1.            To assess whether there is any improvement in a patients dysuria, which question will the nurse ask?

a.            Do you have to urinate at night?

b.            Do you have blood in your urine?

c.             Do you have to urinate frequently?

d.            Do you have pain when you urinate?

ANS: D

Dysuria is painful urination. The alternate responses are used to assess other urinary tract symptoms: hematuria, nocturia, and frequency.

2.            When a patients urine dipstick test indicates a small amount of protein, the nurses

next action should be to

a.            send a urine specimen to the laboratory to test for ketones.

b.            obtain a clean-catch urine for culture and sensitivity testing.

c.             inquire about which medications the patient is currently taking.

d.            ask the patient about any family history of chronic renal failure.

ANS: C

Normally the urinalysis will show zero to trace amounts of protein, but some medications may give false-positive readings. The other actions by the nurse may be appropriate, but checking for medications that may affect the dipstick accuracy should be done first.

3.            A hospitalized patient with possible renal insufficiency after coronary artery bypass surgery is scheduled for a creatinine clearance test. Which equipment will the nurse need to obtain?

a.            Urinary catheter

b.            Cleaning towelettes

c.             Large container for urine

d.            Sterile urine specimen cup

ANS: C

Because creatinine clearance testing involves a 24-hour urine specimen, the nurse should obtain a large container for the urine collection. Catheterization, cleaning of the perineum with antiseptic towelettes, and a sterile specimen cup are not needed for this test.

4.            A 32-year-old patient who is employed as a hairdresser and has a 15 pack-year history of cigarette smoking is scheduled for an annual physical examination. The nurse will plan to teach the patient about the increased risk for

a.            renal failure.

b.            kidney stones.

c.             pyelonephritis.

d.            bladder cancer.

ANS: D

Exposure to the chemicals involved with working as a hairdresser and in smoking both increase the risk of bladder cancer, and the nurse should assess whether the patient understands this risk. The patient is not at increased risk for renal failure, pyelonephritis, or kidney stones.

5.            Which medication taken at home by a 47-year-old patient with decreased renal function will be of most concern to the nurse?

a.            ibuprofen (Motrin)

b.            warfarin (Coumadin)

c.             folic acid (vitamin B9)

d.            penicillin (Bicillin LA)

ANS: A

The nonsteroidal antiinflammatory medications (NSAIDs) are nephrotoxic and should be avoided in patients with impaired renal function. The nurse also should ask about reasons the patient is taking the other medications, but the medication of most concern is the ibuprofen.

6.            A 79-year-old man has been admitted with benign prostatic hyperplasia. What is

most appropriate to include in the nursing plan of care?

a.            Limit fluid intake to no more than 1000 mL/day.

b.            Leave a light on in the bathroom during the night.

c.             Ask the patient to use a urinal so that urine can be measured.

d.            Pad the patients bed to accommodate overflow incontinence.

ANS: B

The patients age and diagnosis indicate a likelihood of nocturia, so leaving the light on in the bathroom is appropriate. Fluids should be encouraged because dehydration is more common in older patients. The information in the question does not indicate that measurement of the patients output is necessary or that the patient has overflow incontinence.