Question 1

The nurse is caring for a client following an open loop resection and fulguration of the bladder who is unable to void. Which of the following actions should the nurse implement first?

Accepted Answer

Sitz baths will relax the perineal muscles and promote voiding. Although the client should be encouraged to drink fluids and Kegel exercises are helpful in the prevention of incontinence, these activities would not be helpful for a client experiencing retention.
Catheter insertion increases the risk for urinary tract infection (UTI) and should be avoided when possible.

Question 2

The nurse is caring for a client with benign prostatic hyperplasia (BPH) and a markedly distended bladder who is agitated and confused. Which of the following interventions prescribed by the health care provider should the nurse implement first?

Accepted Answer

The client's history and clinical manifestations are consistent with acute urinary retention, and the priority action is to relieve the retention by catheterization. The BUN and creatinine measurements can be obtained after the catheter is inserted. The client's agitation may resolve once the bladder distention is corrected, and sedative drugs should be used cautiously in older clients. The IVP is an appropriate test, but does not need to be done urgently.

Question 3

The nurse is preparing a client with bladder cancer for intravesical chemotherapy. Which of the following information should the nurse teach the client about in preparation for the treatment?

Accepted Answer

Intravesical chemotherapy is the instillation of the agent directly into the bladder; therefore the client needs to have an empty bladder before the instillation of the chemotherapy.
Systemic adverse effects are not experienced with intravesical chemotherapy.

Question 4

The nurse is caring for a client who has had an ureterolithotomy with a left ureteral catheter and a urethral catheter in place. Which of the following actions should the nurse include in the plan of care?

Accepted Answer

The health care provider should be notified if the ureteral catheter output decreases since obstruction of this catheter may result in an increase in pressure in the renal pelvis.
Tension on the ureteral catheter should be avoided in order to prevent catheter displacement. To avoid pressure in the renal pelvis, the catheter is not clamped. Since the client is not usually discharged with a ureteral catheter in place, client teaching about both catheters is not needed.

Question 5

A client who has had a transurethral resection with fulguration for bladder cancer 3 days previously calls the nurse at the urology clinic. Which of the following information given by the client is most important to report to the health care provider?

Accepted Answer

Clots in the urine are not expected and require further follow-up. Sitz baths two to three times a day, use of opioids for pain, and anxiety are typical after this procedure.

Question 6

The nurse is caring for a client who is two days postoperative with an ileal conduit, and the client will not look at the stoma or participate in care, and insists that no one but the ostomy nurse specialist care for the stoma. Which of the following nursingdiagnoses best reflects the data that the nurse has obtained?

Accepted Answer

The client's unwillingness to look at the stoma or participate in care indicates that disturbed body image is the best diagnosis. No data suggest that the impact on lifestyle is a concern for the client, or that ineffective coping is a result of an insufficient sense of control. The client's insistence that only the ostomy nurse care for the stoma indicates that denial is not present.

Question 7

Which of the following information noted by the nurse when caring for a client with a bladder infection is most important to report to the health care provider?

Accepted Answer

Flank pain indicates that the client may have developed pyelonephritis as a complication of the bladder infection. The other clinical manifestations are consistent with a lower urinary tract infection (UTI).

Question 8

The nurse is caring for a client with renal calculi, gross hematuria, and severe colicky left flank pain. Which of the following actions is priority at this time?

Accepted Answer

Although all of the nursing actions may be used for clients with renal lithiasis, the client's presentation indicates that management of pain is the highest priority action. If the client has urinary obstruction, increasing oral fluids may increase the symptoms. There is no evidence of infection or nausea.

Question 9

The nurse is caring for a client who had a nephrectomy after having massive trauma to the kidney. Which of the following assessment findings obtained postoperatively is most important to communicate to the surgeon?

Accepted Answer

Because the urine output should be at least 0.5 mL/kg/hour, a 40 mL output for 2 hours indicates that the client may have decreased renal perfusion because of bleeding, inadequate fluid intake, or obstruction at the suture site. The blood pressure requires ongoing monitoring but does not indicate inadequate perfusion at this time. The client should cough and deep breathe, but the crackles do not indicate a need for an immediate change in therapy. The incisional pain should be addressed, but this is not as potentially life-threatening as decreased renal perfusion. In addition, the nurse can medicate the client for pain.

Question 10

The nurse is providing teaching to a client with impaired urinary elimination related to an UTI who weighs 70 kg. Which of the following daily fluid intake amounts should the nurse include in the teaching plan?

Accepted Answer

The recommended daily liquid intake for the ambulatory adult is approximately 33 mL/kg of body weight per day. Thus, a 70-kg person would require 2 310 mL each day. Because the person will obtain approximately 20% of this fluid from food, this leaves 1 848 mL obtained by drinking, or nearly eight 236-mL glasses of fluid.

Question 11

Which assessment finding for a client who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider?

Accepted Answer

The low blood pressure indicates that urosepsis and septic shock may be occurring and should be immediately reported. The other findings are typical of pyelonephritis.

Question 12

Which of the following nursing actions is most helpful in decreasing the risk for

Accepted Answer

Since catheterization bypasses many of the protective mechanisms that prevent urinary tract infection (UTI), avoidance of catheterization is the most effective means of reducing HAI. The other actions will also be helpful, but are not as useful as decreasing urinary catheter use.

Question 13

The nurse is caring for a client who is diagnosed with nephrotic syndrome and has 3+ ankle and leg edema with ascites. Which of the following nursing diagnoses is a priority for the client?

Accepted Answer

The client has massive edema, so the priority problem at this time is the excess fluid volume. The other nursing diagnoses also are appropriate, but the focus of nursing care should be resolution of the edema and ascites.

Question 14

The nurse is assessing a client who has a lower urinary tract infection (UTI). Which of the following symptoms should the nurse ask about initially?

Accepted Answer

Pain with urination is a common symptom of a lower UTI. Urine output does not decrease, but frequency may be experienced. Flank pain and nausea are associated with an upper UTI.

Question 15

Which of the following findings for a client who has had a cystectomy with an ileal conduit the previous day is most important for the nurse to communicate to the health care provider?

Accepted Answer

Tachycardia may indicate infection, hemorrhage, or postoperative atelectasis and shock, which are all serious complications of this surgery. The urine from an ileal conduit normally contains mucus and is cloudy. Hypotonic bowel sounds are expected after bowel surgery. Continuous drainage of urine from the stoma is normal.

Question 16

The nurse observes an unregulated care provider (UCP) taking the following actions when caring for a client with a retention catheter. Which of the following actions require the nurse to intervene with client care?

Accepted Answer

The catheter should not be disconnected from the drainage tube because this increases the risk for urinary tract infection (UTI). The other actions are appropriate and do not require any intervention.

Question 17

The nurse is teaching a client about avoiding the recurrence of a urinary tract infection. Which of the following information should be included in the teaching plan? (Select all that apply.)

Accepted Answer

The nurse would teach about voiding q2hr to q4hr during the day, avoiding bubble baths and advising the client to report cloudy urine, as well as pain, frequency, and urgency. The client is to be taught to wipe from back to front. Diaphragm use should be discouraged temporarily, rather than suggested as an option.

Question 18

The nurse is caring for a client who has bladder cancer and had a cystectomy with creation of an Indiana pouch. Which of the following topics should the nurse include in client teaching?

Accepted Answer

The Indiana pouch enables the client to self-catheterize every 4-6 hours. There is no need for an ostomy device or barrier products. Catheterization of the pouch is not painful.

Question 19

The nurse is caring for a client who has had left-sided extracorporeal shock wave lithotripsy. Which of the following findings is most important to report to the health care provider?

Accepted Answer

Because lithotripsy breaks the stone into small sand, which could cause obstruction, it is important to report a drop in urine output. Left flank pain, bruising, and hematuria are common after lithotripsy.

Quiz 48: Nursing Management Renal and Urologic Problems