feel your pulses there. I can check that the blood is flowing properly to your legs and feet.
2. Are you afraid? Why do you ask?
3. It is a nursing thing. What is that game you are playing?
4. A needle is inserted in your femoral artery so the circulation to your extremity could be compromised during
this test.
Correct Answer: 1
Rationale 1: The patient is 12 years old. Most 12-year-old patients have reached the formal operations stage of
thinking and can think abstractly and reason logically. The correct option addresses the patients question directly.
Rationale 2: Asking the patient a closed question about fear and then asking why the patient asks closes down
communication and may make the patient defensive.
Rationale 3: Telling the patient it is a nursing thing and then changing the subject from the patients question
minimizes the patients concern.
Rationale 4: Using medical terms with which the patient is likely not familiar also blocks communication. This
option may alarm the patient unnecessarily.
Global Rationale: The patient is 12 years old. Most 12-year-old patients have reached the formal operations stage
of thinking and can think abstractly and reason logically. The correct option addresses the patients question
directly. Asking the patient a closed question about fear and then asking why the patient asks closes down
communication and may make the patient defensive. Telling the patient it is a nursing thing and then changing
the subject from the patients question minimizes the patients concern. Using medical terms with which the
patient is likely not familiar also blocks communication. This option may alarm the patient unnecessarily.
Client Need: Psychosocial Integrity
Client Need Sub:
Question 34
Type: MCMA
A nurse observes a colleague including all of these measures when providing care to a patient who recently had a
percutaneous renal biopsy. Which would require the nurse to intervene? Select all that apply.
1. monitors vital signs every 15 minutes
2. applies pressure to site for 15 minutes after procedure
3. teaches patient to use aspirin for minor post procedure pain
4. teaches patient to increase oral fluid intake
5. teaches patient to report decreased urination

Correct Answer: 1,2
Rationale 1: The nurse holds pressure at the percutaneous site of a renal biopsy for 20 minutes after the
procedure.
Rationale 2: The patient is at risk for bleeding and should not use aspirin as an over-the-counter pain reliever
immediately after a renal biopsy, as it will promote bleeding.
Rationale 3: Options 3, 4, and 5 are all correct.
Global Rationale: The nurse holds pressure at the percutaneous site of a renal biopsy for 20 minutes after the
procedure. The patient is at risk for bleeding and should not use aspirin as an over-the-counter pain reliever
immediately after a renal biopsy, as it will promote bleeding. Options 3, 4, and 5 are all correct.
Question 35
Type: MCSA
A patient with an allergy to iodine is scheduled to have the following diagnostic tests. Which requires immediate
nursing intervention?
1. renal angiogram
2. renal scan
3. voiding cystogram
4. portable ultrasonic bladder scan
Correct Answer: 1
Rationale 1: An angiogram includes the use of contrast dye, which often contains iodine. The nurse should
contact the primary healthcare provider to report the iodine allergy.
Rationale 2: The other tests do not use contrast media.

Global Rationale: An angiogram includes the use of contrast dye, which often contains iodine. The nurse should
contact the primary healthcare provider to report the iodine allergy. The other tests do not use contrast media.
Question 36
Type: MCSA
A patient who is scheduled to have a renal ultrasound tells a nurse, I am afraid I will not be able to stand the pain
of this test. Which of these outcomes would be most appropriate for the nurse to establish with this patient? The
patient will
1. explain the typical experience of a patient having a renal ultrasound.
2. discuss feelings associated with painful experiences.
3. explain pain medications available during this procedure.
4. discuss the typical experience of a patient using conscious sedation.
Correct Answer: 1
Rationale 1: A renal ultrasound is a noninvasive test conducted to detect renal or perirenal masses, identify
obstructions, and diagnose renal cysts and solid masses. It is done by applying a conductive gel to the skin and
placing a small external ultrasound probe on the patients skin. Sound waves are recorded on a computer as they
are reflected off tissues.
Rationale 2: There is no discomfort associated with the test.
Rationale 3: Pain medications are not needed.
Rationale 4: When the patient understands the typical experience for a patient having this test, fears of a painful
experience will be addressed and resolved.
Global Rationale: A renal ultrasound is a noninvasive test conducted to detect renal or perirenal masses, identify
obstructions, and diagnose renal cysts and solid masses. It is done by applying a conductive gel to the skin and
placing a small external ultrasound probe on the patients skin. Sound waves are recorded on a computer as they
are reflected off tissues. There is no discomfort associated with the test and pain medications are not needed.
When the patient understands the typical experience for a patient having this test, fears of a painful experience
will be addressed and resolved.
Question 37
Type: MCSA
A public health nurse is performing teaching for a patient who will be obtaining a sample of urine for a urinalysis
at home. Which of these patient comments will cause the nurse to provide clarifying information?
1. I will get the specimen as soon as I get home this evening.
2. I wont touch the inside of the cup or lid.
3. I will refrigerate the specimen until I bring it to the laboratory tomorrow.
4. I will give the laboratory a list of the medications I am taking.
Correct Answer: 1
Rationale 1: An early morning specimen is preferred. The patient is bringing the specimen to the laboratory
tomorrow, so an early morning specimen is possible and the most accurate and useful specimen.
Rationale 2: The other options are correct information.
Global Rationale: An early morning specimen is preferred. The patient is bringing the specimen to the laboratory
tomorrow, so an early morning specimen is possible and the most accurate and useful specimen. The other options
are correct information.
Question 38
Type: MCSA
Which of these laboratory results would be most important for a nurse to monitor for a patient who has lower
abdominal pain and urinary urgency?
1. serum creatinine 1.20 mg/dL
2. urine Osmolality 400 mOsm/kg H2O
3. BUN 30 mg/dL
4. urine culture 150,000 organisms/mL
Correct Answer: 4
Rationale 1: BUN and serum creatinine tests are use primarily to evlauate kidney function.
Rationale 2: Urine osmolality is used to evaluate increaded and decreased urine output.
Rationale 3: BUN and serum creatinine tests are use primarily to evlauate kidney function.
Rationale 4:
Global Rationale:
Question 39
Type: MCSA
A nurse is advising a nursing student who is preparing a teaching presentation for fellow students regarding
urinalysis. Which of these teaching points, if made by the student, requires intervention by the nurse?
1. Urine culture 150,000 organisms/mL. Female patients should separate the labia with one hand and clean the
labia with the other, using sterile cotton swabs saturated with a cleansing solution, wiping back to front.
2. serum creatinine 1.20 mg/dL.
3. urine osmolality 400 mOsm/kg H2O.
4. blood urea nitrogen (BUN) 30 mg/dL.
Correct Answer: 1
Rationale 1:
Rationale 2: The other test results are within normal range.
Global Rationale:
Question 40
Type: MCSA
A nurse is advising a nursing student who is preparing a teaching presentation for fellow students regarding
urinalysis. Which of these teaching points, if made by the student, requires intervention by the nurse?
1. Males patients should retract the foreskin and cleanse the glans with three cotton sponges saturated with
cleansing solution, using a circular motion.
2. Female patients should separate the labia with one hand and clean the labia with the other, using sterile cotton
swabs saturated with a cleansing solution, wiping back to front.
3. After cleansing, patients should start voiding and then begin to collect the specimen.
4. Patients should start taking prescribed antibiotics only after the specimen is collected.
Correct Answer: 1
Rationale 1: The female patient should cleanse the perineum with a front-to-back motion to avoid contaminating
the urethral meatus with fecal bacteria.
Rationale 2: The other options are correct.

Global Rationale: The female patient should cleanse the perineum with a front-to-back motion to avoid
contaminating the urethral meatus with fecal bacteria. The other options are correct.
Question 41
Type: MCSA
A patient has been given instruction about adult polycystic kidney disease (APKD). Which of these statements, if
made by the patient, would indicate that the patient needs further instruction? Select all that apply.
1. This disorder can be cured if I take my medication carefully.
2. APKD is inherited from parent to child.
3. The problem that causes this disease is in the cell chromosomes.
4. Many fluid-filled sacks are found in the kidneys.
5. This disorder can cause my kidneys to work poorly.
Correct Answer: 1
Rationale 1: There is no medication that can cure this disorder.
Rationale 2: Adult polycystic kidney disease (APKD) is linked to a familial chromosome 16 disorder.
Rationale 3: Adult polycystic kidney disease (APKD) is linked to a familial chromosome 16 disorder.
Rationale 4: The disease is characterized by large cysts in one or both kidneys.
Rationale 5: The disease is characterized by a gradual loss of kidney tissue with resultant chronic renal failure.
Global Rationale: There is no medication that can cure this disorder. Adult polycystic kidney disease (APKD) is
linked to a familial chromosome 16 disorder. The disease is characterized by large cysts in one or both kidneys
and a gradual loss of kidney tissue with resultant chronic renal failure.
Question 42
Type: MCSA
A patient states, I have a family history of both type 1 and type 2 diabetes mellitus. Before I decide to have
children, I am going to speak with a healthcare professional who specializes in working with people with health
problems that are passed from parent to child. Which of these statements would be the most appropriate for the
nurse to record in the patients medical record? The patient has a future plan to discuss concerns about familial
tendency for diabetes with
1. a genetic counselor.
2. a home health nurse.
3. an obstetrician.
4. a physical therapist.
Correct Answer: 1
Rationale 1: Genetic counselors specialize in working with families who have diseases associated with heredity.
Rationale 2: The other options are incorrect.
Global Rationale: Genetic counselors specialize in working with families who have diseases associated with
heredity. The other options are incorrect.
Client Need Sub:
Question 43
Type: MCSA
A nurse is reviewing the diagnostic results of renal testing for an 80-year-old patient and notes that the patients
findings include a decreased size of the renal cortex, atherosclerosis of the renal arteries, and hypoosmolality of
urine. Which of these explanations would be most appropriate for the nurse to give the patient?
1. These are typical changes associated with aging.
2. These are signs of chronic renal failure.
3. These are signs of acute renal failure.

4. These are signs of a genetic renal disorder.
Correct Answer: 1
Rationale 1: Typical age-related changes of the renal system include a decreased size of the renal cortex,
atherosclerosis of the renal arteries, and hypoosmolality. This triad in an 80-year-old patient is an expected
finding.
Rationale 2: Some of these manifestations may be associated with acute renal failure.
Rationale 3: Some of these manifestations may be associated with chronic renal failure.
Rationale 4: Some of these manifestations may be associated with a genetic renal disorder.
Global Rationale: Typical age-related changes of the renal system include a decreased size of the renal cortex,
atherosclerosis of the renal arteries, and hypoosmolality. Some of these manifestations may be associated with
acute or chronic renal failure or a genetic renal disorder. This triad in an 80-year-old patient is an expected
finding.
Client Need Sub:
Question 44
Type: MCSA
Which of these assessments of an 86-year-old patient requires immediate nursing intervention?
1. reports of urinary incontinence
2. reports of urinary frequency
3. reports of urinary urgency
4. reports of nocturia
Correct Answer: 1
Rationale 1: Urinary incontinence is not a normal part of aging and requires immediate nursing intervention.
Rationale 2: Reports of urinary frequency are more common in older adults than in younger people. This may
represent normal changes expected with aging.
Rationale 3: Reports of urgency are more common in older adults than in younger people. This may represent
normal changes expected with aging.
Rationale 4: Reports of nocturia are more common in older adults than in younger people. This may represent
normal changes expected with aging.
Global Rationale: Urinary incontinence is not a normal part of aging and requires immediate nursing
intervention. Reports of urinary frequency, urgency, and nocturia are more common in older adults than in
younger people. These may represent normal changes expected with aging.
Client Need Sub:
Question 45
Type: MCSA
All of the following diagnostic tests are ordered for a patient with renal disease. The nurse understands that which
one of the following will be used in the evaluation of the patients glomerular filtration rate (GFR)?
1. creatinine clearance
2. blood urea nitrogen (BUN)
3. intravenous pyelogram (IVP)
4. renal ultrasound
Correct Answer: 1
Rationale 1: Creatinine clearance is correct because this study (a 24-hour urine) measures the ability of the
kidney to clear a given amount of creatinine out of the plasma within a given time period. Creatinine is a
substance produced from the breakdown of muscle and is cleared by the kidney at a constant rate. This test is used
to determine the glomerular filtration rate or the ability of the kidney to clear substances out of the plasma.
Rationale 2: Blood urea nitrogen (BUN) measures the amount of urea in the plasma and, although it is reflective
of kidney function, it can be affected by both protein intake and fluid balance.
Rationale 3: Intravenous pyelogram (IVP) identifies the structures of the urinary system, not the function.
Rationale 4: Renal ultrasound identifies renal or perirenal masses or obstructions.
Global Rationale: Creatinine clearance is correct because this study (a 24-hour urine) measures the ability of the
kidney to clear a given amount of creatinine out of the plasma within a given time period. Creatinine is a
substance produced from the breakdown of muscle and is cleared by the kidney at a constant rate. This test is used
to determine the glomerular filtration rate or the ability of the kidney to clear substances out of the plasma. Blood
urea nitrogen (BUN) measures the amount of urea in the plasma and, although it is reflective of kidney function, it
can be affected by both protein intake and fluid balance. Intravenous pyelogram (IVP) identifies the structures of
the urinary system, not the function. Renal ultrasound identifies renal or perirenal masses or obstructions.
Cognitive Level: Analyzing
Question 46
Type: MCMA
According to evidence-based practice for patients undergoing stem cell transplants, which NANDA nursing
diagnoses would be appropriate?
1. Ineffective Coping
2. Fatigue
3. Interrupted Family Processes
4. Risk for Infection
5. Excess Fluid Imbalance
Correct Answer: 1,2,3,4
Rationale 1: Due to the long-term commitment (6-8 weeks) in isolation and the uncertainty of treatments
outcomes, coping mechanisms often become ineffective due to the variety of physical, mental, and financial
issues that are faced during this life-threatening process. Role strain, depression, pain, loss of independence, and
severe fatigue all contribute to difficulties in coping.
Rationale 2: Fatigue occurs with stem cell transplants from the complete bone marrow suppression, which causes
anemia and decreased RBC to carry the oxygen needed for cellular functioning. Emotional stressors also create a
fatigue while dealing with the entire treatment process. Major depression is not uncommon post-transplant.
Rationale 3: Family commitment and role changes are needed while hospitalized, since strict isolation occurs
during the transplant treatment process. Children might not be allowed to visit, causing further separation by
family members. Job roles (family dynamics) might be changed during hospitalization and recovery.

Rationale 4: Prior to transplant with stem cells, the patient receives total body chemotherapy, causing bone
marrow suppression. Therefore, the WBCs are depleted prior to the transplant, and the ability to fight off an
infection is decreased significantly, creating the need for strict isolation for the patient.
Rationale 5: With chemotherapy, there often is a tendency for nausea and vomiting, leading to fluid loss and not
fluid retention. Therefore, the patient is more likely to have a deficit rather than an excess when receiving
stem cell transplants. Steroid treatment can cause a fluid shift, but usually not an excess fluid balance.
Global Rationale: Due to the long-term commitment (6-8 weeks) in isolation and the uncertainty of treatments
outcomes, coping mechanisms often become ineffective due to the variety of physical, mental, and financial
issues that are faced during this life-threatening process. Role strain, depression, pain, loss of independence, and
severe fatigue all contribute to difficulties in coping. Fatigue occurs with stem cell transplants from the complete
bone marrow suppression, which causes anemia and decreased RBC to carry the oxygen needed for cellular
functioning. Emotional stressors also create a fatigue while dealing with the entire treatment process. Major
depression is not uncommon post-transplant. Family commitment and role changes are needed while hospitalized,
since strict isolation occurs during the transplant treatment process. Children might not be allowed to visit,
causing further separation by family members. Job roles (family dynamics) might be changed during
hospitalization and recovery. Prior to transplant with stem cells, the patient receives total body chemotherapy,
causing bone marrow suppression. Therefore, the WBCs are depleted prior to the transplant, and the ability to
fight off an infection is decreased significantly, creating the need for strict isolation for the patient. With
chemotherapy, there often is a tendency for nausea and vomiting, leading to fluid loss and not fluid retention.
Therefore, the patient is more likely to have a deficit rather than an excess when receiving stem cell
transplants. Steroid treatment can cause a fluid shift, but usually not an excess fluid balance.
Client Need Sub:
Question 47
Type: MCSA
The nurse is caring for a patient who states, My urine has a red-tinged appearance. Which of these questions
would be the most important for the nurse to ask this patient?
1. What medications do you take?
2. Are you allergic to any food or drugs?
3. Do you wake up at night to void?
4. How many times a day do you usually void?
5. What medications do you take?
Correct Answer: 1
Rationale 1: What medications do you take? is correct because several common medications can cause the
urine to become red-tinged. Red-tinged urine that occurs in the absence of medications can indicate hematuria,
and will need further investigation.
Rationale 2: 2. Red-tinged urine is not related to allergies.
Rationale 3: Do you wake up at night to void? is incorrect because this question will elicit data regarding
frequency of urination, not red-tinged urine.
Rationale 4:
Rationale 5:
Global Rationale: Rationale: What medications do you take? is correct because several common medications
can cause the urine to become red-tinged. Red-tinged urine that occurs in the absence of medications can indicate
hematuria, and will need further investigation. Red-tinged urine is not related to allergies. Do you wake up at
night to void? and How many times a day do you usually void? are both incorrect because these questions will
elicit data regarding frequency of urination, not red-tinged urine.
Client Need Sub:
Learning Outcome:
Question 48
Type: MCSA
A nurse is developing a postoperative plan of care for a patient who is scheduled to have a cystogram. Which of
these outcomes should receive priority in the plan?
The patient will be free from signs and symptoms of which of the following?
1. hemorrhage
2. bladder perforation
3. urinary retention
4. postprocedure pain
Correct Answer: 1
Rationale 1: Using the ABCs to prioritize patients needs, hemorrhage relates to circulation and is a priority
concern over bladder perforation, urinary retention, and postoperative pain, though all are important.
concern over bladder perforation, though all are important.
concern over urinary retention, though all are important.
concern over postoperative pain, though all are important.
Global Rationale:
Learning Outcome:


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LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

Rationale 4: There is no indication for daily urinalysis.

Client Need: Physiological Integrity

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

2. Have you been taking your medication on a daily basis?

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

Rationale 3: Parkinsons disease is not associated with kidney disease.

1. rhinovirus taking 10,000 mg of vitamin C daily

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

Rationale 2: During this procedure the bladder will be filled.

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

2. serum creatinine of 1.30 mg/dL

Rationale 1: Clear liquids are allowed.

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

5. teaches patient to report decreased urination

Rationale 3: The other tests do not use contrast media.

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

3. These are signs of acute renal failure.

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

LeMone/Burke/Bauldoff, Medical-Surgical Nursing 5th Edition Test Bank

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