MSS Ch 9: GU Disorders Comprehensive Exam

Question 1

The elderly client being seen in the clinic has complaints of urinary frequency, urgency, and “leaking.” Which priority intervention should the nurse implement when interviewing the client?

1. Ensure communication is nonjudgmental and respectful.
2. Set the temperature for comfort in the examination room.
3. Speak loudly to ensure the client understands the nurse.
4. Ensure the examining room has adequate lighting.

Answer 1

1. Clients who have urinary incontinence are often embarrassed, so it is the re- sponsibility of the nurse to approach this subject with respect and consideration.
2. The temperature of the room is not pertinent to the nurse interviewing the client.
3. The nurse should not assume elderly clients have hearing difficulty. If the client is “hard of hearing,” the nurse should speak clearly and concisely but should not shout.
4. The lighting of the room is not pertinent to interviewing the client about incontinence.

Question 2

The client is experiencing urinary incontinence. Which intervention should the nurse implement?

1. Teach the client to drink prune juice weekly.
2. Encourage the client to eat a high-fiber diet.
3. Discuss the need to urinate every six (6) hours.
4. Explain the importance of wearing cotton underwear.

Answer 2

1. Prune juice is given to prevent constipation but should be taken daily, not weekly.
2. Clients experiencing incontinence should eat a high-fiber diet to avoid constipation, which increases pressure on the bladder, which may increase incontinence.
3. Bladder training is used to assist with urinary incontinence by voiding every two (2) to three (3) hours, not every six (6) hours.
4. Cotton underwear may help decrease urinary tract infections but does not affect urinary incontinence.

Question 3

Which information indicates to the nurse the client teaching about treatment of urinary incontinence has been effective?

1. The client prepares a scheduled voiding plan.
2. The client verbalizes the need to increase fluid intake.
3. The client explains how to perform pelvic floor exercises.
4. The client attempts to retain the vaginal cone in place the entire day.

Answer 3

1. Scheduled voiding allows the client to void every two (2) to three (3) hours apart, and when the client has remained consistently dry, the interval is increased by about 15 minutes.
2. The fluid intake should not be increased but should be adequate to prevent dehydration. The majority of the fluid should be drunk early in the day to prevent nocturia.
3. Pelvic floor (Kegel) exercises should be performed two (2) to three (3) times daily with repetitions of 10 to 30 each session, but this is recommended for stress incontinence, not urinary incontinence.
4. A series of vaginal weights can be used to increase the muscle tone. The time is usually only 15 minutes, not all day.

Question 4

Which intervention should the nurse implement first for the client who has had an incontinent episode?

1. Palpate the client’s bladder to assess for urinary retention.
2. Obtain a bedside commode for the client.
3. Assist the client with changing the wet clothes.
4. Request the UAP to change the client’s linens.

Answer 4

1. The nurse may assess the bladder to determine if urine is being retained but not prior to changing the client’s wet clothes.
2. Having a bedside commode may or may not be helpful to the client who is incontinent.
3. The nurse should first assist the client in getting out of the wet clothes prior to any other action. Wet clothes are embarrassing to the client and can lead to skin breakdown.
4. The client’s linens need to be changed but not prior to changing the client’s wet clothes.

Question 5

The elderly client recovering from a prostatectomy has been experiencing stress incontinence. Which independent nursing intervention should the nurse discuss with the client?

1. Establish a set voiding frequency of every two (2) hours while awake.
2. Encourage a family member to assist the client to the bathroom to void.
3. Apply a transurethral electrical stimulator to relieve symptoms of urinary urgency.
4. Discuss the use of a “bladder drill,” including a timed voiding schedule.

Answer 5

1. Timed voiding is more helpful with neurogenic disorders, such as those related to diabetes.
2. A prompted voiding is useful with a client who does not have the cognitive ability to recognize the need.
3. The use of transvaginal or transurethral electrical stimulation to stimulate the pelvic floor muscles to contract is a collaborative intervention.
4. Use of the bladder training drill is helpful in stress incontinence. The client is instructed to void at scheduled intervals. After consistently being dry, the interval is increased by 15 minutes until the client reaches an acceptable interval.

Question 6

The nurse is preparing the plan of care for the client diagnosed with a neurogenic flaccid bladder. Which expected outcome is appropriate for this client?

1. The client has conscious control over bladder activity.
2. The client’s bladder does not become overdistended.
3. The client has bladder sensation and no discomfort.
4. The client demonstrates how to check for bladder distention.

Answer 6

1. In the neurogenic flaccid bladder, the client has lost the ability to recognize the need to void; therefore, this is not a realistic expected outcome.
2. The treatment goal of the flaccid bladder is to prevent overdistention.
3. The sensation has been lost as a result of a lower motor neuron problem; therefore, there is no sensation to maintain and no discomfort, so this is not a realistic goal.
4. The client does not have to assess the bladder; this is a nursing intervention.

Question 7

Which nursing intervention is most important before attempting to catheterize a client?

1. Determine the client’s history of catheter use.
2. Evaluate the level of anxiety of the client.
3. Verify the client is not allergic to latex.
4. Assess the client’s sensation level and ability to void.

Answer 7

1. To determine if the client has had a catheter in place previously assists with teaching and alleviating anxiety, but it is not the most important intervention.
2. Assessing the level of anxiety is helpful in assisting the client, but does not endanger the client; therefore, it is not the most important intervention.
3. The nurse should always assess for allergies to latex prior to inserting a latex catheter or using a drainage system because, if the client is allergic to latex, use of it could cause a life-threatening reaction.
4. There are many reasons the client is catheterized regardless of the sensation and ability to void. The nurse should not assess this until the catheter is removed.

Question 8

Which client should the nurse not assign to a UAP working on a surgical floor?

1. The client with a suprapubic catheter inserted yesterday.
2. The client who has had an indwelling catheter for the past week.
3. The client who is on a bladder-training regimen.
4. The client who had a catheter removed this morning and is being discharged.

Answer 8

1. This client requires the most skill and knowledge because this client has the greatest potential for an infection; therefore, the client should not be assigned to a UAP.
2. The UAP can care for a client with an indwelling catheter because adherence to Standard Precautions is the only requirement for safe client care.
3. The UAP cannot teach bladder training but can implement the strategies for the client on a bladder-training program, such as taking the client to the bathroom at scheduled times.
4. The UAP can care for this client because noting if the client voided after removal of the catheter is within the realm of the UAP’s ability.

Question 9

The nurse is caring for an elderly client who has an indwelling catheter. Which data warrant further investigation?

1. The client’s temperature is 98.0 ̊F.
2. The client has become confused and irritable.
3. The client’s urine is clear and light yellow.
4. The client feels the need to urinate.

Answer 9

1. This temperature, 98.0 ̊F, is within normal limits and does not require further investigation.
2. When an elderly client’s mental status changes to confused and irritable, the nurse should seek the etiology, which may be a UTI secondary to an indwelling catheter. Elderly clients often do not present with classic signs and symptoms of infection.
3. The client’s urine should be clear and light yellow; therefore, this does not warrant further investigation.
4. The client often has a feeling of the need to void when having an indwelling catheter, but this comment does not warrant further intervention.

Question 10

The nurse is observing the UAP providing direct care to a client with an indwelling catheter. Which data warrant immediate intervention by the nurse?

1. The UAP secures the tubing to the client’s leg with tape.
2. The UAP provides catheter care with the client’s bath.
3. The UAP puts the collection bag on the client’s bed.
4. The UAP cares for the catheter after washing the hands.

Answer 10

1. The client’s catheter should be secured on the leg to prevent manipulation, which increases the risk for a urinary tract infection. This action does not require intervention.
2. The client with an indwelling catheter should receive catheter care with the bath and as needed.
3. The drainage bag should be kept below the level of the bladder to prevent reflux of urine into the renal system; it should not be placed on the bed.
4. Hand hygiene is important before and after handling any portion of the drainage system.

Question 11

Which intervention should the nurse implement when caring for the client with a nephrostomy tube?

1. Change the dressing only if soiled by urine.
2. Clean the end of the connecting tubing with Betadine.
3. Clean the drainage system every day with bleach and water.
4. Assess the tube for kinks to prevent obstruction.

Answer 11

1. The dressing should be routinely changed as often as daily or weekly.
2. When connecting the tubing to the drainage bag, both ends should be cleaned with alcohol, not Betadine.
3. The drainage system can be cleaned daily with soap and water.
4. The nephrostomy tube should never be clamped or have kinks because an obstruction can cause pyelonephritis.

Question 12

The client is 12 hours postoperative renal surgery. Which data warrant immediate intervention by the nurse?

1. The abdomen is soft, nontender, and rounded.
2. Pain is not felt with dorsal flexion of the foot.
3. The urine output is 60 mL for the past two (2) hours.
4. The client’s trough vancomycin level is 24 mcg/mL.

Answer 12

1. The client who has renal surgery is at risk for paralytic ileus from the manipulation of the colon. A soft, rounded, and nontender abdomen does not require intervention.
2. Pain felt with dorsal flexion of the foot indicates a deep vein thrombosis; therefore, a client who is asymptomatic does not require intervention.
3. The minimum of 30 mL/hr does not require intervention by the nurse.
4. The client who has restricted kidney function from surgery should be monitored for damage as a result of the use of aminoglycoside antibiotics, such as vancomycin, which are nephrotoxic. This level is high and warrants notifying the HCP.

Question 13

The nurse is teaching the female client diagnosed with tuberculosis of the urinary tract prior to discharge. Which information should the nurse include specific to this diagnosis?

1. Instruct the client to take the medication with food.
2. Explain condoms should be used during treatment.
3. Discuss the need for follow-up chest x-rays.
4. Encourage a well-balanced diet and fluid intake.

Answer 13

1. Antitubercular medications (rifampin and INH) should be taken one (1) hour before or two (2) two hours after a meal.
2. Clients who have been diagnosed with tuberculosis of the renal tract should use condoms to prevent transmission of the mycobacterium. If the infection is located in the penis or urethra, abstaining from sexual activity is recommended.
3. Follow-up chest x-rays are important for the client with tuberculosis of the lung.
4. Maintaining a well-balanced diet and fluid intake is important for recovery from any illness and for a healthy lifestyle, but it is not specifically for this diagnosis.

Question 14

The nurse is assessing a client diagnosed with urethral strictures. Which data support the diagnosis?

1. Complaints of frequency and urgency.
2. Clear yellow drainage from the urethra.
3. Complaints of burning during urination.
4. A diminished force and stream during voiding.

Answer 14

1. Frequency and urgency are signs and symptoms of a urinary tract infection.
2. Clear yellow urethral drainage is urine.
3. A complaint of burning during voiding is a sign/symptom of urinary tract infection.
4. The client with urethral strictures will report a decrease in force and stream during voiding. The stricture is treated by dilation using small filiform bougies.

Question 15

The nurse is providing discharge teaching to the client diagnosed with polycystic kidney disease. Which statement made by the client indicates the teaching has been effective?

1. “I need to avoid any activity causing a risk for injury to my kidney.”
2. “I should avoid taking medications for high blood pressure.”
3. “When I urinate there may be blood streaks in my urine.”
4. “I may have occasional burning when I urinate with this disease.”

Answer 15

1. Polycystic kidney disease poses an increased risk for rupture of the kidney, and therefore sports activities or occupations with risks for trauma should be avoided.
2. Antihypertensive medications should be taken to protect the kidneys from further damage.
3. Blood should always be reported to the health-care provider, and hematuria is a sign of polycystic kidney disease. Further evaluation is needed.
4. Burning during urination should be treated to prevent further damage to the kidneys and renal system.

Question 16

Which intervention should the nurse include when assessing the client for urinary retention? Select all that apply.

1. Inquire if the client has the sensation of fullness.
2. Percuss the suprapubic region for a dull sound.
3. Scan the bladder with the ultrasound scanner.
4. Palpate from the umbilicus to the suprapubic area. 5. Auscultate the two (2) lower abdominal quadrants.

Answer 16

1. The nurse needs to assess the client’s sensation of needing to void or feeling of fullness.
2. A dull sound heard when percussing the bladder indicates it is filled with urine.
3. A portable bladder scan is used to assess for the presence of urine, rather than using a straight catheter.
4. A distended bladder can be palpated.
5. Auscultation cannot assess the client’s bladder.

Question 17

The nurse is discussing how to prioritize care with the UAP. Which client should the nurse instruct the UAP to see first?

1. The immobile client who needs sequential compression devices removed.
2. The elderly woman who needs assistance ambulating to the bathroom.
3. The surgical client who needs help changing the gown after bathing.
4. The male client who needs the intravenous catheter discontinued.

Answer 17

1. The client who needs a sequential com- pression device removed is not urgent.
2. The elderly woman may have age-related changes (decreased bladder capacity, weakened urinary sphincter, and shortened urethra) causing urinary urgency or incontinence. The elderly client is at risk for falling while attempting to get to the bathroom, so this client should be seen first.
3. Changing a gown does not affect the client’s safety.
4. In many facilities this task cannot be delegated, but the client’s safety is not affected if the IV catheter is not immedi- ately discontinued.

Question 18

The nurse is caring for the client recovering from a percutaneous renal biopsy. Which data indicate the client is complying with client teaching?

1. The client is lying flat in the supine position.
2. The client continues oral fluids restriction while on bedrest.
3. The client uses the bedside commode to urinate.
4. The client refuses to ask for any pain medication.

Answer 18

1. The client needs to lie flat on the back to apply pressure to prevent bleeding.
2. The client has oral intake withheld prior to the biopsy, not after the client is awake.
3. The client must lie flat on the back, so using a bedside commode is not maintaining bedrest.
4. The client should request pain medication if the client is in pain. This indicates the client is not compliant with the client teaching.

Question 19

Which intervention should the nurse implement for the client who has had an ileal conduit?

1. Pouch the stoma with a one (1)-inch margin around the stoma.
2. Refer the client to the United Ostomy Association for discharge teaching.
3. Report to the health-care provider any decrease in urinary output.
4. Monitor the stoma for signs and symptoms of infection every shift.

Answer 19

1. The nurse should maintain the drainage bag with a one-eighth (1/8)-inch border around the stoma.
2. The United Ostomy Association is an excellent referral for information but not for discharge teaching. The nurse retains the responsibility to teach information the client needs to know prior to discharge.
3. The output should be monitored to detect a decreased amount indicating an obstruction from edema or ureteral stenosis. Any decrease should be reported to the health-care provider.
4. The stoma should be monitored much more frequently than once a shift.

Question 20

The nurse is preparing the plan of care for a client with fluid volume deficit. Which interventions should the nurse include in the plan of care? Select all that apply.

1. Monitor vital signs every two (2) hours until stable.
2. Measure the client’s oral intake and urinary output daily.
3. Administer mouth care when bathing the client.
4. Weigh the client weekly in the same clothing at the same time. 5. Assess skin turgor and mucous membranes every shift.

Answer 20

1. Vital signs should be monitored every two (2) hours until stable and more frequently if the client is unstable.
2. Intake and output should be monitored more frequently than every 24 hours. Depending on the client’s condition, frequency may vary from every hour to every four (4) hours.
3. Mouth care should be given as often as needed. A minimum of care should be every eight (8) hours, not once a day when bathing the client.
4. The client should be weighed daily, not weekly, at the same time wearing the same clothing to ensure the reliability of this indicator.
5. Skin turgor and mucous membranes should be assessed every shift or more often depending on the client’s condition.

Question 21

Which outcome should the nurse identify for the client diagnosed with fluid volume excess?

1. The client will void a minimum of 30 mL per hour.
2. The client will have elastic skin turgor.
3. The client will have no adventitious breath sounds.
4. The client will have a serum creatinine of 1.4 mg/dL.

Answer 21

1. Voiding a minimum of 30 mL of urine each hour is appropriate for a client with fluid volume deficit.
2. Elastic skin turgor indicates the client has adequate fluid volume status. This is an expected output for the client with fluid volume deficit.
3. The client with fluid volume excess has too much fluid. Excess fluid is reflected by adventitious breath sounds. Therefore, an expected outcome is to have no excess fluid, as evidenced by normal, clear breath sounds.
4. The creatinine is elevated in a client who is dehydrated. The normal male should have a creatinine of 0.6 to 1.2 mg/dL, and a female client’s normal creatinine is between 0.5 and 1.1 mg/dL.

Question 22

The nurse is caring for a client diagnosed with rule-out nephrotic syndrome. Which intervention should be included in the plan of care?

1. Monitor the urine for bright-red bleeding.
2. Evaluate the calorie count of the 500-mg protein diet.
3. Assess the client’s sacrum for dependent edema.
4. Monitor for a high serum albumin level.

Answer 22

1. Hematuria is not a symptom of nephrotic syndrome.
2. A calorie count may be helpful in the treatment of this client, but a calorie count monitors what the name implies—calories. The dietitian can calculate the amount of protein the client consumes, but this is a protein count.
3. The classic sign/symptom of nephrotic syndrome is dependent edema located on the client’s sacrum and ankles.
4. A low serum albumin level is expected for a client diagnosed with nephrotic syndrome.

Question 23

The nurse is preparing a teaching care plan for the client diagnosed with nephrotic syndrome. Which intervention should the nurse include?

1. Stop steroids if a moon face develops.
2. Provide teaching for taking diuretics.
3. Increase the intake of dietary sodium.
4. Report a decrease in daily weight.

Answer 23

1. Steroid therapy should not be stopped abruptly if signs of toxicity occur, such as moon face, because it may result in adrenal insufficiency.
2. Treatment includes diuretics to eliminate dependent edema, usually in the ankles and sacrum. Medication teaching is an appropriate intervention.
3. Sodium is restricted to prevent fluid retention.
4. A decrease in weight is expected if a diuretic is administered; this indicates the medication is effective.

Question 24

Which intervention is most important for the nurse to implement for the client with a left nephrectomy?

1. Assess the intravenous fluids for rate and volume.
2. Change surgical dressing every day at the same time.
3. Monitor the client’s PT/PTT/INR level daily.
4. Monitor the percentage of each meal eaten.

Answer 24

1. Assessing the rate and volume of intravenous fluid is the most important intervention for the client who has one (1) kidney because an overload of fluids can result in pulmonary edema.
2. A daily dressing change can be performed at any time and is not the priority intervention.
3. A client who has had surgery should not be receiving any type of anticoagulant therapy, so the nurse should not have to monitor this laboratory data.
4. The nurse assesses the amount of food eaten, but it is not the most important intervention.

Question 25

The nurse is preparing the discharge teaching plan for the male client with a left-sided nephrectomy. Which statement indicates the teaching is effective?

1. “I can’t wait to start back to work next week, I really need the money.”
2. “I will take my temperature and if it is above 101 I will call my doctor.”
3. “I am glad I won’t have to keep track of how much I urinate in the day.”
4. “I am happy I will be able eat what I usually eat, I don’t like this food.”

Answer 25

1. The client recovering from a nephrectomy needs to refrain from strenuous or heavy activities, and normal activities should not be resumed until the client is given permission by the surgeon.
2. The client or family needs to contact the surgeon if the client develops chills, flank pain, decreased urinary output, or fever.
3. The client needs to be informed of how to monitor the urinary output and which parameters should be reported to the surgeon.
4. The client needs to follow any dietary or fluid restriction the surgeon prescribes.

Question 26

The client diagnosed with a fluid and electrolyte disturbance in the emergency department is exhibiting peaked T waves on the STAT electrocardiogram. Which interventions should the nurse implement? List in order of priority.

1. Assess the client for leg and muscle cramps.
2. Check the serum potassium level.
3. Notify the health-care provider.
4. Arrange for a transfer to the telemetry floor.
5. Administer Kayexalate, a cation resin.

Answer 26

In order of priority: 1, 2, 3, 5, 4.

1. The nurse should assess to determine if the client is symptomatic of hyperkalemia.
2. A peaked T wave is indicative of hyperkalemia; therefore, the nurse should obtain a potassium level.
3. Hyperkalemia is a life-threatening situation because of the risk of cardiac dysrhythmias; therefore, the nurse should notify the health-care provider.
4. Kayexalate is a medication that will help remove potassium through the gastrointestinal system and should be administered to decrease the potassium level.
5. The client should be monitored continuously for cardiac dysrhythmias, so a transfer to the telemetry unit is warranted.

Question 27

The clinic nurse is reviewing information submitted by the UAP which states the presence of pediculosis pubis. Which area of the client’s body should the nurse assess?

Answer 27

1. Pediculosis capitus is found on the head. Head lice are found commonly in children in elementary schools.
2. Scabies are found on the forearms, and around the waist and elastic lines of underwear.
3. The pubic lice are found in the pubic area and are commonly transmitted during sexual intercourse.
4. The feet are not an area normally associated with body lice.