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Medical Surgical Nursing 1st Edition deWit Sanders Test Bank

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Medical Surgical Nursing 1st Edition deWit Sanders Test Bank

ISBN:

1416032231

ISBN-13:

9781416032236

 

Description

Medical Surgical Nursing 1st Edition deWit Sanders Test Bank

ISBN:

1416032231

ISBN-13:

9781416032236

 

 

 

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Free Nursing Test Questions:

deWit: Medical-Surgical Nursing

 

Test Bank

 

Chapter 33: The Urinary System

 

MULTIPLE CHOICE

 

  1. The 85-year-old patient was held NPO since midnight last night for testing. The procedure is now complete at 10:00 AM. The nurse should:
1. check urine for concentration every hour.
2. measure urine output every 2 hours.
3. assess urine for the presence of glucose.
4. offer 4 ounces of water or juice every hour.

 

 

ANS:   4

Offering small amounts of fluid every hour will re-hydrate the older adult without resorting to IV fluids. The older adult has very little fluid reserve and has lost the ability to concentrate the urine; consequently, a long period without fluid intake can cause dehydration.

 

DIF:    Cognitive Level: application              REF:    816 | Elder Care Points

OBJ:    1 (clinical)       TOP:    Dehydration in the older adult

KEY:   Nursing Process Step: planning

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. The nurse cautions the diabetic patient that ultimately the disease will affect the blood flow through the kidney due to:
1. long-term high glucose levels.
2. scleroses of renal vessels.
3. arterial spasm.
4. long-term insulin use.

 

 

ANS:   2

The long-term effect of diabetes is generalized vasoconstriction, which leads many diabetic patients to renal insufficiency and renal failure.

 

DIF:    Cognitive Level: application              REF:    816                  OBJ:    2 (theory)

TOP:    Renal insufficiency related to diabetes mellitus

KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse explains that, when the kidney suffers an autoimmune inflammatory reaction the glomeruli lose their ability to function effectively, which leads to the condition of:
1. glomerulonephritis.
2. reduced urinary output.
3. nephrosis.
4. nephrotoxicity.

 

 

ANS:   1

Glomerulonephritis occurs when the inflammatory process alters the effectiveness of the semipermeable membrane in the glomeruli.

 

DIF:    Cognitive Level: comprehension       REF:    819                  OBJ:    2 (theory)

TOP:    Glomerulonephritis: etiology             KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse understands that most often tumors occur in the bladder because the bladder wall is exposed most frequently to:
1. retained carcinogens.
2. concentrated urine.
3. acidic fluids.
4. strong metabolic wastes.

 

 

ANS:   1

Retained carcinogenic agents stay in intimate contact with the bladder wall until excreted in the urine.

 

DIF:    Cognitive Level: comprehension       REF:    819                  OBJ:    2 (theory)

TOP:    Bladder cancer related to retained carcinogens

KEY:   Nursing Process Step: assessment

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. When the patient asks why he has so many urinary tract infections (UTIs), the nurse points out that UTIs can result from:
1. bacteria that have colonized in the kidney.
2. viral infections generating debris in the bladder.
3. carelessness in handwashing.
4. spicy foods irritating the bladder wall.

 

 

ANS:   1

Bacteria filtered out of the circulating volume stay in the bladder until excreted with the urine. The bacteria can colonize there.

 

DIF:    Cognitive Level: comprehension       REF:    819                  OBJ:    2 (theory)

TOP:    UTI: etiology                                      KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. The nurse clarifies that nephrotoxic drugs such as doxycycline and rifampin can cause kidney damage by:
1. bacterial destruction of the nephrons.
2. chemical alterations of glomeruli.
3. necrosis of tubules from reduction of oxygenation.
4. “clumping” of cellular debris from killed bacteria.

 

 

ANS:   2

Nephrotoxic drugs may chemically alter the glomeruli, which make them ineffective.

 

DIF:    Cognitive Level: application              REF:    819                  OBJ:    2 (theory)

TOP:    Nephrotoxicity                                   KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. The nurse recommends that, in order to keep optimum flow through the urinary system, a person should have a minimum intake of _____ mL/day.
1. 1000 to 1500
2. 2000 to 2500
3. 3000 to 3500
4. 4000 to 4500

 

 

ANS:   2

Intake of a minimum of 2000 mL/day is adequate to maintain optimal flow through the urinary system.

 

DIF:    Cognitive Level: comprehension       REF:    819                  OBJ:    3 (theory)

TOP:    Optimum fluid intake                         KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. When a patient is put on a sulfa drug, the nurse adds interventions to the nursing care plan to increase the daily fluid intake to a minimum of _____ mL/day.
1. 1500
2. 2000
3. 2500
4. 3000

 

 

ANS:   4

While on nephrotoxic drugs, a fluid intake of 3000 to 3500 mL/day is recommended.

 

DIF:    Cognitive Level: comprehension       REF:    820                  OBJ:    3 (theory)

TOP:    Sulfa drugs: increased fluid intake    KEY:   Nursing Process Step: planning

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. The nurse reviewing lab reports on kidney function identifies a result that suggests decreased renal function, which is:
1. blood urea nitrogen (BUN) 10.5 mg/dL.
2. creatinine 0.6 mg/dL.
3. BUN 15 mg/dL.
4. creatinine 2.0 mg/dL.

 

 

ANS:   4

The normal for BUN is 10 to 20 mg/dL. The normal for creatinine is 0.6 to 1.2 mg/dL. The creatinine is elevated.

 

DIF:    Cognitive Level: application              REF:    820 | Clinical Cues

OBJ:    3 (theory)        TOP:    Serum reports: BUN and creatinine

KEY:   Nursing Process Step: assessment

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. The nurse explains that the diagnostic test cystometrography measures:
1. urine flow volume and muscle function.
2. renal clearance and urinary volume.
3. particulate matter in the urine.
4. time it takes for an injected dye to appear in the urine.

 

 

ANS:   1

Cystometrography measures the urine flow and the muscles that control the flow.

 

DIF:    Cognitive Level: application              REF:    820                  OBJ:    1 (clinical)

TOP:    Cystometrography: purpose               KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. While caring for a 40-year-old woman with a suspected vaginal fistula, the nurse assesses the urine for:
1. pneumaturia.
2. hematuria.
3. oliguria.
4. dysuria.

 

 

ANS:   1

Gas in the urine is a cardinal sign of a vaginal fistula.

 

DIF:    Cognitive Level: comprehension       REF:    827                  OBJ:    2 (clinical)

TOP:    Vaginal fistula: pneumaturia              KEY:   Nursing Process Step: assessment

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. When the patient reports he has blood in his urine the moment he starts to void which disappears until the next time he voids, the nurse is aware that the source of the bleeding is most probably in:
1. the kidney.
2. above the neck of the bladder.
3. in the neck of the bladder.
4. the urethra.

 

 

ANS:   4

Hematuria that begins at the initiation of the stream, then abates, is usually in the urethra. Bleeding from the neck of the bladder will appear at the end of the voiding. Bleeding from above the neck of the bladder will be present all the time.

 

DIF:    Cognitive Level: application              REF:    826                  OBJ:    3 (clinical)

TOP:    Hematuria: location                            KEY:   Nursing Process Step: assessment

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. When the patient complains of having urinary frequency, the nurse would be prompted to inquire about the patient’s intake of:
1. red meat.
2. caffeine.
3. over-the-counter cold remedies.
4. tomato juice.

 

 

ANS:   2

Caffeine and alcohol are common causes of urinary frequency.

 

DIF:    Cognitive Level: application              REF:    827                  OBJ:    2 (theory)

TOP:    Urinary frequency: cause                   KEY:   Nursing Process Step: assessment

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. When irrigating an indwelling catheter, the nurse should:
1. use steady gentle pressure.
2. force solution into catheter to remove obstruction.
3. pull back on plunger if fluid will not enter catheter.
4. count amount of irrigation fluid as output.

 

 

ANS:   1

A steady gentle pressure is all that is necessary to irrigate an indwelling catheter.

 

DIF:    Cognitive Level: application              REF:    829 | Box 33-2

OBJ:    3 (clinical)       TOP:    Irrigation of indwelling catheter

KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Safe, Effective Care Environment: Safety and Infection Control

 

  1. The patient confides that sneezing makes her “wet her pants.” The nurse recognizes this is a cardinal sign of _____ incontinence.
1. urge
2. stress
3. functional
4. overflow

 

 

ANS:   2

Stress incontinence is marked by sphincter failure when intra-abdominal pressure is increased by sneezing, coughing, or laughing.

 

DIF:    Cognitive Level: comprehension       REF:    830                  OBJ:    4 (theory)

TOP:    Incontinence: stress                            KEY:   Nursing Process Step: assessment

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The frustrated patient reports that, after two surgeries to correct incontinence, she is still involuntarily voiding. The nurse suggests that the patient:
1. wear heavy pads.
2. keep a voiding diary.
3. acquire an indwelling catheter.
4. attempt to void every hour.

 

 

ANS:   2

Keeping a voiding diary identifies involuntary voiding times that can be averted by using the toilet just prior to the identified times and using the diary to set up a voiding schedule.

 

DIF:    Cognitive Level: application              REF:    832                  OBJ:    4 (clinical)

TOP:    Incontinence: voiding diary               KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. In instructing the patient in the use of vaginal weight training, the nurse coaches the patient to insert the smallest of the cones in the vagina and:
1. wear it all day.
2. perform 10 Kegel exercises and remove it, repeating this exercise three times a day.
3. hold in place with muscle tightening for 15 minutes and remove it.
4. attempt to expel it with vaginal muscle tightening.

 

 

ANS:   3

The weight is held in place for 15 minutes. When that weight is held without difficulty, the exercises advance using heavier weights.

 

DIF:    Cognitive Level: comprehension       REF:    830                  OBJ:    4 (clinical)

TOP:    Incontinence: vaginal weight training

KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

MULTIPLE RESPONSE

 

  1. The nurse lists the functions of the kidney, which include: (Select all that apply.)
1. regulation of electrolytes.
2. elimination of metabolic waste.
3. regulation of fluid volume.
4. regulation of blood pressure.
5. secretion of erythropoietin.

 

 

ANS:   1

All the options listed are function of the kidney.

 

DIF:    Cognitive Level: comprehension       REF:    818                  OBJ:    1 (theory)

TOP:    Kidney function                                 KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse outlines the age-related changes that occur in the urinary system, which include: (Select all that apply.)
1. hypertrophy of the prostate.
2. decrease in secretion of renin.
3. decrease in muscle tone of bladder.
4. enlargement of bladder.
5. increase in ability to concentrate urine.

 

 

ANS:   1, 2, 3

As the urinary system ages, the bladder size shrinks and the kidney loses its ability to concentrate urine.

 

DIF:    Cognitive Level: comprehension       REF:    818                  OBJ:    2 (theory)

TOP:    Age-related changes in the urinary system

KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse teaching a health class to junior high school students reminds them to empty their bladders as soon as they feel the urge because timely voiding prevents: (Select all that apply.)
1. prolonged exposure of the bladder wall to harmful wastes.
2. overfilling the bladder and stretching the bladder wall.
3. undue strain on the urinary sphincters.
4. changes in urinary character from being in the bladder overlong.
5. pressure of overfull bladder pressing on colon.

 

 

ANS:   1, 2, 3

Urine does not change character in the bladder and does not press on the colon.

 

DIF:    Cognitive Level: comprehension       REF:    819 | Health Promotion Points 33-1

OBJ:    2 (theory)        TOP:    Encouraging voiding frequency

KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. While caring for a patient with an indwelling catheter, the nurse will include in the daily care the interventions of: (Select all that apply.)
1. observing tube placement and level of urine in collection bag.
2. keeping drainage bag below the level of the bed.
3. avoiding patient ambulating with the catheter collection bag.
4. cutting off balloon arm when discontinuing the catheter.
5. cleaning meatus and catheter with soap and water.

 

 

ANS:   1, 2, 5

The balloon arm should not be cut off, but emptied by the use of a syringe. Patients with indwelling catheters can be ambulated as long as the bag is below the insertion site of the catheter.

 

DIF:    Cognitive Level: application              REF:    829 | Box 33-2

OBJ:    3 (clinical)       TOP:    Catheter care

KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Safe, Effective Care Environment: Safety and Infection Control

 

  1. When the patient complains of urinary retention, the nurse can help the patient to void by: (Select all that apply.)
1. giving patient privacy and adequate time to void.
2. offering caffeine or carbonated drinks.
3. providing a warm bath.
4. instructing in the double void technique.
5. running water in lavatory to stimulate urination.

 

 

ANS:   1, 2, 3, 4, 5

All options are acceptable intervention to assist a patient to void.

 

DIF:    Cognitive Level: application              REF:    832                  OBJ:    3 (theory)

TOP:    Urine retention: techniques to relieve

KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

COMPLETION

 

  1. The basic functional unit of the kidney is the ____________________.

 

ANS:

nephron

The nephron is the functional unit of the kidney, housing the glomerulus and the collecting tubules. Each kidney has approximately 1 million nephrons.

 

DIF:    Cognitive Level: knowledge              REF:    817                  OBJ:    1 (theory)

TOP:    Nephron: definition                            KEY:   Nursing Process Step: planning

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. The nurse explains that the urge to void occurs when the bladder contain as little as ____________________ mL of urine.

 

ANS:

150

The bladder will transmit the urge to void with a bladder content as little as 150 mL of urine.

 

DIF:    Cognitive Level: knowledge              REF:    818                  OBJ:    3 (theory)

TOP:    Voiding: urge                                     KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

MATCHING

 

In order to communicate with the patient more effectively, the nurse clarifies the meanings of some urological terms. Match these terms with their correct definitions.

1. Anuria
2. Oliguria
3. Polyuria
4. Nocturia
5. Hematuria

 

 

  1. Diminished urine

 

  1. Blood in the urine

 

  1. Urination at night

 

  1. High urinary output

 

  1. Absence of urine

 

  1. ANS:   2                      DIF:    Cognitive Level: knowledge              REF:    825-826

OBJ:    1 (theory)        TOP:    Definitions of terms

KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. ANS:   5                      DIF:    Cognitive Level: knowledge              REF:    825-826

OBJ:    1 (theory)        TOP:    Definitions of terms

KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. ANS:   4                      DIF:    Cognitive Level: knowledge              REF:    825-826

OBJ:    1 (theory)        TOP:    Definitions of terms

KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. ANS:   3                      DIF:    Cognitive Level: knowledge              REF:    825-826

OBJ:    1 (theory)        TOP:    Definitions of terms

KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. ANS:   1                      DIF:    Cognitive Level: knowledge              REF:    825-826

OBJ:    1 (theory)        TOP:    Definitions of terms

KEY:   Nursing Process Step: implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

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