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. Obtain a midstream urine specimen for culture and sensitivity testing.

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. “I will empty my bladder every 2–4 hours during the day.”

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. In about one week urine will have rust-coloured flecks.

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

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. “I should start taking a high potency multiple vitamin every morning.”

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. Recent sore throat and fever

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. Peripheral and periorbital edema is resolved.

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. Anticoagulants

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. Recent weight gain

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 sardines

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. Have 2 000–3 000 mL of fluid a day.

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. Monitor and record blood pressure daily.

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. Importance of genetic counselling

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. Gonococcal urethritis

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. Bladder cancer

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. Assist the client to the bathroom every 2 hours during the day.

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. Teach the client how to perform Kegel exercises.

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. Use a bladder scan device to check the postvoiding residual.

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. Place a bedside commode near the client’s bed.

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. “I will clean the catheter carefully before and after each catheterization.”

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. Call the health care provider if the ureteral catheter output drops suddenly.

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. Catheterization technique and schedule

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. Disturbed body image related to alteration in self-perception

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. The client has noticed clots in the urine.

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. The need to empty the bladder before treatment

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. Avoid unnecessary catheterizations.

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

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. Blood pressure 88/45 mm Hg

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. Excess fluid volume related to low serum protein levels

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. Insert a urinary retention catheter.

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. Administer prescribed analgesics.

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. 1 850 mL

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. Drop in urine output

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. Assist the client to take a 15-minute sitz bath.

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. Disconnecting the catheter from the drainage tube to obtain a specimen

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. Urine output is 20 mL/hour for 2 hours.

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. Heart rate 102 beats/minute

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. Left-sided flank pain