Question 1

The nurse who is teaching methods of micturition stimulation would stress that the method that may have genitourinary risks is
A) the Credé maneuver.
B) the Valsalva maneuver.
C) "trigger" stimulation.
D) vagal stimulation.

Accepted Answer

The Credé maneuver involves the client placing his or her fingers over the bladder and pressing downward slowly toward the symphysis pubis, as though "milking" the urine out of the urinary system. Complications include causing urinary reflux into the ureters.

Question 2

The nurse caring for a man with a mega-ureter should assess for the potential problem of
A) impotence.
B) incontinence.
C) scrotal swelling.
D) urine reflux.

Accepted Answer

Abnormal dilation of the ureter (mega-ureter) is characterized by dilation and pouching of the ureteral wall just adjacent to the vesicoureteral junction. Mega-ureter causes problems because of refluxing or obstructive effects.

Question 3

After reading the order to "irrigate ureteral catheter with 50 ml of sterile saline solution," the nurse should
A) call the surgeon to clarify.
B) irrigate as ordered.
C) question the order relative to the use of sterile saline.
D) warn the client that there will be some discomfort.

Accepted Answer

Ureteral catheters should be irrigated only with specific orders and then only with 5 to 10 ml of sterile normal saline.

Question 4

A male client has come to the clinic with complaints of urethritis and urinary frequency with burning. The nurse should assess this client for the presence of
A) a sexually transmitted disease.
B) chronic urinary tract infections.
C) congenital bladder defects.
D) reflux and distended bladder.

Accepted Answer

Urethritis is commonly associated with sexually transmitted diseases; in fact, the most common causes are chlamydia and gonorrhea.

Question 5

A nurse is caring for a client with an indwelling Foley catheter. Which intervention takes highest priority?
A) Administer antispasmotics for bladder spasms.
B) Provide meticulous perineal care.
C) Provide privacy when assessing the catheter's patency.
D) Record accurate I&O.

Accepted Answer

Privacy and accurate I&O are important components in the care plan for any client with an indwelling Foley catheter. However, to prevent nosocomial urinary tract infections secondary to catheter use, the nurse should provide meticulous perineal care, maintain the closed drainage system, and only use the catheter for as long as absolutely necessary. Do not use a Foley catheter for "nurse convenience."

Question 6

An elderly client who lives at home is brought to the clinic by her daughter. The daughter states that the client no longer goes out to shop for herself and so is not eating right. The daughter is worried about the client losing weight and seeming depressed. The client appears slightly dehydrated. The nurse should assess the client for
A) dementia.
B) elder abuse.
C) incontinence.
D) medication misuse.

Accepted Answer

People with incontinence often try to isolate themselves and limit their fluid intake in order to lessen the chances of having an "accident." While all four options are valid assessment points, because so many elderly suffer from incontinence that would be the likely place to start.

Question 7

A client is having intravesical BCG instillation for bladder cancer. Safety precautions the nurse should implement include
A) disinfect the toilet and urine containers with bleach.
B) limit time giving direct client care to 30 minutes per 8-hour shift.
C) not allowing visitors into the room during the instillation.
D) wearing a gown and gloves when entering the room.

Accepted Answer

BCG instillation is very toxic and all toilets and urine containers used by the client during the instillation and for 6 hours afterwards need to be disinfected with bleach

Question 8

A nurse in a long-term care facility has several residents who are incontinent. Which of the following actions can this nurse delegate to the unlicensed assistive personnel? (Select all that apply.)
A) Assist residents with exercises to strengthen pelvic muscles.
B) Assist the resident to the bathroom on a set schedule.
C) Increase the time interval for bathroom trips as the resident becomes continent.
D) Measure intake and output and report cloudy urine.
E) Teach residents how to do Kegel exercises to strengthen pelvic muscles.

Accepted Answer

Unlicensed personnel can do all of the above options, except for teaching residents how to do Kegel exercises. Only the nurse can do teaching; however, an unlicensed assistive person can assist the client with doing the exercises by encouraging and reminding the client who has already been taught the technique.

Question 9

A client has interstitial cystitis and has had several treatments with instillation of oxychlorosene (Clorpactin) into the bladder. The client is crying and verbalizing frustration with the frequent treatments that seem to do no good. The best response by the nurse is
A) "Do you get upset easily with other problems?"
B) "I'm concerned that this doesn't seem to be helping you."
C) "Let's ask the doctor when you can expect to see some results."
D) "You seem upset. I can sit with you for a few minutes."

Accepted Answer

Instillation of various agents into the bladder can be one treatment option for interstitial cystitis. However, the treatment is lengthy; it sometimes requires 3 treatments weekly for 2-4 months before any noticeable improvement occurs. Clients easily become frustrated and the nurse's best response is to offer support.

Question 10

A male client is scheduled for radical bladder surgery for advanced cancer. He appears very anxious and is making sexually inappropriate jokes to the nursing staff. The most appropriate nursing diagnosis for this client is
A) Fear related to threat to biologic integrity
B) Impaired coping related to poorly-developed coping mechanisms
C) Knowledge deficit related to amount of pre-operative education needed
D) Risk for Disturbed body image related to possible sexual dysfunction

Accepted Answer

Radical bladder surgery may cause problems with sexual function, including impotence in men. This makes risk for disturbed body image the most appropriate diagnosis for this client, although the others might be appropriate also.

Quiz 34: Management of Clients with Urinary Disorders

The nurse who is teaching methods of micturition stimulation would stress that the method that may have genitourinary risks is

The nurse caring for a man with a mega-ureter should assess for the potential problem of

After reading the order to "irrigate ureteral catheter with 50 ml of sterile saline solution," the nurse should

A male client has come to the clinic with complaints of urethritis and urinary frequency with burning. The nurse should assess this client for the presence of

A nurse is caring for a client with an indwelling Foley catheter. Which intervention takes highest priority?

A client is having intravesical BCG instillation for bladder cancer. Safety precautions the nurse should implement include

A nurse in a long-term care facility has several residents who are incontinent. Which of the following actions can this nurse delegate to the unlicensed assistive personnel? (Select all that apply.)

A client has interstitial cystitis and has had several treatments with instillation of oxychlorosene (Clorpactin) into the bladder. The client is crying and verbalizing frustration with the frequent treatments that seem to do no good. The best response by the nurse is

A male client is scheduled for radical bladder surgery for advanced cancer. He appears very anxious and is making sexually inappropriate jokes to the nursing staff. The most appropriate nursing diagnosis for this client is