Unit P-Genitourinary

Question 1

A nurse reviews the urinalysis of a client and notes the presence of glucose. What action
would the nurse take?
a. Document findings and continue to monitor the client.
b. Contact the primary health care provider and recommend a 24-hour urine test.
c. Review the client’s recent dietary selections over 3 days.
d. Perform a finger stick blood glucose assessment.

Answer 1

ANS: D
Glucose normally is not found in the urine. The normal renal threshold for glucose is about
220 mg/dL (12.2 mmol/L), which means that a person whose blood glucose is less than 220
mg/dL (12.2 mmol/L) will not have glucose in the urine. A positive finding for glucose on
urinalysis indicates high blood sugar. The most appropriate action would be to perform a
blood glucose assessment. The client needs further evaluation for this abnormal result;
therefore, documenting and continuing to monitor are not appropriate. Requesting a 24-hour
urine test or reviewing the client’s dietary selections will not assist the nurse to make a
clinical decision related to this abnormality.

Question 2

A nurse reviews the health history of a client with an oversecretion of renin. Which disorder
would the nurse correlate with this assessment finding?
a. Alzheimer disease
b. Hypertension
c. Diabetes mellitus
d. Viral hepatitis

Answer 2

ANS: B
Renin is secreted when special cells in the distal convoluted tubule, called the macula densa,
sense changes in blood volume and pressure. When the macula densa cells sense that blood
volume, blood pressure, or blood sodium levels are low, renin is secreted. Renin then converts
angiotensinogen into angiotensin I. This leads to a series of reactions that cause secretion of
the hormone aldosterone. This hormone increases kidney reabsorption of sodium and water,
increasing blood pressure, blood volume, and blood sodium levels. Inappropriate or excessive
renin secretion is a major cause of persistent hypertension. Renin has no impact on Alzheimer
disease, diabetes mellitus, or viral hepatitis.

Question 3

A nurse reviews the urinalysis results of a client and notes a urine osmolality of 1200
mOsm/kg (1200 mmol/kg). Which action would the nurse take?
a. Contact the primary health care provider to recommend a low-sodium diet.
b. Prepare to administer an intravenous diuretic.
c. Encourage the client to drink more fluids.
d. Obtain a suction device and implement seizure precautions

Answer 3

ANS: C
Normal urine osmolality ranges from 300 to 900 mOsm/kg (300 to 900 mmol/kg). This
client’s urine is more concentrated, indicating dehydration. The nurse would encourage the
client to drink more water. Dehydration can be associated with elevated serum sodium levels.
Although a low-sodium diet may be appropriate for this client, this diet change will not have a
significant impact on urine osmolality. A diuretic would increase urine output and decrease
urine osmolality further. Low serum sodium levels, not elevated serum levels, place the client
at risk for seizure activity. These options would further contribute to the client’s dehydration
or elevate the osmolality.

Question 4

A nurse assesses a client with renal insufficiency and a low red blood cell count. The client
asks, “Is my anemia related to my kidney problem?” How would the nurse respond?
a. “Red blood cells produce erythropoietin, which increases blood flow to the
kidneys.”
b. “Your anemia and kidney problem are related to inadequate vitamin D and a loss
of bone density.”
c. “Erythropoietin is usually released from the kidneys and stimulates red blood cell
production in the bone marrow.”
d. “Kidney insufficiency inhibits active transportation of red blood cells throughout
the blood.”

Answer 4

ANS: C
Erythropoietin is produced in the kidney and is released in response to decreased oxygen
tension in the renal blood supply. Erythropoietin stimulates red blood cell production in the
bone marrow. Anemia and renal insufficiency are not manifestations of vitamin D deficiency.
The kidneys do not play a role in the transportation of red blood cells or any other cells in the
blood.

Question 5

A nurse contacts the primary health care provider after reviewing a client’s laboratory results
and noting a blood urea nitrogen (BUN) of 35 mg/dL (12.5 mmol/L) and a serum creatinine of
1.0 mg/dL (88.4 mcmol/L). What collaborative care measure would the nurse recommend?
a. Intravenous fluids
b. Hemodialysis
c. Fluid restriction
d. Urine culture and sensitivity

Answer 5

ANS:A
Normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Normal creatinine is 0.6 to 1.2 mg/dL
(53.0 to 106.1 mcmol/L) (males) or 0.5 to 1.1 mg/dL (44.2 to 97.2 mcmol/L) (females).
Creatinine is more specific for kidney function than BUN, because BUN can be affected by
several factors (dehydration, high-protein diet, and catabolism). This client’s creatinine is
normal, which suggests a nonrenal cause for the elevated BUN. A common cause of increased
BUN is dehydration, so the nurse would recommend giving the client more fluids, not placing
the client on fluid restrictions. Hemodialysis is not an appropriate treatment for dehydration.
The lab results do not indicate an infection; therefore, a urine culture and sensitivity are not
appropriate.

Question 6

The nurse is assessing a group of clients for their risk of kidney disease. Which racial/ethnic
group is at the greatest risk as they age?
a. Latino Americans
b. African Americans
c. Jewish Americans
d. Asian Americans

Answer 6

ANS: B
Older African Americans have a greater age-related decrease in glomerular filtration rate
when compared to other racial-ethnic groups. In addition, blood flow decreases and sodium
excretion is less effective in older hypertensive African Americans. These changes make this
group most at risk for kidney disease.

Question 7

A nurse cares for a client with a urine specific gravity of 1.040. What action would the nurse
take?
a. Obtain a urine culture and sensitivity.
b. Place the client on restricted fluids.
c. Assess the client’s creatinine level.
d. Increase the client’s fluid intake.

Answer 7

ANS: D
Normal specific gravity for urine is 1.005 to 1.030. A high specific gravity can occur with
dehydration, decreased kidney blood flow (often because of dehydration), and presence of
antidiuretic hormone. Increasing the client’s fluid intake would be a beneficial intervention.
Assessing the creatinine or obtaining a urine culture would not provide data necessary for the
nurse to make a clinical decision.

Question 8

A nurse reviews a client’s laboratory results. Which results from the client’s urinalysis would
the nurse recognize as abnormal?
a. pH of 5.6
b. Ketone bodies present
c. Specific gravity of 1.020
d. Clear and yellow color

Answer 8

ANS: B
Ketone bodies are by-products of incomplete metabolism of fatty acids. Normally, no ketones
are present in urine. Ketone bodies are produced when fat sources are used instead of glucose
to provide cellular energy. A pH between 4.6 and 8, specific gravity between 1.005 and 1.030,
and clear yellow urine are normal findings in a urinalysis.

Question 9

A nurse cares for a client who is recovering from a closed percutaneous kidney biopsy. The
client states, “My pain has suddenly increased from a 3 to a 10 on a scale of 0-10.” Which
action would the nurse take first?
a. Reposition the client on the operative side.
b. Administer the prescribed opioid analgesic.
c. Assess the client’s pulse rate and blood pressure.
d. Examine the color of the client’s urine.

Answer 9

ANS: C
An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of
possible internal hemorrhage. A change in vital signs (elevated pulse and decreased blood
pressure) can indicate that hemorrhage is occurring.

Question 10

The nurse delegates completing a bladder scan to assistive personnel (AP). Which action by
the AP indicates that the nurse must provide additional instructions when delegating this task?
a. Selecting the female icon for all female patients and male icon for all male patients
b. Telling the client, “This test measures the amount of urine in your bladder.”
c. Applying ultrasound gel to the scanning head and removing it when finished
d. Taking at least two readings using the aiming icon to place the scanning head

Answer 10

ANS: A
The AP should use the female icon for women who have not had a hysterectomy. This allows
the scanner to subtract the volume of the uterus from readings. If a woman has had a
hysterectomy, the AP should choose the male icon. The AP should explain the procedure to
the client, apply gel to the scanning head and clean it after use, and take at least two readings.

Question 11

A nurse reviews a client’s laboratory results. Which results from the client’s urinalysis would
the nurse identify as normal? (Select all that apply.)
a. pH: 6
b. Specific gravity: 1.015
c. Protein: 1.2 mg/dL
d. Glucose: negative
e. Nitrate: small
f. Leukocyte esterase: positive

Answer 11

ANS: A, B, D
The pH, specific gravity, and glucose are all within normal ranges. The other values are
abnormal.

Question 12

The nurse is preparing a client for a percutaneous kidney biopsy. Which laboratory tests
results would the nurse review prior to the procedure? (Select all that apply.)
a. Hemoglobin
b. Hematocrit
c. Sodium
d. Potassium
e. Platelet count
f. Prothrombin time

Answer 12

ANS: A, B, E, F
Kidneys are very vascular and the client is at risk for bleeding after a biopsy. Therefore, it is
essential that the nurse review preprocedure laboratory test results for anemia and coagulation
problems.

Question 13

A nurse assesses a client recovering from a cystoscopy. Which assessment findings would
alert the nurse to urgently contact the primary health care provider? (Select all that apply.)
a. Decrease in urine output
b. Tolerating oral fluids
c. Prescription for metformin
d. Blood clots present in the urine
e. Burning sensation when urinating

Answer 13

ANS:A,D
The nurse would monitor urine output and contact the primary health care provider if urine
output decreases or becomes absent. The nurse would also assess for blood in the client’s
urine. The urine may be pink-tinged, but gross bleeding or blood clots should not be present.
If bleeding is present, the nurse would urgently contact the primary health care provider.
Tolerating oral fluids is a positive outcome and does not need intervention. Metformin would
be a concern if the patient received dye; no dye is used in a cystoscopy procedure. The client
may experience a burning sensation when urinating after this procedure; this would not
require a call to the primary health care provider.

Question 14

A nurse prepares a client for a percutaneous kidney biopsy. What actions should the nurse
take prior to this procedure? (Select all that apply.)
a. Keep the client NPO for 4 to 6 hours.
b. Review coagulation study results.
c. Maintain strict bedrest in a supine position.
d. Assess for blood in the client’s urine.
e. Administer client’s antihypertensive medications.

Answer 14

ANS: A, B, E
Prior to a percutaneous kidney biopsy, the patient should be NPO for 4 to 6 hours.
Coagulation studies should be completed to prevent bleeding after the biopsy. Blood pressure
medications should be administered to prevent hypertension before and after the procedure.
There is no need to keep the patient on bedrest or assess for blood in the client’s urine prior to
the procedure; these interventions should be implemented after a percutaneous kidney biopsy.

Question 15

A nurse plans care for an older adult patient. Which interventions should the nurse include in
this client’s plan of care to promote kidney health? (Select all that apply.)
a. Ensure adequate fluid intake.
b. Leave the bathroom light on at night.
c. Encourage use of the toilet every 6 hours.
d. Delegate bladder training instructions to the assistive personnel (AP).
e. Provide thorough perineal care after each voiding.
f. Assess for urinary retention and urinary tract infection.

Answer 15

ANS: A, B, E, F
The nurse should ensure that the client receives adequate fluid intake and has adequate
lighting to ambulate safely to the bathroom at night, encourage the client to use the toilet
every 2 hours, provide thorough perineal care after each voiding, and assess for urinary
retention and urinary tract infections. The nurse would not delegate any teaching to the AP,
including bladder training instructions. The AP may participate in bladder training activities,
including encouraging and assisting the client to the bathroom at specific times.

Question 16

The nurse assesses a client who has possible bladder cancer. What common assessment
finding associated with this type of cancer would the nurse expect?
a. Urinary retention
b. Urinary incontinence
c. Painless hematuria
d. Difficulty urinating

Answer 16

ANS: C
The classic and most common finding in clients who have bladder cancer is painless and
intermittent hematuria that can be with gross or microscopic. Dysuria, frequency, and urgency
occur in clients who have bladder infection or obstruction.

Question 17

A nurse reviews the laboratory findings of a client with a urinary tract infection (bacterial
cystitis). The laboratory report notes a “shift to the left” in the client’s white blood cell count.
What action would the nurse take?
a. Request that the laboratory perform a differential analysis on the white blood cells.
b. Notify the primary health care provider and start an intravenous line for parenteral
antibiotics.
c. Ask assistive personnel (AP) to strain the client’s urine for renal calculi.
d. Assess the client for a potential allergic reaction and anaphylactic shock.

Answer 17

ANS: B
An increase in band cells creates a “shift to the left.” A left shift most commonly occurs with
urosepsis and is seen rarely with uncomplicated urinary tract infections. The nurse will be
administering antibiotics, most likely via IV, so he or she would notify the primary health care
provider and prepare to give the antibiotics. The shift to the left is part of a differential white
blood cell count. The nurse would not need to strain urine for stones. Allergic reactions are
associated with elevated eosinophil cells, not band cells.

Question 18

A nurse cares for a postmenopausal client who has had two episodes of bacterial urethritis in
the last 6 months. The client asks, “I never have urinary tract infections. Why is this
happening now?” How would the nurse respond?
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 disease.”

Answer 18

ANS: B
Low estrogen levels decrease moisture and secretions in the perineal area and cause other
tissue changes, predisposing it to the development of infection. Urethritis is most common in
postmenopausal women for this reason. Although immune function does decrease with aging
and sexually transmitted diseases are a known cause of urethritis, the most likely reason in
this patient is low estrogen levels. Personal hygiene usually does not contribute to this disease
process.

Question 19

After teaching a client with bacterial cystitis who is prescribed phenazopyridine, the nurse
assesses the client’s understanding. Which statement made by the client indicates a correct
understanding of the teaching?
a. “I will not take this drug with food or milk.”
b. “I will have my partners tested for STIs.”
c. “An orange color in my urine should not alarm me.”
d. “I will drink two glasses of cranberry juice daily.”

Answer 19

ANS: C
Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many clients
think that they have blood in their urine when they see this. In addition, the urine can
permanently stain clothing. There are no dietary restrictions or needs while taking this
medication.

Question 20

After teaching a client who has stress incontinence, the nurse assesses the client’s

understanding. Which statement made by the client indicates a need for further teaching?
a. “I will limit my total intake of fluids.”
b. “I must avoid drinking alcoholic beverages.”
c. “I must avoid drinking caffeinated beverages.”
d. “I shall try to lose about 10% of my body weight.”

Answer 20

ANS: A
Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence or
cystitis. Many people try to manage incontinence by limiting fluids. Alcoholic and caffeinated
beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing
incontinence.

Question 21

The nurse teaches a client who has stress incontinence methods to regain more urinary
continence. Which health teaching is the most important for the nurse to include for this
client?
a. What type of incontinence pads to use?
b. What types of liquids to drink and when?
c. Need to perform intermittent catheterizations.
d. How to do Kegel exercises to strengthen muscles?

Answer 21

ANS: D
The client who has stress incontinence needs to strengthen the muscles of the pelvic floor
using Kegel exercises. Catheterizations would not help with incontinence. Incontinence pads
may need to be used by this client but that is not the most important thing to teach, and it does
not help the client regain more control over his or her bladder.

Question 22

After delegating care to assistive personnel (AP) for a client who is prescribed habit training
to manage incontinence, a nurse evaluates the AP’s understanding. Which action indicates
that the AP needs additional teaching?
a. Toileting the client after breakfast
b. Changing the client’s incontinence brief when wet
c. Encouraging the client to drink fluids
d. Recording the client’s incontinence episodes

Answer 22

ANS: B
Habit training is undermined by the use of absorbent incontinence briefs or pads. The nurse
should reeducate the AP on the technique of habit training. The AP should continue to toilet
the client after meals, encourage the client to drink fluids, and record incontinent episodes.

Question 23

A nurse plans care for a client with overflow incontinence. Which intervention does the nurse
include in this client’s plan of care to assist with elimination?
a. Stroke the medial aspect of the thigh.
b. Use intermittent catheterization.
c. Provide digital anal stimulation.
d. Use the Valsalva maneuver.

Answer 23

ANS: D
In patients with overflow incontinence, the voiding reflex arc is not intact. Mechanical
pressure, such as that achieved through the Valsalva maneuver (holding the breath and
bearing down as if to defecate), can initiate voiding. Stroking the medial aspect of the thigh or
providing digital anal stimulation requires the reflex arc to be intact to initiate elimination.
Due to the high risk for infection, intermittent catheterization should only be implemented
when other interventions are not successful.

Question 24

A client with pneumonia and dementia is admitted with an indwelling urinary catheter in
place. During interprofessional rounds the following day, which question would the nurse ask
the primary health care provider?
a. “Do you want daily weights on this client?”
b. “Will the client be able to return home?”
c. “May we discontinue the indwelling catheter?”
d. “Should we get another chest x-ray today?”

Answer 24

ANS: C
An indwelling urinary catheter dramatically increases the risks of urinary tract infection and
urosepsis. Nursing staff should ensure that catheters are left in place only as long as they are
medically needed. The nurse would inquire about removing the catheter. All other questions
might be appropriate, but because of client safety, this question takes priority.

Question 25

After teaching a client with a history of renal calculi, the nurse assesses the client’s
understanding. Which statement made by the client indicates a correct understanding of the
teaching?
a. “I should drink at least 3 L of fluid every day.”
b. “I will eliminate all dairy or sources of calcium from my diet.”
c. “Aspirin and aspirin-containing products can lead to stones.”
d. “The doctor can give me antibiotics at the first sign of a stone.”

Answer 25

ANS: A
Dehydration contributes to the precipitation of minerals to form a stone. Although increased
intake of calcium causes hypercalcemia and leads to excessive calcium filtered into the urine,
if the client is well hydrated, the calcium will be excreted without issues. Dehydration
increases the risk for supersaturation of calcium in the urine, which contributes to stone
formation. The nurse would encourage the client to drink more fluids, not decrease calcium
intake. Ingestion of aspirin or aspirin-containing products does not cause a stone. Antibiotics
neither prevent nor treat a stone.

Question 26

A nurse cares for a client who has kidney stones from gout ricemia. Which medication does
the nurse anticipate administering?
a. Phenazopyridine
b. Doxycyline
c. Tolterodine
d. Allopurinol

Answer 26

ANS: D
Stones caused by hyperuricmia caused by gout or other reason respond to allopurinol.
Phenazopyridine is given to clients with urinary tract infections. Doxycycline is an antibiotic.
Tolterodine is an anticholinergic with smooth muscle-relaxant properties.

Question 27

A nurse assesses a client who is recovering from extracorporeal shock-wave lithotripsy for
renal calculi. The nurse notes an ecchymotic area on the client’s right lower back. What action
would the nurse take?
a. Administer fresh-frozen plasma.
b. Apply an ice pack to the site.
c. Place the client in the prone position.
d. Obtain serum coagulation test results.

Answer 27

ANS: B
The shock waves from lithotripsy can cause bleeding into the tissues through which the waves
pass. Application of ice can reduce the extent and discomfort of the bruising. Although
coagulation test results and fresh-frozen plasma are used to assess and treat bleeding
disorders, ecchymosis after this procedure is not unusual and does not warrant a higher level
of intervention. Changing the client’s position will not decrease bleeding.

Question 28

A nurse obtains the health history of a client with a suspected diagnosis of bladder cancer.
Which question would the nurse ask when determining this client’s risk factors?
a. “Do you smoke cigarettes?”
b. “Do you use any alcohol?”
c. “Do you use recreational drugs?”
d. “Do you take any prescription drugs?”

Answer 28

ANS: A
Smoking is known to be a factor that greatly increases the risk of bladder cancer. Alcohol use,
recreational drug use, and prescription drug use (except medications that contain phenacetin)
are not known to markedly increase the risk of developing bladder cancer.

Question 29

A nurse teaches a young female client who is prescribed cephalexin for a urinary tract

infection. Which statement would the nurse include in this client’s teaching?
a. “Use a second form of birth control while on this medication.”
b. “You will experience increased menstrual bleeding while on this drug.”
c. “You may experience an irregular heartbeat while on this drug.”
d. “Watch for blood in your urine while taking this medication.”

Answer 29

ANS: A
The client should use a second form of birth control because antibiotic therapy reduces the
effectiveness of estrogen-containing contraceptives. She should not experience increased
menstrual bleeding, an irregular heartbeat, or blood in her urine while taking the drug.

Question 30

A nurse teaches a client with functional urinary incontinence. Which statement would the
nurse include in this client’s teaching?
a. “You must clean around your catheter daily with soap and water.”
b. “You will need to be on your drug therapy for life.”
c. “Operations to repair your bladder are available, and you can consider these.”
d. “You might want to get pants with elastic waistbands.”

Answer 30

ANS: D
Functional urinary incontinence occurs as the result of problems not related to the client’s
bladder, such as trouble ambulating or difficulty accessing the toilet. One desired outcome is
that the client will be able to manage his or her clothing independently. Elastic waistband
slacks that are easy to pull down and back up can help the client get on the toilet in time to
void. The other instructions do not relate to functional urinary incontinence.

Question 31

The nurse assesses a client with a history of urinary incontinence who presents with extreme
dry mouth, constipation, and an inability to void. Which question would the nurse ask first?
a. “Are you drinking plenty of water?”
b. “What medications are you taking?”
c. “Have you tried laxatives or enemas?”
d. “Has this type of thing ever happened before?”

Answer 31

ANS: B
Some types of incontinence or other health problems are treated with anticholinergic
medications. Anticholinergic side effects include dry mouth, constipation, and urinary
retention. The nurse needs to assess the client’s medication list to determine whether the he or
she is taking an anticholinergic medication. The other questions are not as helpful to
understanding the current situation.

Question 32

A nurse teaches a client who is starting urinary bladder training. Which statement would the
nurse include in this client’s teaching?
a. “Use the toilet when you first feel the urge, rather than at specific intervals.”
b. “Initially try to use the toilet at least every half hour for the first 24 hours.”
c. “Try to consciously hold your urine until the scheduled toileting time.”
d. “The toileting interval can be increased once you have been continent for a week.”

Answer 32

ANS: C
The client should try to hold urine consciously until the next scheduled toileting time.
Toileting should occur at specific intervals during the training. The interval can be increased
once the client becomes comfortable with the interval.

Question 33

A nurse assesses a client who presents with renal calculi. Which question would the nurse
ask?
a. “Do any of your family members have this problem?”
b. “Do you drink any cranberry juice?”
c. “Do you urinate after sexual intercourse?”
d. “Do you experience burning with urination?”

Answer 33

ANS: A
There is a strong association between family history and stone formation and recurrence.
Nephrolithiasis is associated with many genetic variations; therefore, the nurse should ask
whether other family members have also had renal stones. The other questions do not refer to
renal calculi but instead are questions that should be asked of a patient with a urinary tract
infection.

Question 34

The nurse is caring for a client with urinary incontinence. The client states, “I am so

embarrassed. My bladder leaks like a young child’s bladder.” How would the nurse respond?
a. “I understand how you feel. I would be mortified.”
b. “Incontinence pads will minimize leaks in public.”
c. “I can teach you strategies to help control your incontinence.”
d. “More people experience incontinence than you might think.”

Answer 34

ANS: C
The nurse would accept and acknowledge the client’s concerns, and assist the client to learn
techniques that will allow control of urinary incontinence. The nurse would not diminish the
client’s concerns with the use of pads or stating statistics about the occurrence of
incontinence

Question 35

A nurse assesses a client who has had two episodes of bacterial cystitis in the last 6 months.
Which question(s) would the nurse ask? (Select all that apply.)
a. “How much water do you drink every day?”
b. “Do you take estrogen replacement therapy?”
c. “Does anyone in your family have a history of cystitis?”
d. “Are you on steroids or other immune-suppressing drugs?”
e. “Do you drink grapefruit juice or orange juice daily?”

Answer 35

ANS: A, B, D
Fluid intake, estrogen levels, and immune suppression all can increase the chance of recurrent
cystitis. Family history is usually insignificant, and cranberry juice, not grapefruit or orange
juice, has been found to increase the acidic pH and reduce the risk for bacterial cystitis.

Question 36

The nurse is caring for a client who is diagnosed with urinary tract infection (UTI). What
common urinary signs and symptoms does the nurse expect? (Select all that apply.)
a. Dysuria
b. Frequency
c. Burning
d. Fever
e. Chills
f. Hematuria

Answer 36

ANS: A, B, C, F
Fever and chills may occur in clients who have a UTI if the infection has expanded beyond
the bladder into the kidneys. However, these symptoms are not urinary signs and symptoms.

Question 37

he nurse is planning health teaching for a client starting mirabegron for urinary incontinence.
What health teaching would the nurse include? (Select all that apply.)
a. “Monitor blood tests carefully if you are prescribed warfarin.”
b. “Avoid crowds and individuals with infection.”
c. “Report any fever to your primary health care provider.”
d. “Take your blood pressure frequently at home.”
e. “Report palpitations or chest soreness that may occur.”

Answer 37

ANS: A, D
This drug can cause increase blood pressure and, therefore, the client’s blood pressure should
be monitored. Mirabegron can increase the effect of warfarin causing bleeding or bruising.
The client will need additional coagulation studies to ensure that the INR is within a
therapeutic range.

Question 38

A client asks the nurse why she has urinary incontinence. What risk factors would the nurse
recall in preparing to respond to the client’s question? (Select all that apply.)
a. Diuretic therapy
b. Anorexia nervosa
c. Stroke
d. Dementia
e. Arthritis
f. Parkinson disease

Answer 38

ANS: A, C, D, E, F
Drugs, such as diuretics, cause frequent voiding, often in large amounts. Diseases or disorders
that limit mobility, such as stroke, arthritis, and Parkinson disease, can prevent an individual
from getting to the bathroom in a timely manner. Mental/behavioral problems, such as
dementia, impair cognition and the ability to recognize when he or she needs to void.

Question 39

A nurse cares for clients with urinary incontinence. Which types of incontinence are correctly
paired with their description? (Select all that apply.)
a. Stress incontinence—urine loss with physical exertion
b. Urge incontinence—loss of urine upon feeling the need to void
c. Functional incontinence—urine loss results from abnormal detrusor contractions
d. Overflow incontinence—constant dribbling of urine
e. Reflex incontinence—leakage of urine without lower urinary tract disorder

Answer 39

ANS: A, B, D
Stress incontinence is a loss of urine with physical exertion, coughing, sneezing, or exercising.
Urge incontinence presents with an abrupt and strong urge to void and usually has a large
amount of urine released with each occurrence. Overflow incontinence occurs with bladder
distention and results in a constant dribbling of urine. Functional incontinence is the leakage
of urine caused by factors other than a disorder of the lower urinary tract. Reflex incontinence
results from abnormal detrusor contractions from a neurologic abnormality.

Question 40

A nurse teaches a client about self-management after experiencing a urinary calculus treated
by lithotripsy. Which statements would the nurse include in this client’s discharge teaching?
(Select all that apply.)
a. “Finish the prescribed antibiotic even if you are feeling better.”
b. “Drink at least 3 L of fluid each day.”
c. “The bruising on your back may take several weeks to resolve.”
d. “Report any blood present in your urine.”
e. “It is normal to experience pain and difficulty urinating.”

Answer 40

ANS: A, B, C
The client should be taught to finish the prescribed antibiotic to ensure that he or she does not
get a urinary tract infection. The client should drink at least 3 L of fluid daily to dilute
potential stone-forming crystals, prevent dehydration, and promote urine flow. After
lithotripsy, the client should expect bruising that may take several weeks to resolve. The client
should also experience blood in the urine for several days. The client should report any pain,
fever, chills, or difficulty with urination to the primary health care provider as these may
signal the beginning of an infection or the formation of another stone.
DIF:

Question 41

After treating several young women for urinary tract infections (UTIs), the college nurse plans
an educational offering on reducing the risk of getting a UTI. What information does the nurse
include? (Select all that apply.)
a. Void before and after each act of intercourse.
b. Consider changing to spermicide from birth control pills.
c. Do not douche or use scented feminine products.
d. Wear loose-fitting nylon panties.
e. Wipe or clean the perineum from front to back.

Answer 41

ANS: A, E
Woman can reduce their risk of contracting UTIs by voiding before and after intercourse, not
douching or using scented feminine products, and wiping from front to back. If spermicides
are currently used, the woman should consider another form of birth control. Loose-fitting
cotton underwear is best.