Chapter 41: Urologic System Introduction
Linton: Medical-Surgical Nursing, 7th Edition
MULTIPLE CHOICE
1. A patient has a nephrostomy tube that has been inserted because of an obstruction in the
ureter: What special precautions in the care of the nephrostomy tube should the nurse
implement?
a. Clamping every 2 hours to allow expansion of the kidney pelvis
b. Instilling no more than 50 mL of sterile water if sterile irrigations are ordered
c. Being certain the tube is connected, not kinked, or not clamped to ensure that it
continually drains
d. Leaving the nephrostomy site open to air
ANS: C
Because of the small capacity of the renal pelvis, drainage must be continuous;
otherwise, the urine may back up and destroy the kidney:
DIF: Cognitive Level: Application REF: p: 806 OBJ: 2
TOP: Nephrostomy Tube KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early
Detection of Disease
2. Which statement by a patient on dialysis, taking gentamicin (Garamycin), should cause
the nurse the most concern?
a. “I have a horrible headache:”
b. “Speak up! I can’t hear you:”
c. “I’ve had diarrhea once or twice today:”
d. “I’m thirsty: I can’t get enough water:”
ANS: B
Garamycin is ototoxic: Indication of hearing impairment suggests drug toxicity:
DIF: Cognitive Level: Comprehension REF: p: 809 OBJ: 2
TOP: Garamycin KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
3. Erythropoietin is a hormone produced by the kidney: What will a deficiency of
erythropoietin in a patient in chronic renal failure result in?
a. Diminished immunologic function with fewer white blood cells
b. Elevated lipid levels in the bloodstream, contributing to accelerated
atherosclerosis
c. Anemia as a result of the diminished number of red blood cells being produced
d. Hypertension as a result of the increased, concentrated blood volume
, ANS: C
Erythropoietin is excreted by the kidneys and stimulates bone marrow to produce red
blood cells:
DIF: Cognitive Level: Comprehension REF: p: 797 OBJ: 1
TOP: Erythropoietin KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
4. A nurse is assessing a patient with renal impairment: Which facial characteristic is a sign
of fluid retention?
a. Broken blood vessels around the nose
b. Periorbital edema
c. Rash on cheeks and neck
d. Facial twitching
ANS: B
Periorbital edema is a sign of fluid retention: Because the patient with renal
impairment has generalized edema, this facial feature is extremely significant in
assessing edema:
DIF: Cognitive Level: Comprehension REF: p: 798 OBJ: 1
TOP: Sign of Fluid Retention KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
5. A nurse is performing frequent catheterizations for residual urine: What causes the
greatest concern for the nurse?
a. Introduction of pathogens into the bladder
b. Frequent genital exposure of the patient
c. Presence of the indwelling catheter
d. Causing urethral erosion
ANS: A
The frequency of introducing a catheter into the bladder offers a very real risk of
infection:
DIF: Cognitive Level: Application REF: p: 805 OBJ: 4
TOP: Urinary Catheterization KEY: Nursing Process Step:
Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection
Control
6. What laboratory value change should indicate to a nurse that a patient with renal failure
has entered the oliguric stage?
a. Blood urea nitrogen (BUN) level rises:
b. Serum calcium increases:
c. Blood volume decreases:
, d. Urine osmolality increases:
ANS: A
In the oliguric stage of renal failure, the urine output decreases to less than 400
mL/day; the BUN, creatinine, and potassium increase; and the serum calcium
decreases: the patient becomes hypervolemic as the urine osmolality increases:
DIF: Cognitive Level: Comprehension REF: p: 799 OBJ: 1
TOP: Oliguric Stage of Renal Failure KEY: Nursing Process Step:
Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
7. What should nursing care focus on when caring for a patient with a ureteral catheter in
place after the removal of a kidney stone?
a. Irrigating the catheter regularly
b. Assessing for patency
c. Including ureteral output with the bladder output
d. Early ambulation
ANS: B
Patency of the ureteral catheter is essential to prevent injury to the kidney: the patient
is on bed rest until the ureteral catheter is removed: the output from the ureteral
catheter is measured and recorded separately, and irrigation, if performed, is not done
on a regular schedule and is not more than 5 mL:
DIF: Cognitive Level: Application REF: p: 806 OBJ: 2
TOP: Ureteral Catheter KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
8. What is true about the urine osmolality when the kidney is adequately functioning?
a. Equal to the osmolality of the serum
b. Approximately half of the serum
c. In a ratio of 10:1 with the serum
d. Equal to the excretion of urea
ANS: A
If the blood osmolality is high, the kidneys need to dilute the blood and excrete more
concentrated urine, and the reverse is true: the osmolality of the serum and the urine
should be equal:
DIF: Cognitive Level: Comprehension REF: p: 803 OBJ: 2
TOP: Kidney Function Tests KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early
Detection of Disease
9. Which urine test provides the most accurate measurement of renal function?
a. BUN
, b. Phosphates
c. Specific gravity
d. Creatinine
ANS: D
Creatinine is not affected by diet, hydration, or liver function and is a better
measurement of liver function than the BUN:
DIF: Cognitive Level: Knowledge REF: p: 803 OBJ: 2
TOP: Creatinine KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
10. A nurse is caring for a patient after urinary diversion surgery: What postoperative nursing
assessment is the priority?
a. Level of fluid intake
b. Position on the left side
c. Keep the bed flat
d. Bowel sounds
ANS: D
The bowel is manipulated during urinary diversion surgeries and frequently leads to
the patient with a paralytic ileus:
DIF: Cognitive Level: Application REF: p: 806 OBJ: 4
TOP: Urinary Diversion KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
MULTIPLE RESPONSE
1. A nurse is caring for a patient with a Foley catheter: What actions should the nurse
implement to decrease this patient’s risk for infection? (Select all that apply:)
a. Keep the bag below the levell of the bed:
b. Provide perineal care twice a day:
c. Flush the tubing as needed:
d. Use Standard Precautions when handling urine and tubing:
e. Keep the drainage system open:
ANS: A, B, D
Keeping the bag below the level of the bed, providing perineal care twice daily, and
using Standard Precautions will assist in decreasing infection risk: Tubing is only
flushed with a physician’s order if required: the drainage system should be closed:
DIF: Cognitive Level: Application REF: p: 805 OBJ: 4
TOP: Foley Catheter KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
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