Advanced Assessment Interpreting Findings 3rd Edition By Goolsby Grubbs – Test Bank

Chapter 11. Genitourinary System

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. When performing a dipstick test on a patient’s urine sample, a positive leukocyte esterase and nitrite is indicative of:
A. Microscopic hematuria
B. Urinary tract infection
C. Calculi in the urine
D. Possible bladder tumor

____ 2. An intravenous pyelogram should not be performed if serum creatinine is:
A. Less than 1.5
B. Greater than 1.0
C. Greater than 1.6
D. Less than 1.0

____ 3. Your 55-year-old male patient presents to the emergency department with complaints of sudden development of severe right-sided, colicky lower abdominal pain. He cannot sit still on the examining table. The patient has previously been in good health. On physical examination, there are no signs of peritoneal inflammation. A urine sample reveals hematuria and crystalluria. Which is the next diagnostic test that should be done immediately?
A. Ultrasound of the abdomen
B. Abdominal x-ray
C. Digital rectal examination
D. Spiral CT scan

____ 4. The most common complication of an untreated urinary obstruction due to a ureteral calculus is:
A. Hydronephrosis
B. Renal artery stenosis
C. Ureteral rupture
D. Kidney mass

____ 5. A 43-year-old male patient complains of right-sided abdominal and pain in the back in the right costovertebral angle region, fever, chills, dysuria, and nausea. On physical examination, there is 102 degree fever, tachycardia, and right costovertebral angle tenderness to percussion. The most likely condition is:
A. Lower urinary tract infection
B. Pyelonephritis
C. Nephrolithiasis
D. Hydronephrosis

____ 6. On a physical examination for employment, a 45-year-old male shows no significant findings and takes no medications. Past medical history and surgery are unremarkable. On urinalysis, hematuria is present. The urinalysis is repeated on another day and still reveals microscopic hematuria. It is important to recognize that painless hematuria can be diagnostic of:
A. Urinary tract infection
B. Bladder cancer
C. Nephrolithiasis
D. Pyelonephritis

____ 7. On DRE, you note that a 45-year-old patient has a firm, smooth, non-tender but asymmetrically shaped prostate. The patient has no symptoms and has a normal urinalysis. The patient’s PSA is within normal limits for the patient’s age. The clinician should:
A. Refer the patient for transrectal ultrasound guided prostate biopsy
B. Obtain an abdominal x-ray of kidneys, ureter, and bladder
C. Recognize this as a normal finding that requires periodic follow-up
D. Obtain urine culture and sensitivity for prostatitis

____ 8. Your 77-year-old patient complains of frequent urination, hesitation in getting the stream started, and nocturnal frequency of urination that is bothersome. On DRE, there is an enlarged, firm, non-tender, smooth prostate. The clinician should recognize these as symptoms of:
A. Prostatitis
B. Prostate cancer
C. Urethritis
D. Benign prostatic hyperplasia

____ 9. Your 66-year-old patient complains of frequency of urination and hesitancy of the urine stream. On DRE, there is a hard, nodular, enlarged, non-tender prostate. The clinician should recognize these as symptoms of:
A. Prostatitis
B. Prostate cancer
C. Urethritis
D. Benign prostatic hyperplasia

____ 10. A 27-year-old male comes in to the clinic for symptoms of dysuria, urinary frequency, as well as urgency and perineal pain. Transrectal palpation of the prostate reveals a very tender, boggy, swollen prostate. The clinician should recognize these as signs of:
A. Prostatitis
B. Prostate cancer
C. Urethritis
D. Benign prostatic hyperplasia

Chapter 11. Genitourinary System
Answer Section

MULTIPLE CHOICE

1. ANS: B
With urinary tract infection, urine dipstick will show positive leukocyte esterase, positive nitrite, and greater than 3 to 5 white blood cells per high-power field.

PTS: 1

2. ANS: C
IVP (also known as intravenous urography or excretory urography) is a study for noninvasive evaluation of the renal pelvis and ureter, with moderate cost and ease of administration. It demonstrates a wide variety of upper tract lesions and is well tolerated by most patients with a serum creatinine of 1.6 or less.

PTS: 1

3. ANS: D
The initial study can be a KUB or IVP; however, many facilities can perform a stone protocol spiral CT, a much more definitive test for the evaluation of kidney stones. CT can demonstrate filling defects. CT scan is a highly specific and sensitive test for urinary tract calculi. After the initial evaluation with CT scan, pain reliever can be administered. An IVP can be done at another time when the patient can better prepare for the test.

PTS: 1

4. ANS: A
Hydronephrosis is swelling of the renal pelvis caused by an obstructing stone, ureteral stricture, prostatic hyperplasia, or renal or abdominal tumor that prevents the kidney from draining. The obstruction can be unilateral or bilateral, symptoms can be sudden or gradual in onset, and progressive renal damage will occur with time.

PTS: 1

5. ANS: B
Pyelonephritis is a bacterial infection of the renal pelvis and parenchyma, typically caused by Escherichia coli ascending from the lower urinary tract. The patient will have bilateral or unilateral flank pain, fever, chills, nausea, and vomiting, and LUTS, such as dysuria, may also be present. The patient will appear ill on presentation, with fever and tachycardia commonly noted. Palpation and/or percussion over the infected side is painful. There may be accompanying abdominal discomfort or abdominal distension.

PTS: 1

6. ANS: B
Approximately 80% to 90% of patients with bladder cancer present with painless gross hematuria. All patients with this classic presentation should be considered to have bladder cancer until proof to the contrary. Patients should be referred to a urologist. They usually undergo cystoscopy to rule out bladder tumor. The majority of patients with bladder cancer present with no urinary tract symptoms or palpable masses.

PTS: 1

7. ANS: C
An asymmetric prostate is typically asymptomatic and not necessarily diagnostic of prostate cancer; asymmetry can be a normal finding on DRE but should be followed periodically to monitor for changes. Age-specific reference ranges for PSA (see Table 11.4) should be used as a guide when there is no previous PSA for comparison. A prostatic nodule found on DRE necessitates a referral to a urologist or radiologist for transrectal ultrasound-guided prostate biopsy and may well be the first indication of the presence of a cancer.

PTS: 1

8. ANS: D
BPH is an enlargement of the transition zone of the prostate gland which occurs as men age. An enlarged prostate causes symptoms that include urinary urgency, frequency, hesitation in getting the stream started, decreased caliber and force of stream, and nocturnal frequency of urination that is bothersome. This collection of symptoms has also been termed prostatism. A patient with BPH shows symmetric or asymmetric enlargement and a firm, smooth, non-tender gland.

PTS: 1

9. ANS: B
A prostate suspicious for malignancy will demonstrate nodular areas and/or overall hardness. Definitive diagnosis is made via prostate biopsy. Routine or urgent referral to a urologist is indicated, depending on the degree of PSA elevation and/or the degree to which it has risen since the previous value in conjunction with any suspicious findings on the rectal examination. A patient with prostate cancer often has no symptoms. Alternatively, an enlarged prostate can cause obstructive symptoms that include urinary urgency, frequency, hesitation in getting the stream started, decreased caliber and force of stream, and nocturnal frequency of urination that is bothersome.

PTS: 1

10. ANS: A
Prostatitis is an acute or chronic infection of the prostate gland. Acute bacterial prostatitis is usually the result of infection by aerobic gram-negative rods (coliform bacteria or Pseudomonas). Enterococcus faecalis, an aerobic gram-positive bacteria, can also cause prostatitis. Routes of infection are ascent from the urethra, reflux of infected urine into the prostatic ducts, direct extension of bacteria, and migration via the lymphatic and vascular system. Acute symptoms commonly include fever, low back and perineal pain, possible penis pain, urinary urgency and frequency, nocturia, dysuria, and muscle and joint aches. Transrectal palpation of the prostate reveals a very tender, boggy, swollen prostate.

PTS: 1