Medical-Surgical Nursing: Assessment and
Management of Clinical Problems, 1st Edition
February 2025
Nursing Assessment: Urinary System
A patient with impaired renal perfusion has secondary hypertension. The nurse understands that one cause of the
hypertension results from
A. increased atrial natriuretic factor (ANF) secretion, which inhibits antidiuretic hormone (ADH).
b. The decreased effect of antidiuretic hormone (ADH) on damaged kidney cells.
c. Increased renin-angiotensin-aldosterone production stimulated by renal ischemia.
d. Increased prostaglandin release from damaged kidney tissue, resulting in vasoconstriction.
Answer: c
In planning care for the patient with spinal cord trauma at the level of T9, the nurse recognizes that the injury will
a. Have little effect on urinary function because the bladder has inherent contraction and relaxation
properties.
b. result in altered bladder function because voluntary control of the bladder requires nervous function
below T9.
c. have no effect on urinary function because bladder function is controlled by nerves arising above the level
of T9.
d. cause altered function of the entire urinary system because the nerves controlling kidney and bladder
function arise below T9.
Answer: b
A patient’s urinalysis indicates a large amount of protein in the urine. The nurse recognizes that this finding most
likely indicates damage of the
a. glomerulus.
b. loop of Henle.
c. collecting duct.
d. proximal convoluted tubule.
Answer: a
When administering furosemide, a drug affecting the normal function of the nephron in the loop of Henle, the
nurse knows the amount of sodium in the filtrate that would not be reabsorbed is approximately
a. a0%.
b. b5%.
c. d5%.
d. 60%.
Answer: b
An older adult woman experiences stress incontinence. The nurse advises the patient that this problem may be
somewhat improved by
a. limiting fluid intake.
b. emptying the bladder qhr.
,c. the use of cholinergic drugs.
d. estrogen replacement therapy.
Answer: d
During assessment of a patient with a disorder of the urinary system, the nurse identifies a potentially nephrotoxic
agent when the patient reports the use of
a. anticoagulants.
b. vitamin supplements.
c. nonsteroidal anti-inflammatory drugs.
d. prophylactic penicillin therapy for rheumatic heart disease.
Answer: c
When the nurse is planning care for an 8b-year-old man, an appropriate intervention based on an understanding of
age-related changes of the urinary system is for the nurse to
a. limit fluid intake to a500 ml/day.
b. leave a light on in the bathroom at night.
c. ask the patient to use a urinal so that all urine can be measured.
d. provide diapers to absorb overflow incontinence and dribbling.
Answer: b
While assessing a patient’s urinary system, the nurse cannot palpate either kidney. The most appropriate
interpretation of this finding by the nurse is that it
a. is a normal finding.
b. is suggestive of hydronephrosis.
c. is diagnostic for polycystic disease.
d. indicates the presence of atrophied kidneys.
Answer: a
To assess tenderness in the flank area related to kidney disease, the nurse uses the percussion technique of striking
a. the posterior costovertebral angle (CVA) margin with the flat of one hand.
b. the junction of the rib cage and vertebral column with the fist of one hand.
c. the area between the iliac crest and the ribs along the midaxillary line with the fist of one hand.
d. One fist against the dorsal surface of the other hand placed flat along the posterior CVA margin.
Answer: d
,The result of a patient’s creatinine clearance test is 60 ml/min. The nurse equates this finding to a glomerular
filtration rate of
a. c0 ml/min.
b. 60 ml/min.
c. ab0 ml/min.
d. bd0 ml/min.
Answer: b
The nurse uses auscultation during assessment of the urinary system to
a. determine the position of the kidneys.
b. assess fluid wave patterns in the bladder.
c. determine the level of a distended bladder.
d. identify renal artery and abdominal aortic bruits.
Answer: d
When analyzing the results of a patient’s urinalysis, the nurse recognizes that a urinary tract infection is indicated
by the finding of
a. protein: d+.
b. glucose: c+.
c. WBC: b0–b6/hpf.
d. specific gravity: a.0a.
Answer: c
The nurse would expect that a patient who has damage to the distal convoluted tubules and collecting ducts to
have a urine specific gravity of
a. a.00a.
b. a.00c.
c. a.0a0.
d. a.0c0.
Answer: a
When teaching a patient scheduled for a cystogram via a cystoscope about the procedure, the nurse tells the
patient
a. “Your doctor will place a catheter into an artery in your groin and inject a dye that will visualize the blood
supply to the kidneys.”
b. “Your doctor will insert a lighted tube into the bladder and inject a dye into your kidneys through little
catheters inserted into the ureters.”
, c. “Your doctor will insert a lighted tube into the bladder through your urethra, inspect the bladder, and
instill a dye that will outline your bladder on x-ray.”
d. “Your doctor will inject a dye into a vein in your arm that is carried to the urinary system. Then a lighted
tube in your bladder will be used to see when the dye appears.”
Answer: c
The nurse informs the patient undergoing cystoscopy that following the procedure, he
a. will receive narcotics as necessary for pain.
b. will be NPO for 8 hours to prevent nausea and vomiting.
c. may experience blood-tinged urine and urinary frequency.
d. will be on bed rest for ab to bd hours following the procedure.
Answer: c
A patient with an elevated blood urea nitrogen (BUN) and serum creatinine is scheduled for a renal arteriogram.
The nurse should question an order from radiology for bowel preparation with the use of
a. castor oil.
b. Fleet enema.
c. tap-water enemas.
d. bisacodyl (Dulcolax) tablets.
Answer: b
The physician orders a clean-catch urine specimen for culture and sensitivity testing for a female patient with a
suspected urinary tract infection. When teaching the patient to obtain the specimen, the nurse instructs the patient
to
a. sit on a bed pan, and after she starts to urinate, the nurse will catch the remaining urine in a specimen cup.
b. clean the labia with antiseptic swabs, void a small amount into the toilet, and then void into a sterile
specimen cup.
c. insert a short, small, “mini” catheter attached to a collecting container into the urinary meatus to obtain
urine for testing.
d. wash the perineal area with soap and water, start the stream of urine, and then pass a clean specimen cup
into the urine flow to catch the remainder of the urine.
Answer: b
A patient with renal disease is scheduled for a creatinine clearance test. In preparing for the test, the nurse
a. obtains supplies for and instructs the patient about a bd-hour urine collection.
b. informs the patient that the test involves only a blood test to measure the waste products in the blood.
c. instructs the patient to fast after the evening meal and that three voided specimens will be obtained an
hour apart in the morning.
Management of Clinical Problems, 1st Edition
February 2025
Nursing Assessment: Urinary System
A patient with impaired renal perfusion has secondary hypertension. The nurse understands that one cause of the
hypertension results from
A. increased atrial natriuretic factor (ANF) secretion, which inhibits antidiuretic hormone (ADH).
b. The decreased effect of antidiuretic hormone (ADH) on damaged kidney cells.
c. Increased renin-angiotensin-aldosterone production stimulated by renal ischemia.
d. Increased prostaglandin release from damaged kidney tissue, resulting in vasoconstriction.
Answer: c
In planning care for the patient with spinal cord trauma at the level of T9, the nurse recognizes that the injury will
a. Have little effect on urinary function because the bladder has inherent contraction and relaxation
properties.
b. result in altered bladder function because voluntary control of the bladder requires nervous function
below T9.
c. have no effect on urinary function because bladder function is controlled by nerves arising above the level
of T9.
d. cause altered function of the entire urinary system because the nerves controlling kidney and bladder
function arise below T9.
Answer: b
A patient’s urinalysis indicates a large amount of protein in the urine. The nurse recognizes that this finding most
likely indicates damage of the
a. glomerulus.
b. loop of Henle.
c. collecting duct.
d. proximal convoluted tubule.
Answer: a
When administering furosemide, a drug affecting the normal function of the nephron in the loop of Henle, the
nurse knows the amount of sodium in the filtrate that would not be reabsorbed is approximately
a. a0%.
b. b5%.
c. d5%.
d. 60%.
Answer: b
An older adult woman experiences stress incontinence. The nurse advises the patient that this problem may be
somewhat improved by
a. limiting fluid intake.
b. emptying the bladder qhr.
,c. the use of cholinergic drugs.
d. estrogen replacement therapy.
Answer: d
During assessment of a patient with a disorder of the urinary system, the nurse identifies a potentially nephrotoxic
agent when the patient reports the use of
a. anticoagulants.
b. vitamin supplements.
c. nonsteroidal anti-inflammatory drugs.
d. prophylactic penicillin therapy for rheumatic heart disease.
Answer: c
When the nurse is planning care for an 8b-year-old man, an appropriate intervention based on an understanding of
age-related changes of the urinary system is for the nurse to
a. limit fluid intake to a500 ml/day.
b. leave a light on in the bathroom at night.
c. ask the patient to use a urinal so that all urine can be measured.
d. provide diapers to absorb overflow incontinence and dribbling.
Answer: b
While assessing a patient’s urinary system, the nurse cannot palpate either kidney. The most appropriate
interpretation of this finding by the nurse is that it
a. is a normal finding.
b. is suggestive of hydronephrosis.
c. is diagnostic for polycystic disease.
d. indicates the presence of atrophied kidneys.
Answer: a
To assess tenderness in the flank area related to kidney disease, the nurse uses the percussion technique of striking
a. the posterior costovertebral angle (CVA) margin with the flat of one hand.
b. the junction of the rib cage and vertebral column with the fist of one hand.
c. the area between the iliac crest and the ribs along the midaxillary line with the fist of one hand.
d. One fist against the dorsal surface of the other hand placed flat along the posterior CVA margin.
Answer: d
,The result of a patient’s creatinine clearance test is 60 ml/min. The nurse equates this finding to a glomerular
filtration rate of
a. c0 ml/min.
b. 60 ml/min.
c. ab0 ml/min.
d. bd0 ml/min.
Answer: b
The nurse uses auscultation during assessment of the urinary system to
a. determine the position of the kidneys.
b. assess fluid wave patterns in the bladder.
c. determine the level of a distended bladder.
d. identify renal artery and abdominal aortic bruits.
Answer: d
When analyzing the results of a patient’s urinalysis, the nurse recognizes that a urinary tract infection is indicated
by the finding of
a. protein: d+.
b. glucose: c+.
c. WBC: b0–b6/hpf.
d. specific gravity: a.0a.
Answer: c
The nurse would expect that a patient who has damage to the distal convoluted tubules and collecting ducts to
have a urine specific gravity of
a. a.00a.
b. a.00c.
c. a.0a0.
d. a.0c0.
Answer: a
When teaching a patient scheduled for a cystogram via a cystoscope about the procedure, the nurse tells the
patient
a. “Your doctor will place a catheter into an artery in your groin and inject a dye that will visualize the blood
supply to the kidneys.”
b. “Your doctor will insert a lighted tube into the bladder and inject a dye into your kidneys through little
catheters inserted into the ureters.”
, c. “Your doctor will insert a lighted tube into the bladder through your urethra, inspect the bladder, and
instill a dye that will outline your bladder on x-ray.”
d. “Your doctor will inject a dye into a vein in your arm that is carried to the urinary system. Then a lighted
tube in your bladder will be used to see when the dye appears.”
Answer: c
The nurse informs the patient undergoing cystoscopy that following the procedure, he
a. will receive narcotics as necessary for pain.
b. will be NPO for 8 hours to prevent nausea and vomiting.
c. may experience blood-tinged urine and urinary frequency.
d. will be on bed rest for ab to bd hours following the procedure.
Answer: c
A patient with an elevated blood urea nitrogen (BUN) and serum creatinine is scheduled for a renal arteriogram.
The nurse should question an order from radiology for bowel preparation with the use of
a. castor oil.
b. Fleet enema.
c. tap-water enemas.
d. bisacodyl (Dulcolax) tablets.
Answer: b
The physician orders a clean-catch urine specimen for culture and sensitivity testing for a female patient with a
suspected urinary tract infection. When teaching the patient to obtain the specimen, the nurse instructs the patient
to
a. sit on a bed pan, and after she starts to urinate, the nurse will catch the remaining urine in a specimen cup.
b. clean the labia with antiseptic swabs, void a small amount into the toilet, and then void into a sterile
specimen cup.
c. insert a short, small, “mini” catheter attached to a collecting container into the urinary meatus to obtain
urine for testing.
d. wash the perineal area with soap and water, start the stream of urine, and then pass a clean specimen cup
into the urine flow to catch the remainder of the urine.
Answer: b
A patient with renal disease is scheduled for a creatinine clearance test. In preparing for the test, the nurse
a. obtains supplies for and instructs the patient about a bd-hour urine collection.
b. informs the patient that the test involves only a blood test to measure the waste products in the blood.
c. instructs the patient to fast after the evening meal and that three voided specimens will be obtained an
hour apart in the morning.
