Deck 69: Care of Patients With Urinary Problems

Question 1

A confused client is hospitalized for possible pneumonia and is admitted from the emergency department with an indwelling catheter in place.During interdisciplinary rounds the following day,what question by the nurse takes priority?

A) "Do you want daily weights on this client?"
B) "Will the client be able to return home?"
C) "Can we discontinue the in-dwelling catheter?"
D) "Should we get another chest x-ray today?"

Answer 1

"Can we discontinue the in-dwelling catheter?"

Question 2

A client who has undergone a nephrolithotomy procedure 24 hours ago now has a fever of 101° F (38.3° C).What is the nurse's priority intervention?

A) Apply a cooling blanket.
B) Strain the client's urine.
C) Notify the health care provider.
D) Document the finding in the client's chart.

Answer 2

Notify the health care provider.

Question 3

Which client is at greatest risk for development of a bacterial cystitis?

A) Older woman not taking estrogen replacement
B) Older man with mild congestive heart failure
C) Middle-aged woman who has never been pregnant
D) Middle-aged man taking cyclophosphamide for cancer therapy

Answer 3

Older woman not taking estrogen replacement

Question 4

A client has kidney stones from secondary hyperoxaluria.Which medication does the nurse anticipate administering?

A) Phenazopyridine (Pyridium)
B) Propantheline (Pro-Banthine)
C) Tolterodine (Detrol-LA)
D) Allopurinol (Zyloprim)

Question 5

A client with severe bacterial cystitis is prescribed cefadroxil (Duricef)and phenazopyridine (Pyridium).What statement by the client indicates an accurate understanding of these medications?

A) "I will not take these drugs with food or milk."
B) "I will stop these drugs if I think I am pregnant."
C) "An orange color in my urine won't alarm me."
D) "I will try to drink a liter of cranberry juice daily."

Question 6

The nurse is assessing the laboratory findings of a client with a urinary tract infection.The laboratory report notes a "shift to the left" in a client's white blood cell count.Which action by the nurse is most appropriate?

A) Request that the laboratory perform a differential analysis on the white blood cells.
B) Notify the health care provider and start an IV line for parenteral antibiotics.
C) Instruct the client to begin straining all urine for renal calculi.
D) Document the finding in the client's chart and continue to monitor.

Question 7

A client with bladder cancer is scheduled to have intravesical chemotherapy.Which statement made by the client indicates correct understanding of this therapy?

A) "My hair will start growing back in 3 to 6 weeks after chemotherapy is over."
B) "My white blood cell count will drop and I will be at increased risk for infection."
C) "This type of chemotherapy is used when no distant metastases are present."
D) "Chemotherapy only controls cancer, so I will also need radiation."

Question 8

The caretaker of a confused client with functional incontinence asks about having an in-dwelling catheter placed.Which is the nurse's best response?

A) "You must be very aggravated about this situation. I will call the provider with this request."
B) "I will teach you how to insert the catheter, which should be used just at night."
C) "We can teach you how to perform intermittent catheterization to drain the bladder."
D) "Because the client is confused, we need to place priority on keeping the skin clean and dry."

Question 9

Which personal factor places a client at risk for bladder cancer?

A) Working in a lumber yard for 10 years
B) 50-pack-year cigarette smoking history
C) Numerous episodes of bacterial cystitis
D) History of sexually transmitted diseases

Question 10

A client has a fungal urinary tract infection.Which assessment by the nurse is most helpful?

A) Palpating and percussing the kidneys and bladder
B) Assessing medical history and current medical problems
C) Performing a bladder scan to assess post-void residual
D) Inquiring about recent travel to foreign countries

Question 11

The nurse is working in a long-term care facility where many clients use habit training to manage incontinence.Which action by unlicensed assistive personnel (UAP)requires intervention by the nurse?

A) Toileting clients after meals
B) Changing incontinence briefs when wet
C) Encouraging clients to drink fluids
D) Recording incontinence episodes

Question 12

The nurse is working in an incontinence clinic and sees older clients.The nurse plans a habit training program for the client with which condition?

A) Confusion
B) Diabetes
C) Early kidney failure
D) Arthritis

Question 13

Which statement made by a client with stress incontinence indicates a need for clarification of nutrition therapy?

A) "I will limit my total intake of fluids."
B) "I will avoid drinking alcoholic beverages."
C) "I will avoid drinking caffeinated beverages."
D) "I will try to lose about 10% of my body weight."

Question 14

A client has a history of renal calculi.Which statement by the client indicates a good understanding of preventive measures?

A) "I know I should drink at least 3 to 4 liters of fluid every day."
B) "I can't eat much dairy or other sources of calcium."
C) "Aspirin and aspirin-containing products can lead to stones."
D) "The doctor will give me antibiotics at the first sign of a stone."

Question 15

Which client statement indicates a good understanding regarding antibiotic therapy for recurrent urinary tract infections?

A) "If my urine becomes lighter and clearer, I can stop taking my medicine."
B) "Even if I feel completely well, I should take the medication until it is gone."
C) "When my urine no longer burns, I will no longer need to take the antibiotics."
D) "If I have a fever higher than 100° F (37.8° C), I should take twice as much medicine."

Question 16

A client has been admitted from a nursing home for a workup to determine the cause of several recent falls.What intervention by the nurse takes priority?

A) Obtain a clean catch or catheterized urine specimen.
B) Document the number of and causative factors for falls.
C) Review the results of recent laboratory work for kidney function.
D) Facilitate neurologic and social work consultations.

Question 17

A postmenopausal female client has had two episodes of bacterial urethritis in the last 6 months.She asks her nurse why this is happening to her now.Which is the nurse's best response?

A) "Your immune system becomes less effective as you age."
B) "Low estrogen levels can make the tissue more susceptible to infection."
C) "You should be more careful with your personal hygiene in this area."
D) "It is likely that you have an untreated sexually transmitted infection."

Question 18

A client is hospitalized with urinary retention,has an indwelling catheter,and is getting IV fluids.Which intervention does the nurse add to the care plan to address the priority problem for this client?

A) Perform catheter care per policy every shift.
B) Encourage fluid intake to 1 liter/day.
C) Apply a moisture barrier cream daily.
D) Document accurate intake and output (I&O) each shift.

Question 19

A client has overflow incontinence.Which intervention does the nurse add to this client's care plan to assist with elimination?

A) Stroking the medial aspect of the thigh
B) Using intermittent catheterization
C) Providing digital anal stimulation
D) Using the Valsalva maneuver

Question 20

A client with a renal calculus has just returned from an extracorporeal shock wave lithotripsy procedure,and the nurse finds an ecchymotic area on the client's right lower back.Which is the nurse's priority intervention?

A) Notify the health care provider.
B) Apply ice to the site.
C) Place the client in the prone position.
D) Document the observation in the chart.

Question 21

Which type of incontinence is most common after a difficult vaginal delivery?

A) Stress
B) Urge
C) Reflex
D) Overflow

Question 22

A client is scheduled to undergo the surgical creation of an ileal conduit.He expresses his anxiety and fear regarding the procedure.Which is an appropriate response from the nurse?

A) "Do you think something for your nerves would be helpful?"
B) "Would you like to discuss the procedure with your doctor once more?"
C) "Are you ready for your sleeping medication now?"
D) "Would you like to speak with someone who has an ileal conduit?"

Question 23

A client is receiving acetohydroxamic acid (Lithostat).Which statement by the client indicates a good understanding of this therapy?

A) "I should finish this antibiotic even if I am feeling better."
B) "I need to drink a full glass of water when I take this drug."
C) "My blood will be drawn occasionally for kidney function tests."
D) "This medication may turn my urine bright orange and stain my clothes."

Question 24

A client with bladder cancer has undergone a complete cystectomy with ileal conduit.Four hours after the surgery,the nurse observes the stoma to be cyanotic.Which is the nurse's priority action?

A) Reassess in 2 hours.
B) Loosen the dressing.
C) Notify the surgeon.
D) Apply oxygen.

Question 25

Which statements about urge incontinence and stress incontinence are true?

A) Urge incontinence involves a post-voiding residual volume less than 50 mL.
B) Stress incontinence occurs because of weak pelvic floor muscles.
C) Stress incontinence usually occurs in people with dementia.
D) Urge incontinence can be managed by increasing fluid intake.
E) Urge incontinence occurs because of abnormal bladder contractions.

Question 26

A client is receiving treatment with levofloxacin (Levaquin).Which teaching topics does the nurse include in this client's care plan?

A) How to assess blood pressure
B) How to assess a radial pulse
C) How to assess a carotid pulse
D) How to assess respirations

Question 27

A client presents with senile dementia,Alzheimer's type (SDAT),and incontinence.Which therapy will best help this client?

A) Bladder training
B) Habit training
C) Exercise therapy
D) Electrical stimulation

Question 28

Which is an initial priority intervention for a client with stress incontinence?

A) Beginning medication and dietary teaching
B) Referring the client to an incontinence clinic
C) Assisting the client in finding absorbent pads
D) Instructing the client to maintain an incontinence diary

Question 29

A client has functional urinary incontinence.Which instruction by the nurse to the client and family helps meet an expected outcome for this condition?

A) "You must clean around your catheter daily with soap and water."
B) "Wash the vaginal weights with a 10% bleach solution after each use."
C) "Operations to repair your bladder are available, and you can consider these."
D) "Buy slacks with elastic waistbands that are easy to pull down."

Question 30

A client in the emergency department reports extreme dry mouth,constipation,and an inability to void.The client's history includes incontinence.Which question by the nurse is most important?

A) "Are you drinking plenty of water?"
B) "Do you take anticholinergic medication?"
C) "Have you tried laxatives or enemas?"
D) "Has this type of thing ever happened before?"

Question 31

The nurse is teaching a client about self-catheterization in the home setting.Which instructions are applicable?

A) "Wash your hands before and after self-catheterization."
B) "Use a large-lumen catheter for each catheterization."
C) "Use lubricant on the tip of the catheter before insertion."
D) "Self-catheterize every 12 hours."
E) "Use sterile gloves for the procedure."
F) "Maintain a specific schedule for catheterization."

Question 32

A client is receiving treatment with liquid nitrofurantoin (Furadantin).Which is the highest priority instruction that the nurse can provide to this client regarding accurate administration of the medication?

A) "The medication should be mixed with cold water before drinking it."
B) "Urine will turn orange immediately after you swallow the drug."
C) "You should ask the pharmacist for a syringe to measure the dose."
D) "The drug is available in granules that must be dissolved."

Question 33

A client is beginning to undergo urinary bladder training.Which is an effective instruction to give this client?

A) "Use the toilet at the first urge, rather than at specific intervals."
B) "Try to consciously hold your urine until the scheduled toileting time."
C) "Initially try to use the toilet at least every half-hour for 24 hours."
D) "The toileting interval can be increased once you have been continent for 1 week."

Question 34

A client has had two episodes of bacterial cystitis in the last 6 months.Which questions should the nurse ask?

A) "How much water do you drink every day?"
B) "Do you take estrogen replacement?"
C) "Does anyone in your family have a history of cystitis?"
D) "Do you have any condition that affects your immune system?"
E) "Are you on steroids or other immune suppressant drugs?"
F) "Do you drink grapefruit juice every day?"

Question 35

A client is being admitted with a suspected diagnosis of bladder cancer.Which question assists the nurse in determining risk factors?

A) "Do you smoke cigarettes?"
B) "Do you use alcohol?"
C) "Do you use recreational drugs?"
D) "Do you take any prescription drugs?"

Question 36

A young woman is being treated with amoxicillin (Amoxil)for a urinary tract infection.Which is the highest priority instruction for the nurse to give this client?

A) "Use a second form of birth control while on the drug."
B) "You will experience increased menstrual bleeding while on this drug."
C) "You may experience an irregular heartbeat while on the drug."
D) "Watch for blood in your urine while taking this drug."