Final Test

The nursing student sees an order for a urinalysis for a patient with frequency, urgency, and dysuria. In order to collect the specimen, what does the student do? a. Use sterile technique to insert a small-diameter (6 Fr) catheter. b. Instruct the patient on how to collect a clean-catch specimen. c. Tell the patient to urinate approximately 10 mL into a specimen cup. d. Take the urine from a bedpan and transfer it into a specimen cup.

B - Instruct the patient on how to collect a clean-catch specimen.

The advanced-practice nurse is performing a digital rectal examination (DRE) and notes that the rectal sphincter contracts on digital insertion. How does the nurse interpret this finding? a. Nerve supply to the bladder is most likely intact. b. There is adequate strength in the pelvic floor. c. A rectocele is placing pressure on the bladder. d. Abnormal function for the bladder is unlikely.

A

Teaching intermittent self-catheterization for incontinence is appropriate for which patient? a. 25-year-old male patient with paraplegia b. 35-year-old female patient with stress incontinence c. 70-year-old patient who wears absorbent briefs d. 18-year-old patient with a severe head injury

A - 25-year-old male patient with paraplegia

Which patient is mostly likely to have mixed incontinence? a. 54-year-old woman who had four full-term pregnancies b. 52-year-old man who had a stroke with neurologic deficits c. 76-year-old man with benign prostatic hyperplasia d. 25-year-old woman who has a pelvic fracture

A - 54-year-old woman who had four full-term pregnancies

The nurse is caring for a patient with an indwelling catheter. What intervention does the nurse use to minimize catheter-related infections? a. Assess the patient daily to determine need for catheter. b. Irrigate the catheter daily with sterile solution to remove debris. c. Use sterile technique when opening system to obtain urine samples. d. Apply antiseptic solutions or antibiotic ointments to the perineal area.

A - Assess the patient daily to determine need for catheter.

The nurse is teaching a woman how to prevent UTIs. What information does the nurse include? a. Clean the perineal area from front to back. b. Always use a condom if spermicides are used for contraception. c. Obtain prescription for oral estrogen for vaginal dryness. d. Avoid urinary stasis by urinating every 6 to 8 hours.

A - Clean the perineal area from front to back.

Patients who have central nervous system lesions from stroke, multiple sclerosis, or parasacral spinal cord lesions may have which type of urinary incontinence? a. Detrusor hyperreflexia b. Mixed c. Stress d. Functional

A - Detrusor hyperreflexia

A patient is diagnosed with a urethral stricture. The nurse prepares the patient for which temporary treatment? a. Dilation of the urethra b. Antibiotic therapy c. Fluid restriction d. Urinary diversion

A - Dilation of the urethra

The nurse is counseling a patient with recurrent symptomatic UTIs about dietary therapy. What information does the nurse give to the patient? a. Drink 50 mL of concentrated cranberry juice every day. b. Low consumption of protein may prevent recurrent UTIs. c. Caffeine, carbonated beverages, and tomato products cause UTI. d. Cranberry tablets are more effective than juice or fluids.

A - Drink 50 mL of concentrated cranberry juice every day.

The urine output of a patient with a kidney stone has decreased from 40 mL/hr to 5 mL/hr. What is the nurse's priority action? a. Ensure IV access and notify the health care provider. b. Perform the Credé maneuver on the patient's bladder. c. Test the urine for ketone bodies. d. Document the finding and continue monitoring.

A - Ensure IV access and notify the health care provider.

The nurse is teaching self-care measures to a patient who had lithotripsy for kidney stones. What information does the nurse include? (Select all that apply.) a. Finish the entire prescription of antibiotics to prevent UTIs. b. Balance regular exercise with sleep and rest. c. Drink at least 3 L of fluid a day. d. Watch for and immediately report bruising after lithotripsy. e. Urine may be bloody for several days. f. Pain in the region of the kidneys or bladder is expected.

A - Finish the entire prescription of antibiotics to prevent UTIs. B - Balance regular exercise with sleep and rest. C - Drink at least 3 L of fluid a day. E - Urine may be bloody for several days.

A patient's recurrent cystitis appears to be related to sexual intercourse. The patient seems uncomfortable talking about the situation. What communication technique does the nurse use to assist the patient? a. Have a frank and sensitive discussion with the patient. b. Give the patient reading material with instructions to call with any questions. c. Call the patient's partner and invite the partner to discuss the problem. d. Talk about other topics until the patient feels more comfortable disclosing.

A - Have a frank and sensitive discussion with the patient.

A patient reports intense urgency, frequency, and bladder pain. Urinalysis results show white blood cells (WBCs) and red blood cells (RBCs) and urine culture results are negative for infection. How does the nurse interpret these findings? a. Interstitial cystitis b. Urethritis c. Bacteriuria d. Infectious cystitis

A - Interstitial cystitis

What does the nurse include in the care plan for a patient who had pyelolithotomy? (Select all that apply.) a. Monitor the amount of bleeding from incisions. b. Restrict fluids to prevent edema and fluid overload. c. Strain the urine to monitor the passage of stone fragments. d. Encourage fluids to avoid dehydration and supersaturation. e. Monitor changes in urine output. f. Administer antibiotics to eliminate or prevent infections.

A - Monitor the amount of bleeding from incisions. C - Strain the urine to monitor the passage of stone fragments. D - Encourage fluids to avoid dehydration and supersaturation. E - Monitor changes in urine output. F - Administer antibiotics to eliminate or prevent infections.

The home health nurse is assessing an older adult patient who refuses to leave the house to see friends or participate in usual activities. She reports taking a bath several times a day and becomes very upset when she has an incontinent episode. What is the priority problem for this patient? a. Negative self-image b. Stress urinary incontinence c. Social isolation d. Potential for skin breakdown

A - Negative self-image

Which task related to care of patients who have indwelling catheters can be delegated to unlicensed assistive personnel (UAP)? a. Perform daily catheter care by washing the perineum and proximal portion of the catheter with soap and water. b. Use sterile technique when inserting the urinary catheter or when opening the system to obtain urine samples. c. Determine whether use of condom catheters is appropriate for male patients and apply the devices accordingly. d. Keep urine collection bag in a place that is readily visible to the patient, so that the patient is reassured of kidney function.

A - Perform daily catheter care by washing the perineum and proximal portion of the catheter with soap and water.

A patient with urinary incontinence is prescribed oxybutynin (Ditropan). What precautions or instructions does the nurse provide related to this therapy? a. Avoid aspirin or aspirin-containing products. b. Increase fluids and dietary fiber intake. c. Report any unusual vaginal bleeding. d. Change positions slowly, especially in the morning.

B - Increase fluids and dietary fiber intake.

A client is hospitalized with urinary retention, has an indwelling catheter, and is getting IV fluids. Which intervention does the nurse add to the care plan to address the priority problem for this client? a. Perform catheter care per policy every shift. b. Encourage fluid intake to 1 liter/day. c. Apply a moisture barrier cream daily. d. Document accurate intake and output (I&O) each shift.

A The most common cause of sepsis in hospitalized clients is a urinary tract infection. Ascending infection from cystitis with an indwelling catheter is a major source of such infections. Encouraging fluids and documenting I&O are probably important interventions, but they do not take priority over preventing a catheter-related infection. Moisture barrier cream would not be needed.

A young woman tells the nurse that she gets frequent UTIs that seem to follow sexual intercourse. Which questions would the nurse ask? (Select all that apply.) a. "Do you use a diaphragm or spermicides for contraception?" b. "Do you feel guilty or embarrassed about your sexual activities?" c. "Have you considered abstaining from intercourse?" d. "Do you and your partner(s) wash the perineal area before intercourse?" e. "Some positions cause more irritation during sex. Have you noticed this?"

A - "Do you use a diaphragm or spermicides for contraception?" D - "Do you and your partner(s) wash the perineal area before intercourse?" E - "Some positions cause more irritation during sex. Have you noticed this?"

The nurse is teaching a patient about self-care measures to prevent UTIs. Which daily fluid intake does the nurse recommend to the patient to prevent a bladder infection? a. 2 to 3 L of water b. 3 to 6 glasses of iced tea c. 4 to 6 cups of electrolyte fluid d. 3 to 4 glasses of juice

A - 2 to 3 L of water

The health care provider has recommended intermittent self-catheterization for a patient with long-term problems of incomplete bladder emptying. Which information does the nurse give the patient about the procedure? a. Perform proper handwashing and cleaning of the catheter to reduce the risk for infection. b. Use a large-lumen catheter and good lubrication for rapid emptying of the bladder. c. Catheterize yourself whenever the bladder gets distended. d. Use sterile technique, especially if catheterization is done by a family member.

A - Perform proper handwashing and cleaning of the catheter to reduce the risk for infection.

The nurse is reviewing a care plan for a patient who has functional incontinence. There is a note that containment is recommended, especially at night. What is the major concern with this approach? a. Skin integrity b. Cost of care and materials c. Self-esteem of the patient d. Fall risk

A - Skin integrity

A patient returns to the medical-surgical unit after having shock wave lithotripsy (SWL). What is an appropriate nursing intervention for the postprocedural care of this patient? a. Strain the urine to monitor the passage of stone fragments. b. Report bruising that occurs on the flank of the affected side. c. Continuously monitor electrocardiogram (ECG) for dysrhythmias. d. Apply a local anesthetic cream to the skin of the affected side.

A - Strain the urine to monitor the passage of stone fragments.

A middle-aged woman has urinary stress incontinence related to weak pelvic muscles. The patient is highly motivated to participate in self-care. Which interventions does the nurse include in the treatment plan? (Select all that apply.) a. Suggest keeping a detailed diary of urine leakage, activities, and foods eaten. b. Suggest wearing absorbent undergarments during the assessment process. c. Teach pelvic floor (Kegel) exercise therapy. d. Teach about vaginal cone therapy. e. Encourage drinking orange juice every day for 4 to 6 weeks. f. Refer to a nutritionist for diet therapy for weight reduction.

A - Suggest keeping a detailed diary of urine leakage, activities, and foods eaten. B - Suggest wearing absorbent undergarments during the assessment process. C - Teach pelvic floor (Kegel) exercise therapy. D - Teach about vaginal cone therapy. F - Refer to a nutritionist for diet therapy for weight reduction.

The nurse is designing a habit training bladder program for an older adult patient who is alert but mildly confused. What task associated with the training program is delegated to the UAP? a. Tell the patient it is time to go to the toilet and assist him to go on a regular schedule. b. Help the patient record the incidents of incontinence in a bladder diary. c. Change the patient's incontinence pants (or pad) every 4 hours. d. Gradually encourage independence and increase the intervals between voidings.

A - Tell the patient it is time to go to the toilet and assist him to go on a regular schedule.

A patient reports symptoms indicating a UTI. Results from which diagnostic test will verify a UTI? a. Urinalysis to test for leukocyte esterase and nitrate b. Urinalysis for glucose and red blood cells c. Urinalysis to test for ketones and protein d. Urinalysis for pH and specific gravity

A - Urinalysis to test for leukocyte esterase and nitrate

A nurse cares for a client admitted from a nursing home after several recent falls. What prescription should the nurse complete first? a. Obtain urine sample for culture and sensitivity. b. Administer intravenous antibiotics. c. Encourage protein intake and additional fluids. d. Consult physical therapy for gait training.

ANS: A Although all interventions are or might be important, obtaining a urine sample for urinalysis takes priority. Often urinary tract infection (UTI) symptoms in older adults are atypical, and a UTI may present with new onset of confusion or falling. The urine sample should be obtained before starting antibiotics. Dietary requirements and gait training should be implemented after obtaining the urine sample.

A young female patient reports experiencing burning with urination. What question does the nurse ask to differentiate between a vaginal infection and a urinary infection? a. "Have you noticed any blood in the urine?" b. "Have you had recent sexual intercourse?" c. "Have you noticed any vaginal discharge?" d. "Have you had fever or chills?"

C - "Have you noticed any vaginal discharge?"

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 liters 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."

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 should 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.

A nurse cares for adult clients who experience urge incontinence. For which client should the nurse plan a habit training program? a. A 78-year-old female who is confused b. A 65-year-old male with diabetes mellitus c. A 52-year-old female with kidney failure d. A 47-year-old male with arthritis

ANS: A For a bladder training program to succeed in a client with urge incontinence, the client must be alert, aware, and able to resist the urge to urinate. Habit training will work best for a confused client. This includes going to the bathroom (or being assisted to the bathroom) at set times. The other clients may benefit from another type of bladder training.

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 additional 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."

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

A nurse obtains the health history of a client with a suspected diagnosis of bladder cancer. Which question should 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?"

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 increase the risk of developing bladder cancer.

A nurse teaches a young female client who is prescribed amoxicillin (Amoxil) for a urinary tract infection. Which statement should 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."

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

7. A nurse teaches a client about self-care after experiencing a urinary calculus treated by lithotripsy. Which statements should 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 liters 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."

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 liters 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 provider as these may signal the beginning of an infection or the formation of another stone.

5. A nurse cares for clients with urinary incontinence. Which types of incontinence are correctly paired with their clinical manifestation? (Select all that apply.) a. Stress incontinence - Urine loss with physical exertion b. Urge incontinence - Large amount of urine with each occurrence 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

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.

6. A nurse teaches a client with a history of calcium phosphate urinary stones. Which statements should the nurse include in this client's dietary teaching? (Select all that apply.) a. "Limit your intake of food high in animal protein." b. "Read food labels to help minimize your sodium intake." c. "Avoid spinach, black tea, and rhubarb." d. "Drink white wine or beer instead of red wine." e. "Reduce your intake of milk and other dairy products."

ANS: A, B, E Clients with calcium phosphate urinary stones should be taught to limit the intake of foods high in animal protein, sodium, and calcium. Clients with calcium oxalate stones should avoid spinach, black tea, and rhubarb. Clients with uric acid stones should avoid red wine.

8. A nurse teaches a female client who has stress incontinence. Which statements should the nurse include about pelvic muscle exercises? (Select all that apply.) a. "When you start and stop your urine stream, you are using your pelvic muscles." b. "Tighten your pelvic muscles for a slow count of 10 and then relax for a slow count of 10." c. "Pelvic muscle exercises should only be performed sitting upright with your feet on the floor." d. "After you have been doing these exercises for a couple days, your control of urine will improve." e. "Like any other muscle in your body, you can make your pelvic muscles stronger by contracting them."

ANS: A, B, E The client should be taught that the muscles used to start and stop urination are pelvic muscles, and that pelvic muscles can be strengthened by contracting and relaxing them. The client should tighten pelvic muscles for a slow count of 10 and then relax the muscles for a slow count of 10, and perform this exercise 15 times while in lying-down, sitting-up, and standing positions. The client should begin to notice improvement in control of urine after several weeks of exercising the pelvic muscles.

A nurse reviews the laboratory findings of a client with a urinary tract infection. The laboratory report notes a "shift to the left" in a client's white blood cell count. Which action should the nurse take? a. Request that the laboratory perform a differential analysis on the white blood cells. b. Notify the provider and start an intravenous line for parenteral antibiotics. c. Collaborate with the unlicensed assistive personnel (UAP) to strain the client's urine for renal calculi. d. Assess the client for a potential allergic reaction and anaphylactic shock.

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 should notify the 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.

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. Which action should 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.

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.

A nurse plans care for clients with urinary incontinence. Which client is correctly paired with the appropriate intervention? a. A 29-year-old client after a difficult vaginal delivery - Habit training b. A 58-year-old postmenopausal client who is not taking estrogen therapy - Electrical stimulation c. A 64-year-old female with Alzheimer's-type senile dementia - Bladder training d. A 77-year-old female who has difficulty ambulating - Exercise therapy

ANS: B Exercise therapy and electrical stimulation are used for clients with stress incontinence related to childbirth or low levels of estrogen after menopause. Exercise therapy increases pelvic wall strength; it does not improve ambulation. Physical therapy and a bedside commode would be appropriate interventions for the client who has difficulty ambulating. Habit training is the type of bladder training that will be most effective with cognitively impaired clients. Bladder training can be used only with a client who is alert, aware, and able to resist the urge to urinate.

After delegating care to an unlicensed assistive personnel (UAP) for a client who is prescribed habit training to manage incontinence, a nurse evaluates the UAP's understanding. Which action indicates the UAP 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

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

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 should 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."

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 client is low estrogen levels. Personal hygiene usually does not contribute to this disease process.

An emergency department nurse assesses a client with a history of urinary incontinence who presents with extreme dry mouth, constipation, and an inability to void. Which question should 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?"

ANS: B Some types of incontinence are treated with anticholinergic medications such as propantheline (Pro-Banthine). Anticholinergic side effects include dry mouth, constipation, and urinary retention. The nurse needs to assess the client's medication list to determine whether the client is taking an anticholinergic medication. If he or she is taking anticholinergics, the nurse should further assess the client's manifestations to determine if they are related to a simple side effect or an overdose. The other questions are not as helpful to understanding the current situation.

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

ANS: B The client should try to hold the urine consciously until the next scheduled toileting time. Toileting should occur at specific intervals during the training. The toileting interval should be no less than every hour. The interval can be increased once the client becomes comfortable with the interval.

A nurse assesses a client with bladder cancer who is recovering from a complete cystectomy with ileal conduit. Which assessment finding should alert the nurse to urgently contact the health care provider? a. The ileostomy is draining blood-tinged urine. b. There is serous sanguineous drainage present on the surgical dressing. c. The ileostomy stoma is pale and cyanotic in appearance. d. Oxygen saturations are 92% on room air.

ANS: C A pale or cyanotic stoma indicates impaired circulation to the stoma and must be treated to prevent necrosis. Blood-tinged urine and serous sanguineous drainage are expected after this type of surgery. Oxygen saturation of 92% on room air is at the low limit of normal.

A confused client with pneumonia is admitted with an indwelling catheter in place. During interdisciplinary rounds the following day, which question should 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. "Can we discontinue the indwelling catheter?" d. "Should we get another chest x-ray today?"

ANS: C An indwelling 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 should inquire about removing the catheter. All other questions might be appropriate, but because of client safety, this question takes priority.

A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of bacterial cystitis? a. A 36-year-old female who has never been pregnant b. A 42-year-old male who is prescribed cyclophosphamide c. A 58-year-old female who is not taking estrogen replacement d. A 77-year-old male with mild congestive heart failure

ANS: C Females at any age are more susceptible to cystitis than men because of the shorter urethra in women. Postmenopausal women who are not on hormone replacement therapy are at increased risk for bacterial cystitis because of changes in the cells of the urethra and vagina. The middle-aged woman who has never been pregnant would not have a risk potential as high as the older woman who is not using hormone replacement therapy.

After teaching a client with bacterial cystitis who is prescribed phenazopyridine (Pyridium), 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. "If I think I am pregnant, I will stop the drug." c. "An orange color in my urine should not alarm me." d. "I will drink two glasses of cranberry juice daily."

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

A nurse teaches a client with functional urinary incontinence. Which statement should the nurse include in this client's teaching? a. "You must clean around your catheter daily with soap and water." b. "Wash the vaginal weights with a 10% bleach solution after each use." c. "Operations to repair your bladder are available, and you can consider these." d. "Buy slacks with elastic waistbands that are easy to pull down."

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 goal is that the client will be able to manage his or her clothing independently. Elastic waistband slacks that are easy to pull down can help the client get on the toilet in time to void. The other instructions do not relate to functional urinary incontinence.

A nurse plans care for a client with overflow incontinence. Which intervention should 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.

ANS: D In clients 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.

A nurse cares for a client who has kidney stones from secondary hyperoxaluria. Which medication should the nurse anticipate administering? a. Phenazopyridine (Pyridium) b. Propantheline (Pro-Banthine) c. Tolterodine (Detrol LA) d. Allopurinol (Zyloprim)

ANS: D Stones caused by secondary hyperoxaluria respond to allopurinol (Zyloprim). Phenazopyridine is given to clients with urinary tract infections. Propantheline is an anticholinergic. Tolterodine is an anticholinergic with smooth muscle relaxant properties.

A nurse cares for a client who is scheduled for the surgical creation of an ileal conduit. The client states, "I am anxious about having an ileal conduit. What is it like to have this drainage tube?" How should the nurse respond? a. "I will ask the provider to prescribe you an antianxiety medication." b. "Would you like to discuss the procedure with your doctor once more?" c. "I think it would be nice to not have to worry about finding a bathroom." d. "Would you like to speak with someone who has an ileal conduit?"

ANS: D The goal for the client who is scheduled to undergo a procedure such as an ileal conduit is to have a positive self-image and a positive attitude about his or her body. Discussing the procedure candidly with someone who has undergone the same procedure will foster such feelings, especially when the current client has an opportunity to ask questions and voice concerns to someone with first-hand knowledge. Medications for anxiety will not promote a positive self-image and a positive attitude, nor will discussing the procedure once more with the physician or hearing the nurse's opinion.

A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for bladder cancer? a. A 25-year-old female with a history of sexually transmitted diseases b. A 42-year-old male who has worked in a lumber yard for 10 years c. A 55-year-old female who has had numerous episodes of bacterial cystitis d. An 86-year-old male with a 50-pack-year cigarette smoking history

ANS: D The greatest risk factor for bladder cancer is a long history of tobacco use. The other factors would not necessarily contribute to the development of this specific type of cancer.

A male college student comes to the clinic reporting burning or difficulty with urination and a discharge from the urethral meatus. Based on the patient's chief complaint, what is the most logical question for the nurse to ask about the patient's past medical history? a. "Do you have a history of a narrow urethra or a stricture?" b. "Could you have been exposed to a sexually transmitted disease (STD)?" c. "Do you have a history of kidney stones?" d. "Have you been drinking an adequate amount of fluids?"

B - "Could you have been exposed to a sexually transmitted disease (STD)?"

For a patient who needs an indwelling catheter for at least 2 weeks, which intervention would help reduce the bacterial colonization along the catheter? a. Secure the catheter to the female patient's thigh. b. Consider the use of a coated catheter. c. Wash the urine bag and outflow tube every day. d. Apply antiseptic ointment to the catheter tubing.

B - Consider the use of a coated catheter.

The nurse is teaching a patient with urge incontinence about dietary modifications. What is the best information the nurse gives to the patient about fluid intake? a. Drink at least 2000 mL per day unless contraindicated. b. Drink 120 mL every hour or 240 mL every 2 hours and limit fluids after dinner. c. Drink fluid freely in the morning hours, but limit intake before going to bed. d. Drinking water is especially good for bladder health.

B - Drink 120 mL every hour or 240 mL every 2 hours and limit fluids after dinner.

The nurse hears in report that the patient is being treated for a fungal UTI. In addition to performing routine care and assessments, the nurse is extra-vigilant for signs/symptoms of which systemic disorder that may underlie the fungal UTI? a. Chronic cardiac disease b. Immune system compromise c. Respiratory system dysfunction d. Connective tissue disorder

B - Immune system compromise

A patient is admitted for an elective orthopedic surgical procedure. The patient also has a personal and family history for urolithiasis. Which circumstance creates the greatest risk for recurrent urolithiasis? a. Giving the patient milk with every meal tray b. Keeping the patient NPO for extended periods c. Giving the patient an opioid narcotic for pain d. Inserting an indwelling catheter for the procedure

B - Keeping the patient NPO for extended periods

Which clinical manifestation indicates to the nurse that interventions for the patient's renal colic are effective? a. Urine is pink-tinged. b. Patient reports that pain is relieved. c. Urine output is 50 mL/min. d. Bladder scan shows no residual urine.

B - Patient reports that pain is relieved.

Which patient with incontinence is most likely to benefit from a surgical intervention? a. Patient with vaginal atrophy and altered urethral competency b. Patient with reflex (overflow) incontinence caused by obstruction c. Patient with functional incontinence related to musculoskeletal weakness d. Patient with urge incontinence or overactive bladder

B - Patient with reflex (overflow) incontinence caused by obstruction

A patient received an antibiotic prescription several hours ago and has started the medication, but requests "some relief from the burning." What comfort measures does the nurse suggest to the patient? a. Take over-the-counter acetaminophen. b. Sit in a sitz bath and urinate into the warm water. c. Place a cold pack over the perineal area. d. Rest in a recumbent position with legs elevated.

B - Sit in a sitz bath and urinate into the warm water.

A patient has agreed to try a bladder training program. What is the priority nursing intervention in starting this therapy? a. Start a schedule for voiding (e.g., every 2-3 hours). b. Teach the patient how to be alert, aware, and able to resist the urge to urinate. c. Convince the patient that the bladder issues are controlling his/her lifestyle. d. Give a thorough explanation of the problem of stress incontinence.

B - Teach the patient how to be alert, aware, and able to resist the urge to urinate.

A patient has been performing Kegel exercises for 2 months. How does the nurse know whether the exercises are working? a. Incontinence is still present, but the patient states that it is less. b. The patient is able to stop the urinary stream. c. There are no complaints of urgency from the patient. d. The patient is using absorbent undergarments for protection.

B - The patient is able to stop the urinary stream.

The nurse is reviewing the laboratory results for an older adult patient with an indwelling catheter. The urine culture is pending, but the urinalysis shows greater than 105 colony-forming units, and the differential WBC count shows a "left shift." How does the nurse interpret these findings? a. Interstitial cystitis b. Urosepsis c. Complicated cystitis d. Radiation-induced cystitis

B - Urosepsis

The employee health nurse is conducting a presentation for employees who work in a paint manufacturing plant. In order to protect against bladder cancer, the nurse advises that everyone who works with chemicals should do what? a. Shower with mild soap and rinse well before they come to work. b. Use personal protective equipment such as gloves and masks. c. Limit their exposure to chemicals and fumes at all times. d. Avoid hobbies such as furniture refinishing that further expose to chemicals.

B - Use personal protective equipment such as gloves and masks.

Which statement by a patient indicates effective coping with a Kock's pouch? a. "I don't have any discomfort, but the pouch frequently overflows." b. "My wife has been irrigating the pouch daily. She likes to do it." c. "I check the pouch every 2 to 3 hours depending on my fluid and diet." d. "I never undress in front of anyone anymore, but I guess that is okay."

C - "I check the pouch every 2 to 3 hours depending on my fluid and diet."

The nurse is evaluating outcome criteria for a patient being treated for urge incontinence. Which statement indicates the treatment has been successful? a. "I'm following the prescribed therapy, but I think surgery is my best choice." b. "I still lose a little urine when I sneeze, but I have been wearing a thin pad." c. "I had trouble at first, but now I go to the toilet every 3 hours." d. "I have been using the bladder compression technique and it works."

C - "I had trouble at first, but now I go to the toilet every 3 hours."

Which patient has the highest risk for bladder cancer? a. 60-year-old male patient with malnutrition secondary to chronic alcoholism and self- neglect b. 25-year-old male patient with type 1 diabetes mellitus, who is noncompliant with therapeutic regimen c. 60-year-old female patient who smokes two packs of cigarettes per day and works in a chemical factory d. 25-year-old female patient who has had three episodes of bacterial (Escherichia coli) cystitis in the past year.

C - 60-year-old female patient who smokes two packs of cigarettes per day and works in a chemical factory

The nurse is working in a long-term care facility. Which circumstance is cause for greatest concern, because the facility has a large number of residents who are developing UTIs? a. Residents are not drinking enough fluids with meals. b. Unlicensed personnel are not assisting with toileting in a timely fashion. c. A large percentage of residents have indwelling urinary catheters. d. Many residents have severe dementia and functional incontinence.

C - A large percentage of residents have indwelling urinary catheters.

Which dietary changes does the nurse suggest to a patient with urge incontinence? a. Limit fluid intake to no more than 2 L/day. b. Peel all fruit before consuming. c. Avoid alcohol and caffeine. d. Avoid smoked or salted food

C - Avoid alcohol and caffeine.

The nurse is caring for a patient who has an indwelling catheter and subsequently developed a UTI. The patient has been receiving antibiotics for several days, but develops hypotension, a rapid pulse, and confusion. The nurse suspects urosepsis and alerts the health care provider. Which diagnostic test is the provider most likely to order to confirm urosepsis? a. Culture of the drainage bag b. Culture of the catheter tip c. Blood culture d. Repeat urinalysis

C - Blood culture

The home health nurse reads in the patient's chart that the patient has asymptomatic bacterial urinary tract infection (ABUTI). Which intervention will the nurse perform? a. Obtain an order for urinalysis and urine culture and sensitivity. b. Check the patient's medication list for appropriate antibiotic order. c. Closely monitor for conditions that cause progression to acute infection. d. Ask the patient when the ABUTI first started and when it was diagnosed.

C - Closely monitor for conditions that cause progression to acute infection.

Several patients at the clinic have just been diagnosed with UTIs. Which patients may need longer antibiotic treatment (7 to 21 days) or different agents than the typical first-line medi- cations? (Select all that apply.) a. Postmenopausal patient b. Patient with urethritis c. Diabetic patient d. Immunosuppressed patient e. Pregnant patient

C - Diabetic patient D -Immunosuppressed patient E - Pregnant patient

A patient is diagnosed with a fungal UTI. Which drug does the nurse anticipate the patient will be treated with? a. Trimethoprim/sulfamethoxazole (Bactrim) b. Ciprofloxacin (Cipro) c. Fluconazole (Diflucan) d. Amoxicillin (Amoxil)

C - Fluconazole (Diflucan)

An older adult patient with a cognitive impair-ment is living in an extended-care facility. The patient is incontinent, but as the family points out, "he will urinate in the toilet if somebody helps him." Which type of incontinence does the nurse suspect in this patient? a. Urge b. Overflow c. Functional d. Stress

C - Functional

The cystoscopy results for a patient include a small-capacity bladder, the presence of Hunner's ulcers, and small hemorrhages after bladder distention. How does the nurse interpret this report? a. Urosepsis b. Complicated cystitis c. Interstitial cystitis d. Urethritis

C - Interstitial cystitis

The nurse is caring for an obese older adult patient with dementia. The patient is alert and ambulatory, but has functional incontinence. Which nursing intervention is best for this patient? a. Help the patient to lose weight. b. Help the patient apply an estrogen cream. c. Offer assistance with toileting every 2 hours. d. Intermittently catheterize the patient.

C - Offer assistance with toileting every 2 hours.

A patient is diagnosed with urethral stricture. What findings does the nurse expect to see documented in the patient's chart for this condition? a. Pain on urination b. Pain on ejaculation c. Overflow incontinence d. Hematuria and pyuria

C - Overflow incontinence

The nurse is talking to a 68-year-old male patient who has lifestyle choices and occupational exposure that put him at high risk for bladder cancer. The nurse is most concerned about which urinary characteristic? a. Frequency b. Nocturia c. Painless hematuria d. Incontinence

C - Painless hematuria

The nurse is caring for an older adult patient with urinary incontinence. The patient is alert and oriented, but refuses to use the call bell and has fallen several times while trying to get to the bathroom. What is the nurse's priority concern for this patient? a. Managing noncompliance b. Accurately measuring urinary output c. Providing fall prevention measures d. Managing urinary incontinence

C - Providing fall prevention measures

A patient reports severe flank pain. The report indicates that urine is turbid, malodorous, and rust-colored; RBCs, WBCs, and bacteria are present; and microscopic analysis shows crystals. What does this data suggest? a. Pyuria and cystitis b. Staghorn calculus with infection c. Urolithiasis and infection d. Dysuria and urinary retention

C - Urolithiasis and infection

The nurse is teaching a man about how to prevent UTIs. What information does the nurse include? a. "Have a minimal fluid intake of 5 L daily, unless contraindicated." b. "Empty your bladder before and after sexual intercourse." c. "Make sure that spermicides are used with condoms." d. "Gently wash the genital area before intercourse."

D - "Gently wash the genital area before intercourse."

A patient has had a bladder suspension and a suprapubic catheter is in place. The patient wants to know how long the catheter will remain in place. What is the nurse's best response? a. "Typically it remains for 24 hours postoperatively." b. "It will be removed at your first clinic visit." c. "When you can void on your own, it will be removed." d. "It will be removed when you can void and residual urine is less than 50 mL."

D - "It will be removed when you can void and residual urine is less than 50 mL."

Which patient should not be advised to take cranberry juice? a. 26-year-old pregnant woman with a history of uncomplicated UTI b. 23-year-old man with history of recurrent kidney stones c. 65-year-old man with urinary retention secondary to enlarged prostate d. 33-year-old woman with dysuria associated with interstitial cystitis

D - 33-year-old woman with dysuria associated with interstitial cystitis

The nurse is teaching a patient a behavioral intervention for bladder compression. In order to correctly perform the Credé method, what does the nurse teach the patient to do? a. Insert the fingers into the vagina and gently push against the vaginal wall. b. Breathe in deeply and direct the pressure towards the bladder during exhalation. c. Empty the bladder, wait a few minutes, and attempt a second bladder emptying. d. Apply firm and steady pressure over the bladder area with the palm of the hand.

D - Apply firm and steady pressure over the bladder area with the palm of the hand.

The nurse is performing an assessment on a patient with probable stress incontinence. Which assessment technique does the nurse use to validate stress incontinence? a. Assess the abdomen to estimate bladder fullness. b. Check for residual urine using a portable ultrasound. c. Catheterize the patient immediately after voiding. d. Ask the patient to cough while wearing a perineal pad.

D - Ask the patient to cough while wearing a perineal pad.

The nurse is caring for a patient with functional incontinence. The UAP reports that "the linens have been changed four times within the past 6 hours, but the patient refuses to wear a diaper." What does the nurse do next? a. Thank the UAP for the hard work and advise to continue to change the linens. b. Call the health care provider to obtain an order for an indwelling catheter. c. Instruct the UAP to stop using the word "diaper" and instead use "incontinence pants." d. Assess the patient for any new urinary problems and ask about toileting preferences.

D - Assess the patient for any new urinary problems and ask about toileting preferences.

What role does drug therapy have as an intervention for reflex (overflow) urinary incontinence? a. Captopril (Capoten) is given to lower urine cystine levels. b. Levofloxacin (Levaquin) is given to prevent UTIs with this type of incontinence. c. Midorine (ProAmatine) is given to increase the contractile force of the bladder. d. Bethanechol chloride (Urecholine) may be used short-term after surgery.

D - Bethanechol chloride (Urecholine) may be used short-term after surgery.

A patient has UTI symptoms but there are no bacteria in the urine. The health care provider suspects interstitial cystitis. The nurse prepares patient teaching material for which diagnostic test? a. Urography b. Abdominal sonography c. Computed tomography (CT) d. Cystoscopy

D - Cystoscopy

A patient comes to the clinic and reports severe flank pain, bladder distention, and nausea and vomiting with increasingly smaller amounts of urine with frank blood. The patient states, "I have kidney stones and I just need a prescription for pain medication." What is the nurse's priority concern? a. Controlling the patient's pain b. Checking the quantity of blood in the urine c. Flushing the kidneys with oral fluids d. Determining if there is an obstruction

D - Determining if there is an obstruction

A patient is returning from the postanesthesia care unit after surgery for bladder cancer resulting in a cutaneous ureterostomy. Where does the nurse expect the stoma to be located? a. On the perineum b. At the beltline c. On the posterior flank d. In the midabdominal area

D - In the midabdominal area

A patient has had surgery for bladder cancer. To prevent recurrence of superficial bladder cancer, the nurse anticipates that the health care provider is likely to recommend which treatment? a. No treatment is needed for this benign condition. b. Intravesical instillation of single-agent chemotherapy. c. Radiation therapy to the bladder, ureters, and urethra. d. Intravesical instillation of bacille Calmette- Guérin.

D - Intravesical instillation of bacille Calmette- Guérin.

A patient is considering vaginal cone therapy, but is a little hesitant because she does not understand how it works. What does the nurse tell her about how vaginal cone therapy improves incontinence? a. It mechanically obstructs urine loss from the urethra. b. It repositions the bladder to reduce compression. c. It increases the normal flora of the perineum. d. It strengthens pelvic floor muscles.

D - It strengthens pelvic floor muscles.

The health care provider verbally informs the nurse that the patient needs a fluoroquinolone antibiotic to treat a UTI. The pharmacy delivers gabapentin (Neurontin). What should the nurse do first? a. Administer the medication as ordered. b. Call the pharmacist and ask for a read back of the order. c. Call the health care provider for clarification of the order. d. Look at the written order to clarify the name of the medication.

D - Look at the written order to clarify the name of the medication.

The nurse is caring for a patient with urolithiasis. Which medication is likely to be given in the acute phase to relieve the patient's severe pain? a. Ketorolac (Toradol) b. Oxybutynin chloride (Ditropan) c. Propantheline bromide (Pro-Banthine) d. Morphine sulfate (Astramorph)

D - Morphine sulfate (Astramorph)

In which patient circumstance would the nurse question the order for the insertion of an indwelling catheter? a. Patient is critically ill and at risk for hypovolemic shock. b. Patient has urinary retention with beginnings of hydronephrosis. c. Patient was in a car accident and has a possible spinal cord injury. d. Patient has functional incontinence related to Alzheimer's disease.

D - Patient has functional incontinence related to Alzheimer's disease.

A patient has been started on oxybutynin (Ditropan) for urinary incontinence. What is the major action of this medication? a. Increases blood flow to the urethra b. Blocks acetylcholine receptors c. Causes slight numbing of the bladder d. Relaxes bladder muscles

D - Relaxes bladder muscles

A patient with a history of kidney stones presents with severe flank pain, nausea, vomiting, pallor, and diaphoresis. He reports freely passing urine, but it is bloody. The priority for nursing care is to monitor for which patient problem? a. Possible dehydration b. Impaired tissue perfusion c. Impaired urinary elimination d. Severe pain

D - Severe pain

A patient repots the loss of small amounts of urine during coughing, sneezing, jogging, or lifting. Which type of incontinence do these symptoms describe? a. Urge b. Overflow c. Functional d. Stress

D - Stress

Which urine characteristic suggests that the patient is drinking a sufficient amount of fluid? a. Urine pH is between 6 to 6.5. b. Urine has a high specific gravity. c. Urine has a faint ammonia odor. d. Urine is a pale yellow color.

D - Urine is a pale yellow color.