chapter 59 med surg
A female client who is diagnosed with a malignant tumor in her bladder is advised to undergo cystectomy followed by a urinary diversion procedure. Which of the following would be most important for the nurse to assess preoperatively? A) Client's manual dexterity and vision B) History of allergy to iodine and seafood C) Dietary habits involving cholesterol-laden food D) Menstrual history
a
An ileal conduit is created for a client after a radical cystectomy. Which of the following would the nurse expect to include in the client's plan of care? A) Application of an ostomy pouch B) Intermittent catheterizations C) Exercises to promote sphincter control D) Irrigating the urinary diversion
a
The nurse is caring for a 13-year-old female client diagnosed with urethritis. Which of the following assessment answers would indicate that further instruction is needed? Select all that apply. A) "I change my sanitary napkin when it is full." B) "My mom buys just regular toilet paper." C) "I take a bubble bath a couple of times per week." D) "I clean my private area with soap and water." E) "I drink fruit drinks because I do not like water."
acd
Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet? A) Low oxalate B) Low purine C) High protein D) High sodium
b
The nurse is caring for a 37-year-old female client with potential interstitial cystitis. Which question, asked by the nurse, is helpful in suggesting the disease? A) "Have you noted any unusual vaginal drainage?" B) "Have you experienced hematuria with cramping?" C) "When was your last menstrual period?" D) "Do you drink alcoholic beverages on a frequent basis?"c
c
The nurse is caring for a client who is following a treatment plan to decrease urinary tract infections. Which of the following indicates the need to change the treatment plan? A) The client has history of repeated antibiotic therapy. B) The client has improved personal hygiene methods. C) The client exhibits continued symptoms. D) The client has diluted urine.
c
The nurse is caring for a client diagnosed with bladder cancer and requiring a cystectomy. The nurse overhears the physician instructing the client on the presence of a stoma with temporary pouch. In gathering information for the client, which urinary diversion would the nurse select? A) Ileal conduit B) Kock Pouch C) Ureterosigmoidostomy D) Indiana Pouch
a
The nurse is caring for a client diagnosed with bladder stones. The client is scheduled for a litholapaxy. Which nursing action is most important to complete prior to the procedure? A) Strain all urine B) Maintain the intake and output C) Maintain 12 hours of nothing by mouth D) Make sure that the nurse has the consent signed
a
The nurse is caring for a client with recurrent urinary tract infections. Which of the following body structures would the nurse instruct as the most frequent cause of women's urinary tract infections? A) The urethra B) The bladder C) The rectum D) The ureters
a
The nurse is employed in an urologist office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? A) Anticholinergic B) Diuretics C) Anticonvulsant D) Cholinergic
a
The nurse is encouraging the client with recurrent urinary tract infections to increase his fluid intake to 8 large glasses of fluids daily. The client states he frequently drinks water and all of the following. Which of the following would the nurse discourage for this client? A) Coffee in the morning B) Fruit juice midmorning C) Milk at lunch D) Ginger ale at dinner time
a
The nurse is providing instruction in stoma care with temporary bag following an ileal conduit surgery. Which of the following instructions is accurate? Select all that apply. A) Ascorbic acid suppresses urine odors. B) Change temporary ostomy bag when it becomes three-quarters (3/4) full. C) Change the pouch every 4 to 7 days if it is a two-piece pouch. D) Change the pouch daily if it is a one-piece pouch. E) Apply an appliance deodorant to decrease odors
ace
A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate, I can't control it and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence? A) Stress B) Urge C) Overflow D) Functiona
b
An older adult male client is participating in a bladder retraining program as part of the treatment for urinary incontinence. The nurse advises him to wear barrier garments such as liners and protective pants. Which suggestion would be most appropriate to help the client maintain skin integrity? A) Avoiding the application of moisture sealant B) Exposing the affected area to air C) Using scented sprays or perfumes D) Avoiding using an electric room deodorizer
b
The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client? A) Suprapubic cystostomy tube B) Permanent drainage with a urethral catheter C) Clean intermittent catheterization D) Credé voiding procedure
b
The nurse is assisting in the transport of a client with an indwelling catheter to the diagnostic studies unit. Which action, made by the nursing assistant, would require instruction? A) The nursing assistant keeps the catheter and drainage bag together when moving the client. B) The nursing assistant places the drainage bag on the client's abdomen for transport. C) The nursing assistant places the drainage bag on the lower area of the wheelchair for transport. D) The nursing assistant holds the drainage bag while the client moves to the wheelchair
b
The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document? A) Urinary frequency B) Urinary urgency C) Urinary incontinence D) Urinary stasis
b
The nurse is caring for a client with a urinary tract infection and a urethral stricture. Which complication of the condition is the primary cause of infection? A) The bladder mucosa attracts bacteria. B) There is a backflow of urine causing a diverticulum. C) Urine leakage occurs as urine passes through the stricture. D) Urine production is limited due to the urine remaining in the bladder.
b
The nurse is caring for a client with cystitis. Which adjunct therapy is the nurse most correct to suggest to keep bacteria from adhering to the wall of the bladder? A) Douching with a vinegar solution B) Drinking cranberry juice C) Flushing the system with water D) Wiping from the urethra to rectum
b
The nurse is caring for four clients on a urinary medical unit. For which client does the nurse need no further medical interventions? A) The client has pain of 7 out of 10 in the mid-abdomen. B) The client has a residual urine of 90 mL on a bedside ultrasound bladder scan. C) The client has a WBC count of 15,000 on recent lab reports. D) The client is unable to void in the morning hours.
b
The nurse is caring for several clients on a urinary medical unit. Which client is at an increased risk for bladder stones? A) The client with frequent urinary tract infections B) The client who is paraplegic C) The client with difficulty ambulating D) The client with abdominal surgery
b
The nurse observes a client's uric acid level of 9.3 mg/dL. When teaching the client about ways to decrease the uric acid level, which diet would the nurse suggest? A) A low-sodium diet B) A low-purine diet C) A diet high in fruits and vegetables D) A diet high in calcium
b
A client is prescribed amitriptyline, an antidepressant for incontinence. The nurse understands which of the following reasons that this drug is an effective treatment? A) Increases contraction of the detrusor muscle B) Increases bladder neck resistance C) Reduces bladder spasticity D) Decreases involuntary bladder contractions
bd
As the nurse comes from morning report, the nurse is instructed to use a bladder scanner on a client following a client's attempt at urination. The client is able to void 300 mL. The client denies any pain on urination. The nurse scans 250 mL of remaining urine in the bladder. Which entry is most correct when documenting the intervention? A) Client voided 300 mL without dysuria B) Client voided 550 mL of urine for the daylight shift C) Client voided 300 mL with 250 mL residual volume D) Bladder scanning resulted in 250 mL
c
The licensed practical nurse is employed as a charge nurse at a long-term care facility. A resident is ordered a catheterization schedule of every 6 hours due to chronic urinary retention. The LPN reports daily catheterization amounts from the previous day ranging from 450 mL to 800 mL. Which nursing action is most correct? A) Continue the same order. B) Obtain an order to decrease the frequency of the catheterizations. C) Obtain an order to increase the frequency of the catheterizations. D) Leave the catheter in if obtaining a urine amount over 500 mL
c
The nurse is assessing a client brought to the emergency department for systemic complications after a traumatic event. Which assessment finding is most suggestive of an intact urinary tract? A) The nurse notes no abnormalities on abdominal inspection. B) The client states diffuse abdominal pain. C) Urine output is pink and noted at 300 mL. D) The physician notes urine leakage upon palpation.
c
The nurse is caring for a client with chronic bladder infections and inflammation. The physician has ruled out several medical diagnoses and is considering interstitial cystitis. The nurse is most correct to anticipate which diagnostic test to confirm the disorder? A) A cystoscopy B) A voiding cystourethrogram C) A bladder biopsy D) A potassium sensitivity test
c
The nurse is caring for a male client who has a significant urinary narrowing secondary to an enlarged prostate. Which nursing action is best to relieve his urinary retention? A) Use a 22 French catheter to remove urine from bladder. B) Teach the Credé's maneuver to remove urine from the bladder. C) Insert a coudé catheter to remove urine from the bladder. D) Use a straight-tipped catheter to remove urine from the bladder.
c
The nurse is completing a plan of care for a client with chronic urinary incontinence. Which of the following outcomes is a priority? A) The client will decrease fluid intake to 1000 mL/day. B) The client will use the bathroom every 30 minutes while awake. C) The client will maintain perineal skin integrity. D) The client will express feelings of acceptance related to condition.
c
The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder? A) Incontinence B) Dysuria C) Hematuria D) Frequency
c
A nurse has been asked to speak to a local women's group about preventing cystitis. Which of the following would the nurse include in the presentation? A) Need to wear underwear made from synthetic material B) Importance of urinating every 4 to 6 hours while awake C) Suggestion to take tub baths instead of showers D) Need to urinate after engaging in sexual intercourse
d
A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom? A) Urinary retention B) Fever C) Frequency D) Painless hematuria
d
The nurse is caring for a client who has chronic urinary retention and discussing the options. When discussing care, which intervention is considered first? A) Completing clean intermittent catheterization B) Inserting a cystostomy tube C) Applying a condom catheter D) Using the Credé's maneuver
d
The nurse is caring for a client with a cystoscopy tube draining urine from the bladder. When reviewing the client's history prior to administering care, which is of most concern? A) Diagnostic studies reporting bladder stones B) Crusted drainage around the cystoscopy tube C) A white blood count of 12,000 cells/mm3 D) New diagnosis of urosepsis
d
The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important? A) Set up a routine schedule of every 4 hours to check for residual urine. B) Check for residual after the client reports the urge to void. C) Record the volume of urine obtained. D) Catheterize the client immediately after the client voids.
d
