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CBUNA CURN practice questions

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Question 1Urologic Anatomy, Physiology, and Terminology

Which structure carries urine from the renal pelvis to the urinary bladder?

  1. The urethra
  2. The ureter Correct answer.
  3. The renal artery
  4. The collecting duct

Explanation

The ureter is the muscular tube that begins at the renal pelvis and transports urine to the bladder by peristalsis. The urethra drains the bladder to the exterior, the collecting duct is intraparenchymal, and the renal artery supplies blood.

Question 2Urologic Anatomy, Physiology, and Terminology

A patient's urinalysis shows a substance that is normally almost completely reabsorbed in the proximal convoluted tubule, so that none appears in final urine. Which substance is this?

  1. Urea
  2. Glucose Correct answer.
  3. Ammonium
  4. Creatinine

Explanation

Filtered glucose is reabsorbed almost entirely in the proximal convoluted tubule via sodium-coupled transporters, so healthy urine is essentially glucose-free. Urea, creatinine, and ammonium are normally excreted in urine.

Question 3Urologic Anatomy, Physiology, and Terminology

Which term describes the normal passage of urine from the bladder?

  1. Mictalgia
  2. Oliguria
  3. Micturition Correct answer.
  4. Nocturia

Explanation

Micturition is the physiological act of voiding urine, coordinated by detrusor contraction and sphincter relaxation. The other terms denote pain on voiding, nighttime voiding, and reduced urine volume, respectively.

Question 4Urologic Anatomy, Physiology, and Terminology

Which portion of the male urethra passes through the prostate gland?

  1. The prostatic urethra Correct answer.
  2. The penile urethra
  3. The membranous urethra
  4. The spongy urethra

Explanation

The male urethra is divided into prostatic, membranous, and spongy (penile) portions; the prostatic segment traverses the prostate from bladder neck to urogenital diaphragm. The membranous part lies in the perineal membrane, and the spongy urethra runs within the corpus spongiosum.

Question 5Urologic Anatomy, Physiology, and Terminology

Which muscle contracts to expel urine during voiding?

  1. The bulbospongiosus muscle
  2. The external urethral sphincter
  3. The detrusor muscle Correct answer.
  4. The cremaster muscle

Explanation

The detrusor is the smooth muscle of the bladder wall; its contraction raises intravesical pressure and drives voiding. The external sphincter relaxes rather than contracts during voiding, and the bulbospongiosus and cremaster have other roles.

Question 6Urologic Anatomy, Physiology, and Terminology

Which structure is the functional unit of the kidney?

  1. The glomerulus
  2. The nephron Correct answer.
  3. The renal corpuscle
  4. The loop of Henle

Explanation

The nephron is the functional unit, comprising the renal corpuscle plus the tubule, and each kidney contains roughly a million of them. The corpuscle, loop of Henle, and glomerulus are components of a nephron, not the whole unit.

Question 7Urologic Anatomy, Physiology, and Terminology

Which term means the presence of blood in the urine?

  1. Hematuria Correct answer.
  2. Pyuria
  3. Glycosuria
  4. Proteinuria

Explanation

Hematuria literally denotes blood in the urine and may be microscopic or macroscopic. Proteinuria, pyuria, and glycosuria denote excess protein, pus cells, and glucose in urine, respectively.

Question 8Urologic Anatomy, Physiology, and Terminology

A patient's creatinine clearance is used to estimate which physiological parameter?

  1. Tubular maximum for glucose
  2. Glomerular filtration rate Correct answer.
  3. Renal plasma flow
  4. Free water clearance

Explanation

Creatinine is freely filtered and minimally handled by the tubule, so its clearance approximates glomerular filtration rate. It does not measure plasma flow, glucose transport capacity, or free water clearance.

Question 9Urologic Anatomy, Physiology, and Terminology

Which hormone increases water reabsorption by inserting aquaporin-2 channels in collecting duct principal cells?

  1. Antidiuretic hormone Correct answer.
  2. Atrial natriuretic peptide
  3. Parathyroid hormone
  4. Aldosterone

Explanation

Antidiuretic hormone binds V2 receptors on principal cells, raising cyclic AMP and trafficking aquaporin-2 to the apical membrane to increase water permeability. Aldosterone acts mainly on sodium transport, ANP promotes natriuresis, and PTH regulates calcium and phosphate.

Question 10Urologic Anatomy, Physiology, and Terminology

In the countercurrent multiplier, which segment is impermeable to water but actively reabsorbs sodium chloride?

  1. The thin descending limb of the loop of Henle
  2. The proximal convoluted tubule
  3. The thick ascending limb of the loop of Henle Correct answer.
  4. The collecting duct

Explanation

The thick ascending limb reabsorbs sodium chloride via the sodium-potassium-chloride cotransporter while remaining water-impermeable, generating the medullary osmotic gradient. The descending limb is water-permeable, and the proximal tubule and collecting duct reabsorb water under different regulation.

Question 11Urologic Anatomy, Physiology, and Terminology

Which renal structure releases renin in response to reduced renal perfusion pressure?

  1. Podocytes
  2. Macula densa cells
  3. Juxtaglomerular cells Correct answer.
  4. Mesangial cells

Explanation

Juxtaglomerular cells are modified smooth muscle cells of the afferent arteriole that store and release renin when perfusion pressure falls. Macula densa cells sense tubular chloride, podocytes form the filtration barrier, and mesangial cells provide structural support.

Question 12Urologic Anatomy, Physiology, and Terminology

A patient has a serum potassium of 6.8 mmol/L with a normal GFR. Which nephron segment is the principal site of regulated potassium secretion?

  1. The proximal convoluted tubule
  2. The cortical collecting duct Correct answer.
  3. The thin descending limb
  4. The glomerulus

Explanation

Potassium secretion is regulated chiefly in the cortical collecting duct, where principal cells drive secretion through apical channels under aldosterone influence. The proximal tubule reabsorbs most filtered potassium, and the descending limb and glomerulus do not perform regulated secretion.

Question 13Urologic Anatomy, Physiology, and Terminology

Which describes the normal relationship between the right and left kidneys in the abdomen?

  1. The left kidney sits lower because of the spleen
  2. Both kidneys lie at the same vertebral level in all adults
  3. The right kidney sits slightly lower because of the liver Correct answer.
  4. The left kidney lies entirely within the pelvis

Explanation

The liver occupies the right upper quadrant and displaces the right kidney inferiorly, so it typically lies slightly lower than the left. The spleen does not displace the left kidney downward in the same way, and neither kidney normally lies in the pelvis.

Question 14Urologic Anatomy, Physiology, and Terminology

Which vessel supplies the bulk of the blood to the ureter?

  1. The hepatic artery
  2. The internal pudendal artery only
  3. The inferior mesenteric artery only
  4. Branches of the renal artery, aorta, and iliac vessels along its course Correct answer.

Explanation

The ureter receives a longitudinal anastomotic supply from branches of the renal artery, abdominal aorta, gonadal vessels, and iliac arteries depending on its level. No single artery supplies the whole ureter, which is why it can be mobilized with preservation of periureteral tissue.

Question 15Urologic Anatomy, Physiology, and Terminology

Which structure lies immediately anterior to the bladder in the male pelvis?

  1. The pubic symphysis Correct answer.
  2. The rectum
  3. The seminal vesicles
  4. The sacrum

Explanation

In the male, the bladder sits behind the pubic symphysis and in front of the rectum, with seminal vesicles posterior to the bladder base. The sacrum is posterior in the pelvis, not anterior to the bladder.

Question 16Urologic Anatomy, Physiology, and Terminology

Which best explains why the bladder can store large volumes at low pressure?

  1. The bladder wall is lined by stratified squamous epithelium that resists stretch
  2. The bladder mucosa is firmly fixed to the muscularis
  3. The detrusor exhibits accommodation through smooth muscle relaxation and compliance Correct answer.
  4. The internal sphincter actively pumps urine back into the ureters

Explanation

Bladder storage depends on smooth muscle compliance and receptive relaxation, allowing volume to rise while intravesical pressure stays low. The urothelium is transitional rather than stratified squamous, there is no backward pumping, and the mucosa is loosely attached to allow unfolding.

Question 17Urologic Anatomy, Physiology, and Terminology

Which term describes urine output of less than 400 mL per day in an adult?

  1. Anuria
  2. Oliguria Correct answer.
  3. Polyuria
  4. Dysuria

Explanation

Oliguria is conventionally defined as adult urine output below about 400 mL per day. Polyuria is excessive output, anuria is essentially absent output, and dysuria is painful voiding.

Question 18Urologic Anatomy, Physiology, and Terminology

A patient's plasma osmolality rises. Which sequence best describes the normal homeostatic response?

  1. Osmoreceptor stimulation, ADH release, collecting duct water reabsorption, concentrated urine Correct answer.
  2. Osmoreceptor inhibition, ADH suppression, collecting duct water reabsorption, dilute urine
  3. Osmoreceptor stimulation, ANP release, collecting duct water reabsorption, concentrated urine
  4. Osmoreceptor stimulation, aldosterone release, proximal sodium reabsorption, dilute urine

Explanation

Rising osmolality stimulates hypothalamic osmoreceptors, prompting posterior pituitary ADH release; ADH increases collecting duct water permeability so water is retained and urine is concentrated. Aldosterone and ANP act primarily on sodium handling rather than this osmoregulatory reflex.

Question 19Urologic Anatomy, Physiology, and Terminology

Which segment of the nephron is the primary site of parathyroid hormone-stimulated calcium reabsorption?

  1. The distal convoluted tubule Correct answer.
  2. The medullary collecting duct
  3. The thin descending limb
  4. The glomerulus

Explanation

PTH enhances calcium reabsorption in the distal convoluted tubule through apical calcium channels and basolateral sodium-calcium exchange. The descending limb, glomerulus, and medullary collecting duct are not the principal PTH-responsive calcium reabsorption sites.

Question 20Urologic Anatomy, Physiology, and Terminology

Which accurately describes the blood supply and drainage of the left testis compared with the left kidney?

  1. The left testicular vein drains into the left renal vein, while the artery arises from the internal iliac artery
  2. The left testicular vein drains into the left renal vein, while the testicular artery arises from the abdominal aorta Correct answer.
  3. The left testicular vein drains into the inferior vena cava, while the artery arises from the internal iliac artery
  4. The left testicular vein drains into the inferior vena cava, while the artery arises from the renal artery

Explanation

The testicular arteries arise from the abdominal aorta, and the left testicular vein drains into the left renal vein at a right angle, unlike the right vein which enters the inferior vena cava. This asymmetry is clinically relevant to varicocele formation.

Question 21Urologic Anatomy, Physiology, and Terminology

Which mechanism best explains how the kidney excretes a concentrated urine during dehydration?

  1. Reabsorption of water in the thick ascending limb
  2. The medullary osmotic gradient plus ADH-driven water permeability of the collecting duct Correct answer.
  3. Filtration of protein-free plasma at a higher rate in the medulla
  4. Active water secretion into the collecting duct driven by sodium pumps

Explanation

Concentrated urine requires the corticomedullary osmotic gradient built by the loop of Henle and urea recycling, together with ADH-mediated aquaporin-2 insertion in the collecting duct. Water is not actively secreted, and the thick ascending limb is water-impermeable.

Question 22Urologic Anatomy, Physiology, and Terminology

A patient has a lesion of the sacral parasympathetic outflow to the bladder. Which voiding pattern is most consistent with this lesion?

  1. An overactive bladder with frequent uninhibited contractions
  2. Urinary retention caused by detrusor-sphincter synergy
  3. An areflexic bladder that fails to contract, requiring catheter drainage Correct answer.
  4. Normal voiding with preserved sensation

Explanation

Sacral parasympathetic fibers (S2-S4) drive detrusor contraction, so their loss produces an areflexic, atonic bladder that cannot empty effectively. Uninhibited contractions reflect loss of supraspinal inhibition rather than parasympathetic loss, and normal voiding would not be expected.

Question 23Urologic Anatomy, Physiology, and Terminology

Which statement best distinguishes the renal corpuscle from the juxtaglomerular apparatus in functional terms?

  1. The corpuscle reabsorbs glucose, while the juxtaglomerular apparatus secretes potassium
  2. The corpuscle concentrates urine, while the juxtaglomerular apparatus dilutes urine
  3. The corpuscle secretes renin, while the juxtaglomerular apparatus filters plasma
  4. The corpuscle filters plasma, while the juxtaglomerular apparatus regulates filtration and renin release Correct answer.

Explanation

The renal corpuscle is the filtration unit where plasma is filtered into Bowman space, whereas the juxtaglomerular apparatus senses tubular fluid and regulates afferent arteriolar tone and renin release. Reabsorption, secretion, and concentration occur in tubular segments, not these structures.

Question 24Urologic Anatomy, Physiology, and Terminology

Which layer of the bladder wall contains the muscle responsible for voiding?

  1. The lamina propria
  2. The muscularis propria (detrusor) Correct answer.
  3. The urothelium
  4. The serosa

Explanation

The muscularis propria of the bladder, known as the detrusor, contains interlacing smooth muscle bundles whose contraction generates voiding pressure. The lamina propria and urothelium are mucosal layers, and the serosa is an outer connective covering.

Question 25Patient Assessment, Documentation, and Communication

A patient scheduled for a contrast-enhanced CT reports a prior reaction to iodinated contrast. Which premedication regimen is most consistent with standard practice before the study?

  1. No premedication is needed because prior reactions are not predictive
  2. Hydrocortisone 100 mg IV push immediately before the contrast injection
  3. Diphenhydramine 50 mg orally once, 30 minutes before contrast, with no corticosteroid
  4. Prednisone 50 mg orally at 13, 7, and 1 hour before contrast plus diphenhydramine 50 mg orally 1 hour before contrast Correct answer.

Explanation

Standard elective premedication combines a corticosteroid given on a tapering schedule beginning the day before with an antihistamine about one hour before contrast. This reduces the frequency and severity of recurrent reactions, though it does not eliminate risk. Emergency or accelerated regimens exist but are less effective.

Question 26Patient Assessment, Documentation, and Communication

Which finding on a pre-procedure assessment most strongly predicts difficulty with airway management during sedation?

  1. Body mass index of 24 with a neck circumference of 35 cm
  2. History of well-controlled hypertension
  3. Mallampati class I with a mouth opening greater than 3 cm
  4. Mallampati class IV with a thyromental distance under 6 cm Correct answer.

Explanation

A high Mallampati class combined with a short thyromental distance signals a crowded upper airway and limited space for laryngoscopy or rescue ventilation. These features together raise the predicted difficulty beyond either finding alone. The other listed findings are not recognized airway predictors.

Question 27Patient Assessment, Documentation, and Communication

When documenting a patient's allergy to shellfish in the medical record, which entry best supports safe contrast decision-making?

  1. Shellfish allergy, avoid all seafood
  2. Allergy: shellfish; reaction hives; no prior iodinated contrast exposure Correct answer.
  3. Allergy list pending review
  4. Possible food sensitivity, details unknown

Explanation

A useful allergy entry names the agent, describes the reaction type, and notes relevant exposure history so the team can judge risk. Shellfish allergy is not a proven marker of iodinated contrast reaction, and vague entries force clinicians to guess. Specificity and reaction description are the documentation standards.

Question 28Patient Assessment, Documentation, and Communication

A patient with an estimated glomerular filtration rate of 28 mL/min/1.73 m2 is being considered for iodinated contrast. Which action is most appropriate?

  1. Give a double dose of contrast to shorten the study
  2. Proceed without modification because eGFR thresholds apply only to inpatients
  3. Weigh the diagnostic benefit against contrast-associated kidney injury risk and document the discussion Correct answer.
  4. Cancel the study permanently because contrast is absolutely contraindicated

Explanation

Reduced eGFR raises the risk of contrast-associated acute kidney injury, but the decision balances clinical urgency against that risk. The reasoning and patient discussion should be documented, and preventive measures such as hydration considered. Contrast is not absolutely contraindicated in this setting.

Question 29Patient Assessment, Documentation, and Communication

During a procedure under moderate sedation, the patient becomes unresponsive to voice but responds to a light shoulder tap. How should this level of sedation be classified?

  1. Deep sedation
  2. General anesthesia
  3. Minimal sedation
  4. Moderate sedation Correct answer.

Explanation

Moderate sedation is a drug-induced depression of consciousness in which the patient responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Responding only to a tap rather than to voice still fits this category when airway and ventilation are maintained. Deep sedation would require repeated or painful stimulation to elicit a response.

Question 30Patient Assessment, Documentation, and Communication

Which monitoring element is required for every patient receiving moderate sedation, regardless of procedure type?

  1. Routine intra-arterial blood pressure monitoring
  2. Continuous pulse oximetry with intermittent blood pressure and cardiac rhythm assessment Correct answer.
  3. Arterial blood gas sampling every 30 minutes
  4. Hourly measurement of serum electrolytes

Explanation

Moderate sedation standards require continuous oxygen saturation monitoring along with periodic blood pressure and rhythm assessment. These measures detect hypoxemia and hemodynamic changes early enough to intervene. Blood gases, electrolytes, and invasive monitoring are reserved for specific clinical indications.

Question 31Patient Assessment, Documentation, and Communication

A patient tells the nurse, "I am not sure I want to go through with this test after what happened to my sister." Which response best demonstrates active listening?

  1. "Tell me more about what happened with your sister and how it is affecting your decision." Correct answer.
  2. "Would you like me to bring the consent form back later?"
  3. "Most patients tolerate this without any problems."
  4. "You should not worry; this test is very safe."

Explanation

Active listening invites the patient to elaborate and conveys that the concern is understood, which supports informed decision-making. Offering reassurance before exploring the concern dismisses the patient's experience. An open invitation to explain is the core technique.

Question 32Patient Assessment, Documentation, and Communication

Which technique is most appropriate when using a professional medical interpreter for a patient with limited English proficiency?

  1. Use gestures and skip interpretation for simple instructions
  2. Ask the patient's adult child to interpret to save time
  3. Speak to the interpreter in the third person about the patient throughout
  4. Speak directly to the patient and pause for interpretation after each short segment Correct answer.

Explanation

Working with an interpreter, the clinician addresses the patient directly and pauses for interpretation in short segments to preserve accuracy and rapport. Using family members, especially children, risks errors and role conflicts. Speaking about the patient rather than to them undermines the relationship.

Question 33Patient Assessment, Documentation, and Communication

A patient with suspected meningitis is awake, alert, and oriented with stable vital signs. Which documentation best reflects a complete initial neurological assessment?

  1. Glasgow Coma Scale 15
  2. Neuro checks ongoing
  3. Patient seems fine today
  4. Alert and oriented to person, place, time, and situation; pupils equal and reactive; moves all extremities; speech clear Correct answer.

Explanation

A complete neurological entry documents level of orientation, pupillary findings, motor function, and speech so that later changes can be detected. A single score or vague phrase does not capture the specific findings. Detail supports comparison over time and continuity of care.

Question 34Patient Assessment, Documentation, and Communication

A patient's blood pressure is 86/52 mm Hg with a heart rate of 118 beats per minute and cool extremities. Which action should the nurse take first?

  1. Initiate rapid assessment and escalate to the responsible clinician immediately Correct answer.
  2. Ask the patient to ambulate to assess for dizziness
  3. Administer the next scheduled oral antihypertensive dose
  4. Document the values and recheck in one hour

Explanation

Hypotension with compensatory tachycardia and poor peripheral perfusion indicates hemodynamic compromise requiring immediate escalation. Prompt notification and rapid assessment allow resuscitation to begin without delay. Delayed rechecking or administering antihypertensives would worsen the situation.

Question 35Patient Assessment, Documentation, and Communication

Which statement about obtaining informed consent for a procedure is most accurate?

  1. Consent obtained by a family member is always sufficient for an adult patient
  2. The nurse may obtain the signature after the physician has explained the procedure, risks, benefits, and alternatives Correct answer.
  3. A signed form alone proves that informed consent occurred
  4. The nurse may independently explain the risks and obtain consent if the physician is busy

Explanation

The physician is responsible for disclosing the procedure, risks, benefits, and alternatives; the nurse may witness the signature and verify understanding. A signature documents consent but does not by itself establish that the discussion was adequate. Adult patients with capacity consent for themselves.

Question 36Patient Assessment, Documentation, and Communication

A patient with a documented do-not-resuscitate order is scheduled for a minor procedure requiring sedation. What is the most appropriate approach?

  1. Discuss with the patient which treatments remain desired during the procedure and document the plan Correct answer.
  2. Cancel the procedure because sedation is incompatible with a DNR order
  3. Have the nurse decide whether to honor the order during the case
  4. Automatically suspend the order for all procedures without discussion

Explanation

DNR orders should be reviewed before procedures so that the patient's goals and the specific interventions desired during sedation are clarified and documented. Automatic suspension ignores patient autonomy, and blanket cancellation denies beneficial care. The plan should be explicit and communicated to the team.

Question 37Patient Assessment, Documentation, and Communication

Which element is essential when documenting a medication error that occurred during a procedure?

  1. An opinion that the error was unavoidable
  2. An objective description of what happened, the patient's response, and the notification made Correct answer.
  3. Omission of the event from the record to protect the team
  4. A statement blaming the pharmacy for the error

Explanation

Error documentation should be factual and objective, including the event, the patient's condition, interventions, and who was notified. Blame and speculation do not belong in the record, and omitting a significant event compromises safety and continuity. Honest documentation supports both the patient and system improvement.

Question 38Patient Assessment, Documentation, and Communication

A patient reports chest pain during an infusion. Which set of findings would most strongly suggest an acute coronary syndrome rather than a noncardiac cause?

  1. Pain with diaphoresis, nausea, and radiation to the left arm Correct answer.
  2. Pain reproduced by palpation of the chest wall
  3. Pain relieved completely by changing position
  4. Sharp pain only on deep inspiration with clear lung sounds

Explanation

Chest pain accompanied by diaphoresis, nausea, and radiation to the arm is a classic pattern raising concern for myocardial ischemia. Pain reproduced by palpation suggests musculoskeletal origin, while pleuritic or positional pain points elsewhere. Recognizing the high-risk pattern drives urgent ECG and escalation.

Question 39Patient Assessment, Documentation, and Communication

Which finding is most consistent with the onset of an anaphylactic reaction during contrast administration?

  1. Gradual onset of localized itching at the injection site over several hours
  2. Sudden urticaria with wheezing, hypotension, and throat tightness Correct answer.
  3. Isolated bradycardia with warm, dry skin
  4. Delayed low-grade fever 24 hours after the study

Explanation

Anaphylaxis is a rapid multisystem reaction typically involving skin, respiratory, and cardiovascular findings such as urticaria, bronchospasm, hypotension, and airway swelling. Prompt recognition and epinephrine are time-critical. Isolated or delayed findings do not fit this pattern.

Question 40Patient Assessment, Documentation, and Communication

A patient is unable to provide a history because of confusion, and no family member is present. Which action best supports safe care?

  1. Review available records, contact the primary care provider or emergency contact, and document the sources used Correct answer.
  2. Wait indefinitely until a family member arrives before any care
  3. Assume the patient has no allergies since none are stated
  4. Proceed with the procedure without any history and document that none was available

Explanation

When the patient cannot give a history, the clinician should gather information from records and collateral sources and document where it came from. Assuming absence of allergies or proceeding without any attempt to obtain history creates avoidable risk. Care should continue while history is pursued.

Question 41Patient Assessment, Documentation, and Communication

Which statement best describes the purpose of a structured handoff such as SBAR during transfer of a patient after a procedure?

  1. It is used only when the patient's condition is stable
  2. It replaces the need for a written procedure note
  3. It allows omission of pending results to shorten the report
  4. It provides a consistent framework for communicating the situation, background, assessment, and recommendations Correct answer.

Explanation

SBAR organizes handoff communication so that key clinical information and recommended actions are conveyed reliably. It supplements, rather than replaces, the written record. Pending results and concerns should be included because they affect ongoing care.

Question 42Patient Assessment, Documentation, and Communication

A patient describes taking "a little white water pill" for blood pressure but cannot name it. Which approach best improves medication history accuracy?

  1. Omit the medication because the name is unknown
  2. Ask about the bottle, pharmacy, dose frequency, and timing, and record the details obtained Correct answer.
  3. Record "water pill" as the medication name and move on
  4. Assume it is furosemide and document it as confirmed

Explanation

Accurate medication reconciliation uses concrete prompts such as the pill appearance, pharmacy, dose, and schedule, and documents exactly what was learned. Recording vague descriptions or assuming an identity introduces error. Omission loses information that may affect contrast or sedation planning.

Question 43Patient Assessment, Documentation, and Communication

Which documentation entry meets the standard for recording a patient's pain assessment?

  1. Pain 7/10, sharp, left lower quadrant, began 2 hours ago, radiating to back; interventions and response noted Correct answer.
  2. Patient appears uncomfortable
  3. Patient in pain
  4. Pain medication given as ordered

Explanation

A complete pain entry documents intensity, quality, location, onset, radiation, and the response to intervention. Vague phrases or a medication note alone do not convey the assessment. Detailed descriptions support reassessment and treatment decisions.

Question 44Patient Assessment, Documentation, and Communication

A patient with chronic kidney disease is scheduled for a procedure. Which laboratory value is most relevant to assess before administering a nephrotoxic medication?

  1. Prothrombin time and international normalized ratio
  2. Serum creatinine and estimated glomerular filtration rate Correct answer.
  3. Hemoglobin and hematocrit
  4. Serum amylase and lipase

Explanation

Serum creatinine and estimated glomerular filtration rate reflect renal clearance and guide dose adjustment of renally eliminated or nephrotoxic drugs. Hematologic, coagulation, and pancreatic markers address different risks. Basing the decision on renal function reduces the chance of further kidney injury.

Question 45Patient Assessment, Documentation, and Communication

During a procedure, the patient's oxygen saturation falls from 98% to 88% on room air while the respiratory rate is 8 breaths per minute. What is the most appropriate initial action?

  1. Increase the sedative to reduce movement
  2. Stimulate the patient, support the airway, and administer supplemental oxygen while summoning help Correct answer.
  3. Document the value and continue the procedure unchanged
  4. Continue monitoring and recheck in 10 minutes

Explanation

Falling saturation with bradypnea indicates hypoventilation, often from sedation, and requires immediate airway support, stimulation, oxygen, and assistance. Delay or continued sedation risks further deterioration. The response should be documented after the patient is stabilized.

Question 46Patient Assessment, Documentation, and Communication

Which communication practice best supports a patient's health literacy during discharge instructions after an outpatient procedure?

  1. Use plain language, limit key points, and use teach-back to confirm understanding Correct answer.
  2. Use medical terminology to demonstrate expertise
  3. Speak quickly to cover all instructions in the time available
  4. Provide a dense printed handout and ask the patient to read it at home

Explanation

Plain language, a small number of prioritized messages, and teach-back verify that the patient can restate and apply the instructions. Dense handouts alone and rapid delivery reduce comprehension. Confirming understanding is the central strategy.

Question 47Patient Assessment, Documentation, and Communication

A patient's advance directive designates a health care agent. The patient is now unconscious and the agent is unavailable. What should the team do?

  1. Ignore the directive because the agent cannot be reached
  2. Proceed with treatments the directive explicitly refuses
  3. Follow the documented directive and attempt to contact the agent while providing necessary care Correct answer.
  4. Ask any available staff member to make decisions instead

Explanation

The written directive remains valid and should guide care while efforts continue to reach the designated agent. Ignoring the document or substituting arbitrary decision-makers disregards the patient's expressed wishes. Providing necessary care while honoring the directive is the appropriate course.

Question 48Patient Assessment, Documentation, and Communication

Which finding during assessment most suggests the patient may be experiencing a vasovagal reaction rather than an anaphylactic reaction?

  1. Generalized flushing with pruritus
  2. Tachycardia with urticaria and wheezing
  3. Rapid onset of facial and laryngeal swelling
  4. Bradycardia with pallor, diaphoresis, and hypotension Correct answer.

Explanation

Vasovagal reactions typically produce bradycardia with pallor, diaphoresis, and hypotension from increased vagal tone. Anaphylaxis more often involves tachycardia with urticaria, wheezing, and swelling. Distinguishing the two guides treatment, since epinephrine is indicated for anaphylaxis but not for a simple vasovagal episode.

Question 49Infection Prevention, Asepsis, and Catheter Care

A nurse is preparing to insert an indwelling urinary catheter. Which action best demonstrates maintenance of surgical asepsis during the procedure?

  1. Reusing the same sterile gloves after touching the patient's bed linens
  2. Wearing clean gloves and washing the meatus with tap water before insertion
  3. Using sterile gloves to handle the catheter and keeping the sterile field in view at all times Correct answer.
  4. Placing the sterile drape on the bed and adjusting it with bare hands as needed

Explanation

Surgical asepsis requires that sterile items touch only sterile items and that the nurse continuously monitors the field. Sterile gloves must be worn when handling the catheter, and any break in technique contaminates the field. Clean gloves and tap water do not meet the standard for catheter insertion.

Question 50Infection Prevention, Asepsis, and Catheter Care

Which statement correctly describes the difference between medical asepsis and surgical asepsis?

  1. Medical asepsis requires sterile gloves, while surgical asepsis requires only hand hygiene
  2. Medical asepsis is used only in operating rooms, while surgical asepsis is used in all patient rooms
  3. Medical asepsis eliminates all microorganisms, while surgical asepsis only reduces them
  4. Medical asepsis reduces the number and spread of microorganisms, while surgical asepsis eliminates all microorganisms Correct answer.

Explanation

Medical asepsis, or clean technique, reduces the number and transmission of microorganisms through hand hygiene, barriers, and environmental cleaning. Surgical asepsis, or sterile technique, aims to eliminate all microorganisms from objects and areas. The two techniques differ in purpose and are used in different clinical situations.