BIOLOGY 102. Medical-Surgical Nursing Critical Thinking in Client Care, CHAPTER 27 AND 28

Medical-Surgical Nursing Critical Thinking in Client Care, 4th Edition Priscilla LeMon

CHAPTER 27 AND 28

Chapter 27

1. The nurse assesses a client admitted to the medical–surgical unit for uncontrolled type I diabetes mellitus and notes that the client’s urine is cloudy and foul-smelling. Which of the following diagnostic tests does the nurse anticipate will be ordered based on this finding?

1. 1. Blood urea nitrogen (BUN)
   2. Creatinine clearance
   3. Residual urine
   4. Urine culture and sensitivity (C&S).

1. When preparing a client 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. 1. Blood urea nitrogen (BUN) 55 mg/dl
   2. Serum creatinine 1.3 mg/dl
   3. Urine culture <10,000 organisms/ml
   4. Residual urine of 80 ml

1. The postoperative client has voided a small amount of urine, and then reports to the nurse feeling like she has to void but is unable to do so. The physician orders the nurse to obtain residual urine for which of the following reasons?

1. 1. To determine renal function
   2. To detect the presence of abnormal substances in urine
   3. To evaluate the amount of urine in bladder post-voiding
   4. To measure the total amount of bladder capacity

4. Because of normal changes due to aging, the nurse anticipates that a 75-year-old client’s serum creatinine level might be which of the following?

1. 1. Higher than normal
   2. Lower than normal
   3. Variable with fluid status
   4. Within normal range

5. The nurse collects all of the following data on a male client scheduled for a CT scan of the kidneys. Which of the findings will necessitate cancellation of the procedure at this time?

  a. Allergy to iodine and seafood

  b. Urinary output of 1,200 ml in 24 hours

  c. Last bowel movement one day ago

  d. Height 5’8” and weight 160 pounds

6. A client tells the nurse conducting a health assessment interview related to urinary structure and function that she has noted red-tinged urine. Which of the following questions will the nurse ask next?

a. “Are you allergic to any food or drugs?”

b. “Do you wake up at night to void?”
c. “How many times a day do you usually void?”

d. “What medications do you take?”

7. A female client, age 68, tells the nurse that she is unable to hold her urine and frequently finds that she has voided involuntarily. The nurse analyzes this finding as which of the following?

a.       An abnormal finding requiring further testing

b.      An indication of the presence of a urinary infection

c.       A normal outcome of the aging process

d.      The result of having several children

8. All of the following diagnostic tests are ordered on a client with renal disease. The nurse understands that which one will help evaluate the client’s glomerular filtration rate (GFR)?

a. Blood urea nitrogen (BUN)

b. Creatinine clearance

c. Intravenous pyelogram (IVP)

d. Renal ultrasound

Chapter 28

1. The nurse in an emergent care center assesses a 40-year-old female client who has presented with a fever of 101.2°F and complaints of urinary frequency and urgency. Which of the following questions does the nurse ask to elicit further data indicative of suspected urinary tract infection (UTI) cystitis?

1. 1. “Do you have any upper abdominal pain or cramping?”
   2. “Do you have any symptoms of menopause?”
   3. “Have you experienced painful urination or blood in your urine?”
   4. “How long have you had a fever, and have you had chills with this?”

1. The nurse best evaluates teaching for a female client with a urinary tract infection who has been treated with a three-day course of oral trimethoprim-sulfamethoxazole (TMP-SMZ) has been effective if the client does which of the following?
   1. Increases intake of fluids, especially citrus juice.
   2. Practices Kegel exercises on daily basis.
   3. Returns within 10 days for a follow-up urine culture.
   4. States she will wear underwear made from cotton materials.

1. The nurse practices strict aseptic technique when inserting an indwelling urinary catheter, and also does which of the following to reduce the risk of catheter-associated infection?

1. 1. Inflates a balloon while the catheter is in the urethra.
   2. Instructs client not to void around the catheter.
   3. Irrigates the catheter with sterile saline on a daily basis.
   4. Uses an anesthetic lubricating gel during insertion.

Nursing Process: Implementation

Category of Client Need: Safe, Effective Care Environment: Safety and Infection Control

1. The nurse identifies which of the following clients as having the greatest risk for urinary stones?

1. 1. 70-year-old male with a recent history of myocardial infarction
   2. 45-year-old female with paraplegia from an auto accident
   3. 60-year-old male with type II diabetes mellitus
   4. 30-year-old female with several episodes of urinary infection

1. A client with several episodes of urinary calculi has been found through analysis to have stones composed of calcium phosphate. The nurse teaches this client to reduce intake of which of the following foods?

1. 1. Flour, milk, and milk products
   2. Organ meats, sardines, and seafood
   3. Tomatoes, fruits, and nuts
   4. Chicken, beef, and ham products

1. A newly admitted client to the medical–surgical unit is found to have ureteral calculi. The nursing diagnosis having priority is which of the following?

1. 1. Pain, Acute
   2. Fluid Volume, Deficient
   3. Knowledge, Deficient
   4. Skin Integrity, Risk for Impaired

1. The nurse assesses that a client who had a radical cystectomy with creation of an ileal conduit two days ago because of bladder cancer has a urinary output of 100 ml for the past six hours. The nursing diagnosis established is Urinary Elimination, Impaired. Which of the following is the most appropriate nursing action?

1. 1. Continue to monitor the urinary drainage on hourly basis.
   2. Encourage the client to increase oral intake of fluids.
   3. Record the output on the flow sheet.
   4. Report the urinary output to the physician.

1. The nurse evaluates the client with a neurogenic bladder for which of the following results of the administered anticholinergic medication oxybutynin (Ditropan)?

1. 1. Decreased urinary incontinence
   2. Increased urinary output within 30 minutes
   3. Decreased complaints of bladder pain
   4. Increased frequency of urination