Deck 34: Management of Clients with Urinary Disorders

Question 1

When the nurse notes that the ureteral catheter is no longer draining urine, the most appropriate action would be to

A) clamp the urethral catheter to promote drainage from the ureteral catheter.
B) do nothing, since this is a normal occurrence in the first 24 hours.
C) irrigate the ureteral catheter with 30 ml of sterile saline.
D) notify the physician immediately.

Answer 1

notify the physician immediately.

Question 2

In caring for a client with interstitial cystitis, the nurse would focus significant nursing interventions on

A) administering antibiotics.
B) providing emotional support.
C) teaching about an acid-ash diet.
D) teaching preventive measures.

Answer 2

providing emotional support.

Question 3

For a client experiencing urinary incontinence, in the initial plan of care the nurse would include

A) encouraging the client to void frequently.
B) limiting fluid intake.
C) teaching Kegel exercises.
D) using adult diapers to prevent accidents.

Answer 3

teaching Kegel exercises.

Question 4

For a client experiencing urinary retention with overflow, the factor in the client's history that would prompt the nurse to question an order for a cholinergic medication is

A) bladder outlet obstruction.
B) diabetes mellitus.
C) frequent UTIs.
D) multiple pregnancies.

Question 5

A client with urinary incontinence is scheduled for surgery. The client states "This will fix my incontinence." The nurse should assess this client for the presence of

A) an anatomic defect.
B) an infection.
C) pyelonephritis.
D) the presence of residual urine.

Question 6

A client is being rehabilitated after surgery to create a Kock pouch. The nurse should include which information in the client's teaching plan?

A) Care of a suprapubic catheter
B) Self-catheterization technique
C) Technique for applying a permanent pouch
D) Technique for irrigating a ureteral catheter

Question 7

To determine if a client has an initial manifestation typically seen in clients with bladder neoplasm, the nurse would ask

A) "Do you have pain when you urinate?"
B) "Do you produce larger amounts of urine than you have in the past?"
C) "Have you noticed any blood in your urine?"
D) "Have you noticed that you urinate more frequently than you used to?"

Question 8

For a client with a history of recurrent UTIs who is prescribed an acid-ash diet, the nurse would advise the client to include

A) alcohol.
B) carbonated beverages.
C) coffee.
D) cranberry juice.

Question 9

The nurse teaching self-catheterization technique should include the importance of

A) catheterizing every 3 to 4 hours.
B) drinking at least 500 ml of fluid before catheterization.
C) sterile technique.
D) using the Credé maneuver before catheterization.

Question 10

A nurse working on a rehabilitation unit is caring for several clients with neurogenic bladder. The client who probably should not be a candidate for intermittent catheterization teaching is the

A) 15-year-old client who cannot understand sterile technique.
B) 26-year-old paraplegic client.
C) 26-year-old woman with an active sex life.
D) 35-year-old man with an erratic work schedule.

Question 11

The nurse explains to a client who is receiving oxybutynin (Ditropan) for control of urinary incontinence that the drug's effect is

A) decreasing bladder contractility.
B) increasing serotonin in the CNS, leading to bladder wall relaxation.
C) promoting relaxation of the bladder outlet.
D) reducing intra-abdominal pressure.

Question 12

A client has an autonomous neurogenic bladder. The nurse plans care for this client understanding that the client

A) cannot perceive bladder fullness or initiate or maintain urination.
B) feels no bladder-filling sensation but empties the bladder reflexively.
C) feels the sensation of the bladder filling but cannot initiate micturition.
D) has a temporary problem with initiating micturition.

Question 13

In a client with a history of frequent urinary tract infections (UTIs), the nurse would note the need for further teaching when the client says "I

A) am on an oral contraceptive."
B) often take baths instead of showers."
C) use unscented tampons during my period."
D) use a water-soluble lubricant for intercourse."

Question 14

Nursing care for a client with urinary bladder calculi should include

A) checking for abdominal distention.
B) collecting a 24-hour urine specimen for calcium.
C) encouraging fluid intake up to 4000 ml/day.
D) maintaining bed rest.

Question 15

An enterostomal therapist would suggest that the location for a urinary stoma is the

A) lower abdominal quadrants.
B) pubic area.
C) rib margins.
D) umbilical area.

Question 16

The nurse would realize that additional teaching is needed when the client with a ureteroileostomy says "I

A) am going shopping for new clothing that will better accommodate the pouch."
B) will change the pouch when it begins to leak."
C) won't drink too much so the amount of urine I make will be less."
D) am going to cut down on eating dairy products."

Question 17

In teaching a client who requires a condom catheter for control of incontinence how to properly apply the system, the nurse stresses that part of the correct method for applying the device is to

A) apply the condom close to the end of the penis.
B) attach the device with tape wrapped around the shaft of the penis.
C) fasten the sheath with elastic tape applied in a spiral manner.
D) retract the foreskin before application.

Question 18

During a bladder training program for a client with spinal cord injury using intermittent catheterization, the client suddenly complains of a throbbing headache. Noting that the client's blood pressure is elevated, the priority action by the nurse is to

A) catheterize the client.
B) limit fluids for the remainder of the day.
C) notify the physician immediately.
D) place the client flat in bed.

Question 19

Noting that the client's stoma is red and moist 8 hours after urinary diversion surgery, the nurse would

A) continue to make hourly assessments of the stoma.
B) notify the surgeon immediately.
C) remove the pouch and reapply it correctly.
D) remove the pouch to expose the stoma to air.

Question 20

The nurse reinforces explanations that the procedure for lithotripsy involves

A) capturing of stones via a scope.
B) dissolution of stones with medication.
C) fragmenting of stones by shock waves.
D) surgical removal of stones.

Question 21

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.

Question 22

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.

Question 23

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.

Question 24

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.

Question 25

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.

Question 26

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.

Question 27

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.

Question 28

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.

Question 29

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."

Question 30

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