chapter 48

Question 1

A client returns to the clinic with recurrent dysuria after being treated with
trimethoprim-sulfamethoxazole for 3 days. Which of the following actions should the
nurse plan to take?
a. Remind the client about the need to drink 1 000 mL of fluids daily.
b. Obtain a midstream urine specimen for culture and sensitivity testing.
c. Teach the client to take the prescribed trimethoprim-sulfamethoxazole for at least 3
more days.
d. Suggest that the client use acetaminophen to treat the symptoms.

Answer 1

B
Since uncomplicated urinary tract infections (UTIs) are usually successfully treated with 3
days of antibiotic therapy, this client will need a urine culture and sensitivity to determine
appropriate antibiotic therapy. Acetaminophen would not be as effective as other
over-the-counter (OTC) medications such as phenazopyridine in treating dysuria. The
fluid intake should be increased to at least 1 800 mL/day. Since the UTI has persisted after
treatment with trimethoprim-sulfamethoxazole, the client is likely to need a different
antibiotic.

Question 2

The nurse is providing client teaching to a client with cystitis regarding prevention of
future urinary tract infections (UTIs). Which of the following client statements indicate
that teaching has been effective?
a. “I can use vaginal sprays to reduce bacteria.”
b. “I will drink a quart of water or other fluids every day.”
c. “I will wash with soap and water before sexual intercourse.”
d. “I will empty my bladder every 2–4 hours during the day.”

Answer 2

D
Voiding every 2–4 hours is recommended to prevent UTIs. Use of vaginal sprays is
discouraged. The bladder should be emptied before and after intercourse, but cleaning with
soap and water is not necessary. A quart of fluids is insufficient to provide adequate urine
output to decrease risk for UTI.

Question 3

The nurse is caring for a client who has had a segmental cystectomy. Which of the
following information should the nurse include in the postoperative teaching for the client?
a. Limit fluid intake for at least 7 days.
b. Urine should be amber and not contain blood clots.
c. In about one week urine will have rust-coloured flecks.
d. Avoid sitz baths for a week after surgery.

Answer 3

C
Approximately 7–10 days following tumour resection or ablation, the patient may observe
dark red or rust-coloured flecks in the urine. These are anticipated and represent scabs
from the healing tumour resection sites. Other postoperative instructions for a segmental
cystectomy includes to drink a large volume of fluid each day for the first week following
the procedure and to avoid intake of alcoholic beverages. Urine is anticipated to be pink
during the first several days after the procedure, but it should not be bright red or contain
blood clots. The patient can be encouraged to take a 15–20-minute sitz bath two to three
times a day to promote muscle relaxation and to reduce the risk of urinary retention.

Question 4

The nurse is caring for a client with benign prostatic hyperplasia who has chills, fever, and
is vomiting. Which of the following findings by the nurse is most helpful in determining
whether the client has an upper urinary tract infection (UTI)?
a. Suprapubic pain
b. Bladder distention
c. Foul-smelling urine
d. Costovertebral tenderness

Answer 4

D
Costovertebral tenderness is characteristic of pyelonephritis. The other symptoms are
characteristic of lower UTI and are likely to be present if the client also has an upper UTI.

Question 5

The nurse is teaching a client with interstitial cystitis about management of the condition.
Which of the following client statements indicate that further instruction is required?
a. “I will have to stop having coffee and orange juice for breakfast.”
b. “I should start taking a high potency multiple vitamin every morning.”
c. “I will buy some calcium glycerophosphate (Prelief) at the pharmacy.”
d. “I should call the doctor about increased bladder pain or odorous urine.”

Answer 5

B
High-potency multiple vitamins may irritate the bladder and increase symptoms. The other
client statements indicate good understanding of the teaching.

Question 6

The nurse is admitting a client with acute glomerulonephritis. Which of the following
assessments is most important for the nurse to include?
a. Recent sore throat and fever
b. History of high blood pressure
c. Frequency of bladder infections
d. Family history of kidney stones

Answer 6

A
Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep
throat. It is not caused by hypertension, urinary tract infection (UTI), or kidney stones.

Question 7

Which of the following findings by the nurse for a client admitted with glomerulonephritis
indicates that treatment has been effective?
a. The client denies pain with voiding.
b. The urine dipstick is negative for nitrites.
c. Peripheral and periorbital edema is resolved.
d. The antistreptolysin-O (ASO) titre is decreased.

Answer 7

C
Since edema is a common clinical manifestation of glomerulonephritis, resolution of the
edema indicates that the prescribed therapies have been effective. Antibodies to
streptococcus will persist after a streptococcal infection. Nitrites will be negative and the
client will not experience dysuria since the client does not have a urinary tract infection.

Question 8

The nurse is caring for a client with nephrotic syndrome who develops flank pain. Which
of the following medication classifications should the nurse anticipate including in the
client teaching plan?
a. Antibiotics
b. Anticoagulants
c. Corticosteroids
d. Antihypertensives

Answer 8

B
Flank pain in a client with nephrosis suggests a renal vein thrombosis, and anticoagulation
is needed. Antibiotics are used to treat a client with flank pain caused by pyelonephritis.
Antihypertensives are used if the client has high blood pressure. Corticosteroids may be
used to treat nephrotic syndrome but will not resolve a thrombosis.

Question 9

The nurse is admitting a client with new onset nephrotic syndrome. Which of the
following findings should the nurse expect to assess related to this illness?
a. Poor skin turgor
b. High urine ketones
c. Recent weight gain
d. Low blood pressure

Answer 9

C
The client with a nephrotic syndrome will have weight gain associated with edema.
Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal
because of the edema. Urine protein is high.

Question 10

The nurse is caring for a client whose renal calculus is analyzed as being very high in uric
acid. To prevent recurrence of stones, which of the following foods should the nurse teach
the client to avoid eating?
a. Milk and dairy products
b. Legumes and dried fruits
c. Organ meats and sardines
d. Spinach, chocolate, and tea

Answer 10

C
Organ meats and fish such as sardines increase purine levels and uric acid. Spinach,
chocolate, and tomatoes should be avoided in clients who have oxalate stones. Milk, dairy
products, legumes, and dried fruits may increase the incidence of calcium-containing
stones.

Question 11

Which of the following actions should the nurse teach to a client to help prevent the
recurrence of renal calculi?
a. Use a filter to strain all urine.
b. Avoid dietary sources of calcium.
c. Drink diuretic fluids such as coffee.
d. Have 2 000–3 000 mL of fluid a day.

Answer 11

D
A fluid intake of 2 000–2 200 mL daily is recommended to help flush out minerals before
stones can form. Avoidance of calcium is not usually recommended for clients with renal
calculi. Coffee tends to increase stone recurrence. There is no need for a client to strain all
urine routinely after a stone has passed, and this will not prevent stones.

Question 12

The nurse is planning teaching for a client with benign nephrosclerosis. Which of the
following information should the nurse include in the teaching plan?
a. Monitor and record blood pressure daily.
b. Obtain and document daily weights.
c. Measure daily intake and output amounts.
d. Prevent bleeding caused by anticoagulants.

Answer 12

A
Hypertension is the major symptom of nephrosclerosis. Measurements of intake and
output and daily weights are not necessary unless the client develops renal insufficiency.
Anticoagulants are not used to treat nephrosclerosis.

Question 13

The nurse is caring for a young adult female client who is diagnosed with polycystic
kidney disease. Which of the following information should the nurse include in teaching at
this time?
a. Importance of genetic counselling
b. Complications of renal transplantation
c. Methods for treating chronic and severe pain
d. Differences between hemodialysis and peritoneal dialysis

Answer 13

A
Because a young female client may be considering having children, the nurse should
include information about genetic counselling when teaching the client. The well-managed
client will not need to choose between hemodialysis and peritoneal dialysis or know about
the effects of transplantation for many years. There is no indication that the client has
chronic pain.

Question 14

The nurse is assessing a male client with symptoms of a feeling of incomplete bladder
emptying and a split, spraying urine stream. Which of the following conditions should the
nurse question the client about when taking a health history?
a. Bladder infection
b. Recent kidney trauma
c. Gonococcal urethritis
d. Benign prostatic hyperplasia

Answer 14

C
The client’s clinical manifestations are consistent with urethral strictures, a possible
complication of gonococcal urethritis. These symptoms are not consistent with benign
prostatic hyperplasia, kidney trauma, or bladder infection.

Question 15

The nurse is obtaining the health history for a client who smokes two packs of cigarettes
daily. Which of the following conditions should the nurse include in the teaching plan that
the client is at an increased risk for developing?
a. Kidney stones
b. Bladder cancer
c. Bladder infection
d. Interstitial cystitis

Answer 15

B
Cigarette smoking is a risk factor for bladder cancer. The client’s risk for developing
interstitial cystitis, urinary tract infection (UTI), or kidney stones will not be reduced by
quitting smoking.

Question 16

The nurse is admitting an older-adult client with dehydration who is confused and
incontinent of urine. Which of the following nursing actions is best to include in the plan
of care?
a. Apply absorbent incontinent pads.
b. Restrict fluids after the evening meal.
c. Insert an in-dwelling catheter until the symptoms have resolved.
d. Assist the client to the bathroom every 2 hours during the day.

Answer 16

D
In older or confused clients, incontinence may be avoided by using scheduled toileting
times. In-dwelling catheters increase the risk for urinary tract infection (UTI). Incontinent
pads increase the risk for skin breakdown. Restricting fluids is not appropriate in a client
with dehydration.

Question 17

A female client asks the nurse for a perineal pad, stating that laughing or coughing causes
leakage of urine. Which of the following interventions is best to include in the care plan?
a. Assist the client to the bathroom q3hr.
b. Place a commode at the client’s bedside.
c. Demonstrate how to perform the Credé manoeuvre.
d. Teach the client how to perform Kegel exercises.

Answer 17

D
Exercises to strengthen the pelvic floor muscles will help reduce stress incontinence. The
Credé manoeuvre is used to help empty the bladder for clients with overflow incontinence.
Placing the commode close to the bedside and assisting the client to the bathroom are
helpful for functional incontinence.

Question 18

The nurse is caring for a client following rectal surgery who voids about 50 mL of urine
every 30–60 minutes. Which of the following nursing actions is best?
a. Use a bladder scan device to check the postvoiding residual.
b. Monitor the client’s intake and output over the next few hours.
c. Have the client take small amounts of fluid frequently throughout the day.
d. Reassure the client that this is normal after rectal surgery because of anesthesia.

Answer 18

A
A bladder scan device can be used to check for residual urine after the client voids.
Because the client’s history and clinical manifestations are consistent with overflow
incontinence, it is not appropriate to have the client drink small amounts. Although
overflow incontinence is not unusual after surgery, the nurse should intervene to correct
the physiological problem, not just reassure the client. The client may develop reflux into
the renal pelvis as well as discomfort from a full bladder if the nurse waits to address the
problem for several hours.

Question 19

The nurse is caring for a client who has a history of functional urinary incontinence.
Which of the following nursing actions should be included in the plan of care?
a. Place a bedside commode near the client’s bed.
b. Demonstrate the use of the Credé manoeuvre to the client.
c. Use an ultrasound scanner to check postvoiding residuals.
d. Teach the use of Kegel exercises to strengthen the pelvic floor.

Answer 19

A
Modifications in the environment make it easier to avoid functional incontinence.
Checking for residual urine and performing the Credé manoeuvre are interventions for
overflow incontinence. Kegel exercises are useful for stress incontinence.

Question 20

The home health nurse is teaching a client with a neurogenic bladder how to use
intermittent catheterization for bladder emptying. Which of the following client statements
indicates that the teaching has been effective?
a. “I will use a sterile catheter and gloves for each time I self-catheterize.”
b. “I will clean the catheter carefully before and after each catheterization.”
c. “I will need to buy seven new catheters weekly and use a new one every day.”
d. “I will need to take prophylactic antibiotics to prevent any urinary tract infections.”

Answer 20

B
Clients who are at home can use a clean technique for intermittent self-catheterization and
change the catheter every 7 days. There is no need to use a new catheter every day, to use
sterile catheters, or to take prophylactic antibiotics.

Question 21

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?
a. Provide education about home care for both catheters.
b. Apply continuous steady tension to the ureteral catheter.
c. Clamp the ureteral catheter unless output from the urethral catheter stops.
d. Call the health care provider if the ureteral catheter output drops suddenly.

Answer 21

D
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 22

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?
a. Application of ostomy appliances
b. Catheterization technique and schedule
c. Analgesic use before emptying the pouch
d. Use of barrier products for skin protection

Answer 22

B
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 23

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 nursing diagnoses best
reflects the data that the nurse has obtained?
a. Anxiety related to threat to current status (effects of procedure on lifestyle)
b. Disturbed body image related to alteration in self-perception
c. Ineffective coping related to insufficient sense of control
d. Ineffective denial related to ineffective coping strategies (denial of altered body
function)

Answer 23

B
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 24

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?
a. The client is using opioids for pain.
b. The client has noticed clots in the urine.
c. The client is very anxious about the cancer.
d. The client is taking a 15-minute sitz bath twice a day.

Answer 24

B
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 25

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?
a. Premedicating to prevent nausea
b. Where to obtain wigs and scarves
c. The importance of oral care during treatment
d. The need to empty the bladder before treatment

Answer 25

D

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 26

Which of the following nursing actions is most helpful in decreasing the risk for
hospital-acquired infection (HAI) of the urinary tract in clients admitted to the hospital?
a. Avoid unnecessary catheterizations.
b. Encourage adequate oral fluid intake.
c. Test urine with a dipstick daily for nitrites.
d. Provide thorough perineal hygiene to clients.

Answer 26

A
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 27

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?
a. Nausea
b. Flank pain
c. Poor urine output
d. Pain with urination

Answer 27

D
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 28

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?
a. Foul-smelling urine
b. Complaint of flank pain
c. Blood pressure 88/45 mm Hg
d. Temperature 37.8°C (100°F)

Answer 28

C
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 29

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?
a. Excess fluid volume related to low serum protein levels
b. Activity intolerance related to increased weight and fatigue
c. Disturbed body image related to peripheral edema and ascites
d. Altered nutrition: less than required related to protein restriction

Answer 29

A
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 30

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?
a. Insert a urinary retention catheter.
b. Schedule an intravenous pyelogram.
c. Administer lorazepam 0.5 mg PO.
d. Draw blood for blood urea nitrogen (BUN) and creatinine testing.

Answer 30

A
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 31

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?
a. Encourage oral fluid intake.
b. Administer prescribed analgesics.
c. Monitor temperature every 4 hours.
d. Give antiemetics as needed for nausea.

Answer 31

B
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 32

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?
a. 650 mL
b. 1 250 mL
c. 1 850 mL
d. 2 450 mL

Answer 32

C
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 33

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?
a. Blood in urine
b. Left flank pain
c. Left flank bruising
d. Drop in urine output

Answer 33

D
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.

Question 34

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?
a. Insert a straight catheter and drain the bladder.
b. Assist the client to take a 15-minute sitz bath.
c. Encourage the client to drink several glasses of water.
d. Teach the client how to do isometric perineal exercises.

Answer 34

B
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 35

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?
a. Taping the catheter to the skin on the client’s upper inner thigh
b. Cleaning around the client’s urinary meatus with soap and water
c. Using an alcohol-based hand cleaner before performing catheter care
d. Disconnecting the catheter from the drainage tube to obtain a specimen

Answer 35

D
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 36

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?
a. Blood pressure is 102/58.
b. Incisional pain level is 8/10.
c. Urine output is 20 mL/hour for 2 hours.
d. Crackles are heard at both lung bases.

Answer 36

C
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 37

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?
a. Cloudy appearing urine
b. Hypotonic bowel sounds
c. Heart rate 102 beats/minute
d. Continuous drainage from stoma

Answer 37

C
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 38

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?
a. Dysuria
b. Hematuria
c. Left-sided flank pain
d. Temperature 37.8°C (100°F)

Answer 38

C
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).