Final Test Session

2nd Professional BSN,4 year Programme

Subject: Adult Health Nursing I

Topic: Unit III (Genitourinary system)

Name:_______________ Roll No._____________ Date:_____________ Total Marks:65

(Objective Section)

Encircle the correct answer:

1. When a female client with an indwelling urinary (Foley) catheter insists on walking to
the hospital lobby to visit with family members, nurse Rose teaches how to do this
without compromising the catheter. Which client action indicates an accurate
understanding of this information?
a. The client sets the drainage bag on the floor while sitting down.
b. The client keeps the drainage bag below the bladder at all times.
c. The client clamps the catheter drainage tubing while visiting with the family.
d. The client loops the drainage tubing below its point of entry into the drainage bag.
2. A 36 year old female, who is 29 weeks pregnant, reports she is experiencing burning
when voiding. The physician orders a urinalysis. Which statement by the patient
demonstrates she understands how to collect the specimen?
a. "I’ll hold the cup firmly against the urethra while collecting the sample."
b. "I will cleanse back to front with the antiseptic wipe before peeing in the cup."
c. "First, i will pee a small amount of urine in the toilet and then collect the rest in the
cup."
d. "I will be sure to drink a lot of fluids to keep the urine diluted before peeing into the
cup."
3. You’re providing discharge teaching to a female patient on how to prevent urinary
tract infections. Which statement is INCORRECT?
a. "Void immediately after sexual intercourse."
b. "Avoid wearing tight fitting underwear."
c. "Try to void every 2-3 hours."
d. "Use scented sanitary napkins or tampons during menstruation."
4. Nurse Pete is reviewing the report of a client’s routine urinalysis. Which value should
the nurse consider abnormal?
a. Specific gravity of 1.03
b. Urine Ph of 3.0
 c. Absence of protein
d. Absence of glucose
5. What is the most common cause of acute glomerulonephritis?
a. Staph infection on the skin
b. Strep Infection in the throat
c. Fungal Infections
d. None of the above
6. How much renal tissue is effected during any case of glomerulonephritis?
a. Just the Glomeruli
b. Half of the renal tissue
c. Glomeruli and outside lining
d. All of the renal tissue
7. You're providing an in-service to a group of nurses about the different types of kidney
stones. You explain to the attendees that the most common type of kidney stone is
made up of:
a. Cholesterol
b. Calcium and oxalate
c. Calcium and phosphate
d. Uric acid
8. What are extreme S/S of Acute Glomerulonephritis?
a. Edema
b. Increase Blood Pressure
c. Hematurea and Proteinurea
d. All of the above
9. Arsenic in drinking water has been tied to an increased risk of what type of cancer?
a. Bladder
b. Lung
c. Kidney
d. All of the above
10. Nurse Vic is monitoring the fluid intake and output of a female client recovering from
an exploratory laparotomy. Which nursing intervention would help the client avoid a
urinary tract infection (UTI)?
a. Maintaining a closed indwelling urinary catheter system and securing the catheter to
the leg.
b. Limiting fluid intake to 1 L/day.
c. Encouraging the client to use a feminine deodorant after bathing.
d. Encouraging the client to douche once a day after removal of the indwelling urinary
catheter.
11. Which of the following symptoms do you expect to see in a patient diagnosed with
acute pyelonephritis?
a. Jaundice and flank pain
 b. Costovertebral angle tenderness and chills
c. Burning sensation on urination
d. Polyuria and nocturia
12. You have a patient that might have a urinary tract infection (UTI). Which statement by
the patient suggests that a UTI is likely?
a. “I pee a lot.”
b. “It burns when I pee.”
c. “I go hours without the urge to pee.”
d. “My pee smells sweet.”
13. Which patient is at greatest risk for developing a urinary tract infection (UTI)?
a. A 35 y.o. woman with a fractured wrist
b. A 20 y.o. woman with asthma
c. A 50 y.o. postmenopausal woman
d. A 28 y.o. with angina
14. You have a patient that is receiving peritoneal dialysis. What should you do when you
notice the return fluid is slowly draining?
a. Check for kinks in the outflow tubing.
b. Raise the drainage bag above the level of the abdomen.
c. Place the patient in a reverse Trendelenburg position.
d. Ask the patient to cough.
15. A 30 y.o. female patient is undergoing hemodialysis with an internal arteriovenous
fistula in place. What do you do to prevent complications associated with this device?
a. Insert I.V. lines above the fistula.
b. Avoid taking blood pressures in the arm with the fistula.
c. Palpate pulses above the fistula.
d. Report a bruit or thrill over the fistula to the doctor.
16. Your patient becomes restless and tells you she has a headache and feels nauseous
during hemodialysis. Which complication do you suspect?
a. Infection
b. Disequilibrium syndrome
c. Air embolism
d. Acute hemolysis
17. Your patient with chronic renal failure reports pruritus. Which instruction should you
include in this patient’s teaching plan?
a. Rub the skin vigorously with a towel.
b. Take frequent baths.
c. Apply alcohol-based emollients to the skin.
d. Keep fingernails short and clean.
18. An 18 y.o. student is admitted with dark urine, fever, and flank pain and is diagnosed
with acute glomerulonephritis. Which would most likely be in this student’s health
history?
 a. Renal calculi
b. Renal trauma
c. Recent sore throat
d. Family history of acute glomerulonephritis
19. Which drug is indicated for pain related to acute renal calculi?
a. Narcotic analgesics
b. Nonsteroidal anti-inflammatory drugs (NSAIDS)
c. Muscle relaxants
d. Salicylates
20. Which of the following causes the majority of UTI’s in hospitalized patients?
a. Lack of fluid intake
b. Inadequate perineal care
c. Invasive procedures
d. Immunosuppression
21. Clinical manifestations of acute glomerulonephritis include which of the following?
a. Chills and flank pain
b. Oliguria and generalized edema
c. Hematuria and proteinuria
d. Dysuria and hypotension
22. You expect a patient in the oliguric phase of renal failure to have a 24 hour urine
output less than:
a. 200ml
b. 400ml
c. 800ml
d. 1000ml
23. The most common early sign of kidney disease is:
a. Sodium retention
b. Elevated BUN level
c. Development of metabolic acidosis
d. Inability to dilute or concentrate urine
24. A patient is experiencing which type of incontinence if she experiences leaking urine
when she coughs, sneezes, or lifts heavy objects?
a. Overflow
b. Reflex
c. Stress
d. Urge
25. Immediately post-op after a prostatectomy, which complications require priority
assessment of your patient?
a. Pneumonia
b. Hemorrhage
c. Urine retention
 d. Deep vein thrombosis
26. The most indicative test for prostate cancer is
a. A thorough digital rectal examination
b. Magnetic resonance imaging (MRI)
c. Excretory urography
d. Prostate-specific antigen
27. A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to
include in her discharge teaching?
a. Take cool baths.
b. Avoid tampon use.
c. Avoid sexual activity.
d. Drink 8 to 10 eight-oz glasses of water daily.
28. What is the priority nursing diagnosis with your patient diagnosed with end-stage
renal disease?
a. Activity intolerance
b. Fluid volume excess
c. Knowledge deficit
d. Pain
29. Your 60 y.o. patient with pyelonephritis and possible septicemia has had five UTIs
over the past two years. She is fatigued from lack of sleep, has lost weight, and
urinates frequently even in the night. Her labs show: sodium, 154 mEq/L; osmolarity
340 mOsm/L; glucose, 127 mg/dl; and potassium, 3.9 mEq/L. Which nursing diagnosis
is a priority?
a. Fluid volume deficit related to osmotic diuresis induced by hyponatremia
b. Fluid volume deficit related to inability to conserve water
c. Altered nutrition: Less than body requirements related to hypermetabolic state
d. Altered nutrition: Less than body requirements related to catabolic effects of insulin
deficiency
30. Which sign indicates the second phase of acute renal failure?
a. Daily doubling of urine output (4 to 5 L/day).
b. Urine output less than 400 ml/day.
c. Urine output less than 100 ml/day.
d. Stabilization of renal function.
31. Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which
information is important for providing care for the patient?
a. The patient shouldn’t feel pain during initiation of dialysis.
b. The patient feels best immediately after the dialysis treatment.
c. Using a stethoscope for auscultating the fistula is contraindicated.
d. Taking a blood pressure reading on the affected arm can cause clotting of the fistula.
32. A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet is
best on days between dialysis treatments?
 a. Low-protein diet with unlimited amounts of water.
b. Low-protein diet with a prescribed amount of water.
c. No protein in the diet and use of a salt substitute
d. No restrictions.
33. After the first hemodialysis treatment, your patient develops a headache,
hypertension, restlessness, mental confusion, nausea, and vomiting. Which condition
is indicated?
a. Disequilibrium syndrome
b. Respiratory distress
c. Hypervolemia
d. Peritonitis
34. Which action is most important during bladder training in a patient with a neurogenic
bladder?
a. Encourage the use of an indwelling urinary catheter.
b. Set up specific times to empty the bladder.
c. Encourage Kegel exercises.
d. Force fluids.
35. A patient with diabetes has had many renal calculi over the past 20 years and now has
chronic renal failure. Which substance must be reduced in this patient’s diet?
a. Carbohydrates
b. Fats
c. Protein
d. Vitamin C
36. What is the best way to check for patency of the arteriovenous fistula for
hemodialysis?
a. Pinch the fistula and note the speed of filling on release.
b. Use a needle and syringe to aspirate blood from the fistula.
c. Check for capillary refill of the nail beds on that extremity.
d. Palpate the fistula throughout its length to assess for a thrill.
37. You have a paraplegic patient with renal calculi. Which factor contributes to the
development of calculi?
a. Increased calcium loss from the bones.
b. Decreased kidney function.
c. Decreased calcium intake.
d. High fluid intake.
38. A patient who received a kidney transplant returns for a follow-up visit to the
outpatient clinic and reports a lump in her breast. Transplant recipients are:
a. At increased risk for cancer due to immunosuppression caused by cyclosporine
(Neoral).
b. Consumed with fear after the life-threatening experience of having a transplant.
c. At increased risk for tumors because of the kidney transplant.
 d. At decreased risk for cancer, so the lump is most likely benign.
39. You’re developing a care plan with the nursing diagnosis risk for infection for your
patient that received a kidney transplant. A goal for this patient is to:
a. Remain afebrile and have negative cultures.
b. Resume normal fluid intake within 2 to 3 days.
c. Resume the patient’s normal job within 2 to 3 weeks.
d. Try to discontinue cyclosporine (Neoral) as quickly as possible.
40. You suspect kidney transplant rejection when the patient shows which symptoms?
a. Pain in the incision, general malaise, and hypotension.
b. Pain in the incision, general malaise, and depression.
c. Fever, weight gain, and diminished urine output.
d. Diminished urine output and hypotension.
41. Your patient returns from the operating room after abdominal aortic aneurysm repair.
Which symptom is a sign of acute renal failure?
a. Anuria
b. Diarrhea
c. Oliguria
d. Vomiting
42. Which cause of hypertension is the most common in acute renal failure?
a. Pulmonary edema
b. Hypervolemia
c. Hypovolemia
d. Anemia
43. A patient returns from surgery with an indwelling urinary catheter in place and empty.
Six hours later, the volume is 120ml. The drainage system has no obstructions. Which
intervention has priority?
a. Give a 500 ml bolus of isotonic saline.
b. Evaluate the patient’s circulation and vital signs.
c. Flush the urinary catheter with sterile water or saline.
d. Place the patient in the shock position and notify the surgeon.
44. Which of the following assessment data would most likely be related to a client’s
current complaint of stress incontinence?Irrigate and clean the meatus before
catheterization.
a. The client’s intake of 2 to 3 L of fluid per day.
b. The client’s history of three full-term pregnancies.
c. The client’s age of 45 years.
d. The client’s history of competitive swimming.
45. The nurse is developing a teaching plan for a client with stress incontinence. Which of
the following instructions should be included?
a. Avoid activities that are stressful and upsetting.
b. Avoid caffeine and alcohol.
 c. Do not wear a girdle.
d. Limit physical exertion.
46. A client has urge incontinence. Which of the following signs and symptoms would the
nurse expect to find in this client?
a. Inability to empty the bladder.
b. Loss of urine when coughing.
c. Involuntary urination with minimal warning.
d. Frequent dribbling of urine.
47. During a client’s urinary bladder catheterization, the bladder is emptied gradually. The
best rationale for the nurse’s action is that completely emptying an overdistended
bladder at one time tends to cause:
a. Renal failure
b. Abdominal cramping
c. Possible shock
d. Atrophy of bladder musculature
48. What change indicates recovery in a patient with nephrotic syndrome?
a. Disappearance of protein from the urine.
b. Decrease in blood pressure to normal.
c. Increase in serum lipid levels.
d. Gain in body weight.
49. Which criterion is required before a patient can be considered for continuous
peritoneal dialysis?
a. The patient must be hemodynamically stable.
b. The vascular access must have healed.
c. The patient must be in a home setting.
d. Hemodialysis must have failed.
50. Your patient has complaints of severe right-sided flank pain, nausea, vomiting, and
restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP 140/90
mmHg, Pulse 118 beats/min., respirations 33 breaths/minute, and temperature,
98.0F. Which subjective data supports a diagnosis of renal calculi?
a. Pain radiating to the right upper quadrant.
b. History of mild flu symptoms last week.
c. Dark-colored coffee-ground emesis.
d. Dark, scanty urine output.
Subjective Section

1. Explain phases of acute renal failure

2. Write down the nursing management of a patient with urinary bladder carcinoma

3. Define glomerulonephritis and discuss its causes