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Introductory Medical Surgical Nursing 11th Edition Timby Smith Test Bank

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Introductory Medical Surgical Nursing 11th Edition Timby Smith Test Bank

ISBN-13: 978-1451177329

ISBN-10: 1451177321

 

 

Description

Introductory Medical Surgical Nursing 11th Edition Timby Smith Test Bank

ISBN-13: 978-1451177329

ISBN-10: 1451177321

 

 

 

 

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Free Nursing Test Questions:

Chapter 57, Introduction to the Urinary System

1. Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys?
  A) Radiography
  B) Angiography
  C) Computed tomography (CT scan)
  D) Cystoscopy
  Ans: B
  Feedback:
  Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the bladder.

 

 

2. During the physical examination of a client, the nurse monitors for signs that may indicate a urinary tract disorder. Which of the following would suggest that the client may have a urinary tract disorder?
  A) Light-headedness
  B) Malaise
  C) Periorbital edema
  D) Flank pain
  Ans: C, D
  Feedback:
  Periorbital edema, among other signs, such as edema of the extremities, cardiac failure, and mental changes may indicate a urinary tract disorder. Light-headedness and flank pain may suggest urinary bleeding. Malaise is a sign of systemic infection. Flank pain and malaise could occur after a biopsy, and if they occur, the physician is to be notified immediately.

 

 

3. A client is scheduled for a renal angiography. Which of the following would be appropriate before the test?
  A) Monitor the client for signs of electrolyte and water imbalance.
  B) Monitor the client for an allergy to iodine contrast material.
  C) Assess the client’s mental changes.
  D) Evaluate the client for periorbital edema.
  Ans: B
  Feedback:
  A renal angiography procedure will be contraindicated if the client is allergic to iodine contrast material. Therefore, it is important for the nurse to monitor the client for an allergy to iodine contrast material. The nurse monitors the client for the signs of electrolyte and water imbalance, mental changes, and periorbital edema at any time regardless of the test being done.

 

 

4. A client who is suspected of urinary tract infection is asked to collect a 24-hour urine specimen for culture. Which of the following measures can the nurse suggest to the client that may help prevent the entire urine specimen from becoming contaminated?
  A) Collect the voided urine sample primarily before 5 AM.
  B) Refrigerate the specimen until it is taken to the laboratory.
  C) Use the same receptacle for voiding and defecation.
  D) Store the collected urine away from sunlight.
  Ans: B
  Feedback:
  To prevent the entire urine specimen from becoming contaminated, the urine specimen should be refrigerated until it can be taken to the laboratory. The nurse should ask the client to use separate receptacles for voiding and defecation to prevent any part of the specimen from being lost or contaminated. Urinating and collecting the urine sample only before 5 AM and collecting and storing the urine away from sunlight will not help prevent the urine specimen from becoming contaminated.

 

 

5. When describing the functions of the kidney to a client, which of the following would the nurse include?
  A) Regulation of white blood cell production
  B) Synthesis of vitamin K
  C) Control of water balance
  D) Secretion of the enzyme renin
  Ans: C, D
  Feedback:
  Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins. They also produce the enzyme renin.

 

 

6. A group of students is reviewing for a test on the urinary and renal system. The students demonstrate understanding of the information when they identify which of the following as part of the upper urinary tract?
  A) Bladder
  B) Urethra
  C) Ureters
  D) Pelvic floor muscles
  Ans: C
  Feedback:
  The upper urinary tract is composed of the kidneys, renal pelvis, and ureters. The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.

 

 

7. A nurse is describing the renal system to a client with a kidney disorder. Which structure would the nurse identify as emptying into the ureters?
  A) Nephron
  B) Renal pelvis
  C) Parenchyma
  D) Glomerulus
  Ans: B
  Feedback:
  The renal pelvis empties into the ureter, which carries urine to the bladder for storage. The nephron consists of the glomerulus, afferent arteriole, efferent arteriole, Bowman’s capsule, distal and proximal convoluted tubules, the loop of Henle, and collecting tubule. The nephron is located in the cortex and carries out the functions of the kidney. The parenchyma is made up of the cortex and medulla.

 

 

8. The nurse reviews a client’s history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following?
  A) Kidney stones
  B) Neurogenic bladder
  C) Chronic renal failure
  D) Fistula
  Ans: A
  Feedback:
  A client with hyperparathyroidism is at risk for kidney stones. The client with diabetes mellitus is a risk factor for developing chronic renal failure and neurogenic bladder. A client with radiation to the pelvis is at risk for urinary tract fistula.

 

 

9. A client has a full bladder. Which sound would the nurse expect to hear on percussion?
  A) Tympany
  B) Dullness
  C) Resonance
  D) Flatness
  Ans: B
  Feedback:
  Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very dense tissue, such as the bone or muscle.

 

 

10. The nurse is providing care to a client who has had a renal biopsy. The nurse would need to be alert for signs and symptoms of which of the following?
  A) Bleeding
  B) Infection
  C) Dehydration
  D) Allergic reaction
  Ans: A
  Feedback:
  Renal biopsy carries the risk of postprocedure bleeding because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater. Dehydration and allergic reaction are not associated with a renal biopsy.

 

 

11. The nurse is caring for a client with oliguria. When instructing the client on the process of urine formation, place the following in correct sequence. Use all options.
  A) Products enter the Bowman’s capsule
  B) Drains from the collecting tubules
  C) Filtration of plasma by glomerulus
  D) Moves through the nephrons and is absorbed or excreted
  E) Flows into the renal pelvis and down the ureter
  F) Drains into the bladder then out the urethra
  Ans: A, B, C, D, E, F
  Feedback:
  There are three main steps with substeps in the complex process of forming urine. The glomerular filtration begins with filtering of the blood plasma by the glomerulus. Next, the filtrate enters Bowman’s capsule and moves through the tubular system of the nephron and is either absorbed into circulation or excreted as urine. The formed urine drains from the collecting tubules into the renal pelvis and down each ureter to the bladder and out through the urethra.

 

 

12. The nurse is caring for clients at a long-term care facility. When considering activities in the summer heat, which physiologic change of renal aging can also result in geriatric dehydration?
  A) Decreased ability to concentrate urine
  B) Decreased renal blood flow
  C) Thickening of the renal tubules
  D) Double voiding
  Ans: A
  Feedback:
  A gerontologic consideration of aging is the decreased ability to concentrate urine. This consideration leads to an increased susceptibility to dehydration further complicated by a deficit in thirst. Other age-related changes include a decrease in renal blood flow and a thickening of the renal tubules. These changes lead to an alteration in the excretion of drugs in older adults, increasing the risk of drug toxicity. Double voiding is remaining at the toilet after voiding to allow time for additional urine to be excreted.

 

 

13. The nurse is caring for a client who has a history of urine reflux. To assess the client for this urinary complication, which nursing action is best?
  A) Ask the client if voiding sufficient quantities has been a problem.
  B) Monitor the client’s intake and output for inconsistency.
  C) Have the client void into a collection device.
  D) Palpate the client’s bladder for distension.
  Ans: D
  Feedback:
  Normally, urine flows in one direction because of peristaltic action and because the ureters enter the bladder at an oblique angle. The reflux of urine (urine that flows backward) can occur secondary to a distended bladder. By palpating for bladder distension, the nurse is able to determine that reflux urine traveled back to the bladder instead of traveling from the bladder down the urethra. All of the other options provide data that can be helpful, but actually feeling for the distension is best. Using a bladder scanner would also provide an amount of urine in the bladder.

 

 

14. The client tells the nurse of the feeling of always needing to void. The nurse instructs on normal urine elimination. At which amount of urine accumulation in the bladder is the nerve reflex triggered to signal the need to void?
  A) 150 mL
  B) 300 mL
  C) 500 mL
  D) 750 mL
  Ans: A
  Feedback:
  The nerve reflex is triggered when approximately 150 mL of urine accumulates.

 

 

15. The nurse is completing a full exam of the renal system. Which assessment finding best documents the need to offer the use of the bathroom?
  A) Tenderness over the kidneys
  B) Bruits noted over the abdominal area
  C) A dull sound when percussing over the bladder
  D) The ingestion of 8 oz of water
  Ans: C
  Feedback:
  A dull sound when percussing over the bladder indicates a full bladder. Because the bladder is full, the nurse would offer for the client to use the bathroom. Tenderness over the kidney can indicate an infection or stones. Bruits are an abnormal vascular sound that does not indicate the need to use the bathroom. Ingesting water does not mean that the client has to void at this time.

 

 

16. The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client assess for an allergy to shellfish?
  A) Radiography
  B) Computed tomography with contrast
  C) Cystoscopy
  D) Bladder ultrasonography
  Ans: B
  Feedback:
  The nurse is correct to assess for an allergy to shellfish most times when a contrast medium is ordered. The other options do not necessarily have a contrast medium.

 

 

17. The nurse caring for a client is providing instructions for an upcoming renal angiography. Which nursing action, explained in the preoperative instructions, is essential in the postprocedure period?
  A) Encourage voiding following the procedure.
  B) Assess renal blood work.
  C) Assess cognitive status.
  D) Complete a pulse assessment of the legs and feet.
  Ans: D
  Feedback:
  A renal angiography provides details about the arterial blood supply to the kidney. A catheter is passed up the femoral artery into the aorta in the area of the renal artery. After the procedure, a pressure dressing remains in place for several hours. It is essential that the nurse palpates pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Reviewing lab work is completed in the preoperative period. Voiding assesses renal status that provides additional data in the postprocedural period. Assessing cognitive status is completed due to the sedative that is administered in the preprocedural period.

 

 

18. The client is admitted to the nursing unit for a biopsy of the urinary tract tissue. When planning nursing care for the postoperative period, which nursing intervention documents the prescribed activity level?
  A) Maintain the client on bedrest
  B) Assist the client for bathroom privileges
  C) Ambulate the client in the hall
  D) Activity as tolerated
  Ans: A
  Feedback:
  In the postoperative period, the client remains on bed rest as the nurse assess for signs of bleeding. If the client is to be discharged on the following day, the client is to maintain limited activity for several days to avoid spontaneous bleeding.

 

 

19. The nurse is caring for clients on a medical urinary unit. Which client, scheduled for a urinary procedure, will be prescribed antibiotics following the procedure?
  A) The client scheduled for a voiding cystourethrography
  B) The client scheduled for a cystoscopy
  C) The client scheduled for a retrograde pyelography
  D) The client scheduled for a cystometrography
  Ans: D
  Feedback:
  A cystometrography evaluates bladder tone and capacity. Because solution is instilled into the client’s bladder, antibiotics may be prescribed for a day or two. The other options do not regularly have antibiotics prescribed.

 

 

20. The nurse is reviewing urine tests to obtain client baseline information. Which of the following urine tests is preferred to identify characteristics of normal and abnormal urine?
  A) A 24-hour urine kept in the bathroom on ice
  B) A catheterized specimen obtained at no particular time
  C) A clean-catch midstream specimen from the first voiding of the morning
  D) A specimen obtained from an indwelling Foley catheter’s bag
  Ans: C
  Feedback:
  When obtaining urine for baseline information, the preferred test is a clean-catch midstream specimen obtained from the first voiding of the morning. Specialized testing is not done until a baseline test is completed to identify abnormal readings. It is best to obtain data from the least invasive method. Specimens from a Foley catheter are obtained from the port not from the bag.

 

 

21. The nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client’s symptoms and urine specific gravity is anticipated?
  A) The specific gravity will be inversely proportional.
  B) The specific gravity will equal to one.
  C) The specific gravity will be high.
  D) The specific gravity will be low.
  Ans: C
  Feedback:
  The nurse assesses all of the data to make an informed decision on client status. On a hot day, the client found outside will be perspiring. When dehydration occurs, a client will have low urine output and increased specific gravity of urine. Normal specific gravity is inversely proportional. The density of distilled water is one. A low specific gravity is noted in a client with high fluid intake and who is not losing systemic fluid.

 

 

22. Which of the following urine characteristics would the nurse anticipate when caring for a client whose lab work reveals a high urine specific gravity related to dehydration?
  A) Dark amber urine
  B) Clear or light yellow urine
  C) Red urine
  D) Turbid urine
  Ans: A
  Feedback:
  Concentrated urine (one with a high specific gravity) is a dark amber color due to the solutes in the urine. Clear or yellow urine indicates a flushing of the urinary system. Red urine indicates hematuria. A turbid urine may indicate bacteriuria.

 

 

23. The nurse has received morning lab work on a client with chronic renal disease. Which finding indicates renal disease?
  A) Urine pH of 6.5
  B) Urine nitrate: negative
  C) Protein level of 400 mg/dL
  D) Specific gravity: 1.002
  Ans: C
  Feedback:
  The nurse must analyze components of a urinalysis to determine abnormal results. Protein at a level of 400 mg/dL is high and indicates renal disease. The other results are normal.

 

 

24. A client asks the nurse why a creatinine clearance test is accurate. The nurse is most correct to reply which of the following?
  A) “Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney.”
  B) “Creatinine is metabolized in the liver and excreted by the kidney at a regular rate.”
  C) “Creatinine is a stress-related response that is excreted by the kidney.”
  D) “Creatinine is found in the urine to make the urine acidic and can be measured.”
  Ans: A
  Feedback:
  A creatinine clearance test is used to determine kidney function and creatinine excretion. Creatinine results from a breakdown of phosphocreatine. It is filtered by the glomeruli and excreted at a consistent rate by the kidney.

 

 

25. The nurse is caring for a client prescribed gentamicin 110 mg every 8 hours for 10 days. Which laboratory study is anticipated to monitor medication side effects?
  A) Blood chemistry
  B) BUN and serum creatinine
  C) Creatinine clearance test
  D) Urine osmolality
  Ans: B
  Feedback:
  The client who is on a therapeutic regimen of gentamicin is ordered laboratory studies of a BUN and serum creatinine to monitor for signs of nephrotoxicity related to medication therapy. Nephrotoxicity from the use of an aminoglycoside is reversible if the medication is discontinued. The other laboratory studies do not focus on nephrotoxicity.

 

 

26. Which nursing action is best to comfort the client prior to urologic testing?
  A) Reassure the client the nurses are here to help and all will be fine.
  B) Allow for client’s family to be present during testing.
  C) Provide for privacy and allow verbalization of concerns.
  D) Allow the client to determine the care to be provided.
  Ans: C
  Feedback:
  Clients undergoing diagnostic testing are often anxious and worried. Clients having urologic testing may also feel embarrassed. Provide privacy, reassurance, and information and maintain professional and empathic attitude. Allowing families to be present during testing and the client to determine care is not appropriate and may be distracting to the client.

 

 

27. The nurse is caring for an 84-year-old client who is being admitted for diagnostic studies for a potential renal disorder. The nurse planning care has initiated a care plan of “Knowledge Deficit related to poor understanding of diagnostic studies as manifested by client statements of not understanding diagnostic procedures and elevated anxiety.” Which nursing interventions does the nurse include in the plan of care? Select all that apply.
  A) Assess client’s level of understanding.
  B) Provide written reading material.
  C) Remain with client and answer questions.
  D) Administer an ordered sedative.
  E) Use simple language.
  F) Direct instruction to family.
  Ans: A, C, D, E
  Feedback:
  The nurse is caring for a client who is unsure of the diagnostic study and is anxious. The nursing interventions to assist the client begin with understanding knowledge base following an assessment of understanding. Next, remaining with client and answering questions in simple terms alleviates anxiety and opens teaching and communication. If all consents are signed, an ordered sedative may diminish client anxiety. Providing written material at this time is not helpful and may increase anxiety. All instruction should be primarily directed toward the client but include all family members.

 

 

28. When teaching a client about a diagnostic procedure, which teaching philosophy provides the best manner to present the information to the client?
  A) Stand beside the client and direct all information in the client’s direction.
  B) Begin with the information most difficult to understand.
  C) Include humorous pictures to lighten the mood.
  D) Move from general details of the procedure to specifics.
  Ans: D
  Feedback:
  Move from the general aspects such as purpose of the procedure to specifics including how the client will assist in the procedure. Doing so provides a foundation of knowledge and proceeds to more specific information. The client is more willing to participate when knowing the rationale. Standing beside the client, particularly if the client is in bed or seated, is a position of power. Humorous pictures do not convey the importance of the procedure or client participation.

 

 

29. The nurse discontinues a client’s Foley catheter following diagnostic procedure. When assessing the client’s voided urine, it is noted to be concentrated with red strings. Which nursing action is best?
  A) Ambulate the client in the hall.
  B) Instruct the client to increase fluid intake.
  C) Call the physician for further instructions.
  D) Wait to see the next voided specimen.
  Ans: B
  Feedback:
  The nurse is correct to instruct the client to increase fluid intake and then will assess the next voided specimen. Concentrated urine can be a sign that fluids are needed and red strings within the urine can be from irritation of the Foley catheter. It is too early to call the physician unless the nurse has other documentation of an infection or urinary problem.

 

 

30. The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client’s kidneys for tenderness?
  A) The upper abdominal quadrants on the left and right side
  B) The costovertebral angle
  C) Above the symphysis pubis
  D) Around the umbilicus
  Ans: B
  Feedback:
  The nurse is correct to assess the kidneys for tenderness at the costovertebral angle. The other options are incorrect.

 

 

31. The nurse is instructing a senior high health class on the function of the kidney. The nurse is correct to highlight which information? Select all that apply.
  A) Regulates estrogen and progesterone
  B) Excretes waste products
  C) Controls blood pressure
  D) Regulate calcium and the synthesis of vitamin D
  E) Activates growth hormone
  F) Regulates red blood cell production
  Ans: B, C, D, E, F
  Feedback:
  The nurse is correct to highlight all of the options except regulates estrogen and progesterone. The pituitary gland controls hormone secretion.

 

 

32. The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable?
  A) Clients have frequent urinary tract infections.
  B) Clients develop a neurogenic bladder.
  C) Clients have urinary frequency.
  D) Clients have chronic renal failure.
  Ans: D
  Feedback:
  Although all of the options may occur in the client with diabetes mellitus, the option which is most notable, and potentially life threatening, is chronic renal failure.

 

 

33. The nurse is obtaining a history on a client stating nocturia. When evaluating the client’s evening behaviors, which may be the cause of the problem?
  A) The client takes 8 oz of water after dinner with her evening medications.
  B) The client urinates for the evening while getting ready for bed.
  C) The client takes a furosemide (Lasix) with the evening medications.
  D) The client uses the Credé’s maneuver when urinating at bedtime.
  Ans: C
  Feedback:
  Taking a diuretic furosemide (Lasix) in the evening can produce nocturia when the therapeutic action of the medication is initiated. A diuretic should be administered in the morning or no later than early evening to avoid nocturia. Drinking water with medications after dinner, urinating before bed, and using the Credé’s maneuver to remove urine from the bladder are acceptable methods to avoid large fluid intake before bedtime and eliminate urine from the bladder before the nighttime period.

 

 

34. The nurse is instructing a 3-year-old’s mother regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as normal finding for this age-group?
  A) Dysuria
  B) Enuresis
  C) Hematuria
  D) Anuria
  Ans: B
  Feedback:
  The nurse would be most correct to document that enuresis, the involuntary voiding during sleep or commonly called “wetting the bed,” is a normal finding in a pediatric client younger than 5 years old. Dysuria (pain on urination), hematuria (red blood cells in urine), and anuria (urine output less than 50 mL/day) are all abnormal findings needing further investigation.

 

 

35. The nurse is assisting the physician in completing a cystoscopy. In which position would the nurse place the client when preparing for the procedure?
  A) On the client’s back with knees to the side
  B) On the client’s back with feet in the stirrups
  C) On the client’s right side with a pillow behind the back
  D) On the client’s left side with a pillow behind the back
  Ans: B
  Feedback:
  The client who is undergoing a cystoscopy will be positioned on the back with the feet in stirrups. The client is also to have an empty bladder and may be sedated for the procedure.

 

 

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