Chapter 69

Question 1

1. Which client is at greatest risk for development of a bacterial cystitis?
   a. Older woman not taking estrogen replacement
   b. Older man with mild congestive heart failure
   c. Middle-aged woman who has never been pregnant
   d. Middle-aged man taking cyclophosphamide for cancer therapy

Answer 1

ANS: A
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 using hormone replacement therapy

Question 2

2. A client has a fungal urinary tract infection. Which assessment by the nurse is most helpful?
   a. Palpating and percussing the kidneys and bladder
   b. Assessing medical history and current medical problems
   c. Performing a bladder scan to assess post-void residual
   d. Inquiring about recent travel to foreign countries

Answer 2

ANS: B
Clients who are severely immune compromised or who have diabetes mellitus are more prone to fungal urinary tract infection. The nurse should assess for these factors. A physical examination and a post-void residual may be needed, but not until further information is obtained. Travel to foreign countries probably would not be as important, because even if exposed, the client needs some degree of immune compromise to develop a fungal urinary tract infection.

Question 3

3. The nurse is assessing 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 by the nurse is most appropriate?
   a. Request that the laboratory perform a differential analysis on the white blood cells.
   b. Notify the health care provider and start an IV line for parenteral antibiotics.
   c. Instruct the client to begin straining all urine for renal calculi.
   d. Document the finding in the client’s chart and continue to monitor.

Answer 3

ANS: B
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 client would not need to strain urine for stones, and because sepsis carries a high mortality rate, the nurse should not just note the findings as the only action.

Question 4

4. Which client statement indicates a good understanding regarding antibiotic therapy for recurrent urinary tract infections?
   a. “If my urine becomes lighter and clearer, I can stop taking my medicine.”
   b. “Even if I feel completely well, I should take the medication until it is gone.”
   c. “When my urine no longer burns, I will no longer need to take the antibiotics.”
   d. “If I have a fever higher than 100° F (37.8° C), I should take twice as much medicine.”

Answer 4

ANS: B
Antibiotic therapy is most effective, especially for recurrent urinary tract infections, when the client takes the prescribed medication for the entire course, not just when symptoms are present. The other statements demonstrate that additional teaching is needed for the client.

Question 5

5. A postmenopausal female client has had two episodes of bacterial urethritis in the last 6 months. She asks her nurse why this is happening to her now. Which is the nurse’s best response?
   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 infection.”

Answer 5

ANS: B
Low estrogen levels decrease moisture and the types of 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 (STDs) 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.

Question 6

6. 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.

Answer 6

ANS: 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.

Question 7

7. A client with severe bacterial cystitis is prescribed cefadroxil (Duricef) and phenazopyridine (Pyridium). What statement by the client indicates an accurate understanding of these medications?
   a. “I will not take these drugs with food or milk.”
   b. “I will stop these drugs if I think I am pregnant.”
   c. “An orange color in my urine won’t alarm me.”
   d. “I will try to drink a liter of cranberry juice daily.”

Answer 7

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.

Question 8

8. Which statement made by a client with stress incontinence indicates a need for clarification of nutrition therapy?
   a. “I will limit my total intake of fluids.”
   b. “I will avoid drinking alcoholic beverages.”
   c. “I will avoid drinking caffeinated beverages.”
   d. “I will try to lose about 10% of my body weight.”

Answer 8

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.

Question 9

9. The nurse is working in an incontinence clinic and sees older clients. The nurse plans a habit training program for the client with which condition?
   a. Confusion
   b. Diabetes
   c. Early kidney failure
   d. Arthritis

Answer 9

ANS: A
For a bladder training program to succeed in 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.

Question 10

10. The nurse is working in a long-term care facility where many clients use habit training to manage incontinence. Which action by unlicensed assistive personnel (UAP) requires intervention by the nurse?
    a. Toileting clients after meals
    b. Changing incontinence briefs when wet
    c. Encouraging clients to drink fluids
    d. Recording incontinence episodes

Answer 10

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 other actions by the UAP are appropriate.

Question 11

11. A client has overflow incontinence. Which intervention does the nurse add to this client’s care plan to assist with elimination?
    a. Stroking the medial aspect of the thigh
    b. Using intermittent catheterization
    c. Providing digital anal stimulation
    d. Using the Valsalva maneuver

Answer 11

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.

Question 12

12. The caretaker of a confused client with functional incontinence asks about having an in-dwelling catheter placed. Which is the nurse’s best response?
    a. “You must be very aggravated about this situation. I will call the provider with this request.”
    b. “I will teach you how to insert the catheter, which should be used just at night.”
    c. “We can teach you how to perform intermittent catheterization to drain the bladder.”
    d. “Because the client is confused, we need to place priority on keeping the skin clean and dry.”

Answer 12

ANS: D
In-dwelling catheters are used only as a last resort because of the risk for ascending urinary tract infection and sepsis. The use of containment pads should be attempted as a means of controlling wetness first. If the client has skin breakdown, an in-dwelling catheter can be placed temporarily until the area has healed. But for a client with cognitive impairment, continence probably cannot be achieved, so the focus turns to maintaining skin integrity.

Question 13

13. A confused client is hospitalized for possible pneumonia and is admitted from the emergency department with an indwelling catheter in place. During interdisciplinary rounds the following day, what question by the nurse takes priority?
    a. “Do you want daily weights on this client?”
    b. “Will the client be able to return home?”
    c. “Can we discontinue the in-dwelling catheter?”
    d. “Should we get another chest x-ray today?”

Answer 13

ANS: C
An in-dwelling 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.

Question 14

14. A client has a history of renal calculi. Which statement by the client indicates a good understanding of preventive measures?
    a. “I know I should drink at least 3 to 4 liters of fluid every day.”
    b. “I can’t eat much dairy or other sources of calcium.”
    c. “Aspirin and aspirin-containing products can lead to stones.”
    d. “The doctor will give me antibiotics at the first sign of a stone.”

Answer 14

ANS: A
Dehydration contributes to the precipitation of minerals to form a stone. Ingestion of calcium or aspirin does not cause a stone. Antibiotics neither prevent nor treat a stone.

Question 15

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

Answer 15

ANS: D
Stones caused by secondary hyperoxaluria respond to allopurinol (Zyloprim). Pyridium is given to clients with urinary tract infections (UTIs). Pro-Banthine is an anticholinergic. Detrol and Detrol-LA are anticholinergics with smooth muscle relaxant properties.

Question 16

16. A client with a renal calculus has just returned from an extracorporeal shock wave lithotripsy procedure, and the nurse finds an ecchymotic area on the client’s right lower back. Which is the nurse’s priority intervention?
    a. Notify the health care provider.
    b. Apply ice to the site.
    c. Place the client in the prone position.
    d. Document the observation in the chart.

Answer 16

ANS: B
The shock waves can cause bleeding into the tissues through which the waves pass. Application of ice can reduce the extent and discomfort of the bruising.

Question 17

17. A client has been admitted from a nursing home for a workup to determine the cause of several recent falls. What intervention by the nurse takes priority?
    a. Obtain a clean catch or catheterized urine specimen.
    b. Document the number of and causative factors for falls.
    c. Review the results of recent laboratory work for kidney function.
    d. Facilitate neurologic and social work consultations.

Answer 17

ANS: A
Although all interventions are or might be important, obtaining a urine sample for urinalysis takes priority. Often UTI symptoms in older adults are atypical, and a UTI may present with new onset of confusion or of falling.

Question 18

18. A client who has undergone a nephrolithotomy procedure 24 hours ago now has a fever of 101° F (38.3° C). What is the nurse’s priority intervention?
    a. Apply a cooling blanket.
    b. Strain the client’s urine.
    c. Notify the health care provider.
    d. Document the finding in the client’s chart.

Answer 18

ANS: C
The elevated temperature indicates a possible infection. Treatment must be initiated as soon as possible to prevent septic complications. The nurse needs to notify the provider so that appropriate diagnostic studies and treatment can be started. The temperature is not high enough to warrant a cooling blanket, and straining the urine will not help find a cause for the fever.

Question 19

19. Which personal factor places a client at risk for bladder cancer?
    a. Working in a lumber yard for 10 years
    b. 50-pack-year cigarette smoking history
    c. Numerous episodes of bacterial cystitis
    d. History of sexually transmitted diseases

Answer 19

ANS: B
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.

Question 20

20. A client with bladder cancer is scheduled to have intravesical chemotherapy. Which statement made by the client indicates correct understanding of this therapy?
    a. “My hair will start growing back in 3 to 6 weeks after chemotherapy is over.”
    b. “My white blood cell count will drop and I will be at increased risk for infection.”
    c. “This type of chemotherapy is used when no distant metastases are present.”
    d. “Chemotherapy only controls cancer, so I will also need radiation.”

Answer 20

ANS: C
Intravesical chemotherapy is used when the tumor has not metastasized. Once metastasis has occurred, systemic chemotherapy and radiation may be used after surgery. The other statements are not accurate.

Question 21

21. A client with bladder cancer has undergone a complete cystectomy with ileal conduit. Four hours after the surgery, the nurse observes the stoma to be cyanotic. Which is the nurse’s priority action?
    a. Reassess in 2 hours.
    b. Loosen the dressing.
    c. Notify the surgeon.
    d. Apply oxygen.

Answer 21

ANS: C

A pale or cyanotic stoma indicates impaired circulation to the stoma and must be treated to prevent necrosis.

Question 22

22. Which is an initial priority intervention for a client with stress incontinence?
    a. Beginning medication and dietary teaching
    b. Referring the client to an incontinence clinic
    c. Assisting the client in finding absorbent pads
    d. Instructing the client to maintain an incontinence diary

Answer 22

ANS: D
Maintaining a diary detailing times of urine leakage, activities, and foods eaten will aid in the diagnostic process by showing whether a connection can be made between specific factors that seem to trigger the incontinence episodes. Use of medication or absorbent pads or referral to a specialty clinic may be used as part of the treatment plan at some point, but an accurate assessment needs to occur first.

Question 23

23. A client presents with senile dementia, Alzheimer’s type (SDAT), and incontinence. Which therapy will best help this client?
    a. Bladder training
    b. Habit training
    c. Exercise therapy
    d. Electrical stimulation

Answer 23

ANS: B
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. Exercise therapy may be too difficult for the cognitively impaired client to grasp, and electrical stimulation will be traumatic for this client.

Question 24

24. A client is being admitted with a suspected diagnosis of bladder cancer. Which question assists the nurse in determining risk factors?
    a. “Do you smoke cigarettes?”
    b. “Do you use alcohol?”
    c. “Do you use recreational drugs?”
    d. “Do you take any prescription drugs?”

Answer 24

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

Question 25

25. A client is scheduled to undergo the surgical creation of an ileal conduit. He expresses his anxiety and fear regarding the procedure. Which is an appropriate response from the nurse?
    a. “Do you think something for your nerves would be helpful?”
    b. “Would you like to discuss the procedure with your doctor once more?”
    c. “Are you ready for your sleeping medication now?”
    d. “Would you like to speak with someone who has an ileal conduit?”

Answer 25

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. Medications for anxiety or sleep will not promote this, nor will discussing the procedure once more with the physician. However, discussing the procedure candidly with a former client will foster such feelings, especially when the current client has an opportunity to ask questions and voice concerns to someone with first-hand knowledge of the procedure.

Question 26

26. A client is receiving treatment with levofloxacin (Levaquin). Which teaching topics does the nurse include in this client’s care plan?
    a. How to assess blood pressure
    b. How to assess a radial pulse
    c. How to assess a carotid pulse
    d. How to assess respirations

Answer 26

ANS:	B
The client should assess his or her own radial pulse at least twice daily because this class of drugs can induce serious cardiac dysrhythmias. Assessment of blood pressure and respirations will not allow the client to detect these cardiac side effects. The easiest place to find a pulse is at the radial site.

Question 27

27. A young woman is being treated with amoxicillin (Amoxil) for a urinary tract infection. Which is the highest priority instruction for the nurse to give this client?
    a. “Use a second form of birth control while on the drug.”
    b. “You will experience increased menstrual bleeding while on this drug.”
    c. “You may experience an irregular heartbeat while on the drug.”
    d. “Watch for blood in your urine while taking this drug.”

Answer 27

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.

Question 28

28. A client is receiving treatment with liquid nitrofurantoin (Furadantin). Which is the highest priority instruction that the nurse can provide to this client regarding accurate administration of the medication?
    a. “The medication should be mixed with cold water before drinking it.”
    b. “Urine will turn orange immediately after you swallow the drug.”
    c. “You should ask the pharmacist for a syringe to measure the dose.”
    d. “The drug is available in granules that must be dissolved.”

Answer 28

ANS: C
Nitrofurantoin is available in a suspension that must be measured accurately for the correct dose. Common household spoons are not accurate for this task, and the client should request a syringe from the pharmacist. The medication does not have to be mixed before taking, and it will not discolor the urine. The drug is not available in granules that are dissolved.

Question 29

29. A client is receiving acetohydroxamic acid (Lithostat). Which statement by the client indicates a good understanding of this therapy?
    a. “I should finish this antibiotic even if I am feeling better.”
    b. “I need to drink a full glass of water when I take this drug.”
    c. “My blood will be drawn occasionally for kidney function tests.”
    d. “This medication may turn my urine bright orange and stain my clothes.”

Answer 29

ANS: C
Lithostat is used as long-term therapy with clients who have struvite stones. Lithostat prevents bacteria from splitting urea. Clients receiving Lithostat must have their serum creatinine monitored during therapy. The other statements are not accurate.

Question 30

30. Which type of incontinence is most common after a difficult vaginal delivery?
    a. Stress
    b. Urge
    c. Reflex
    d. Overflow

Answer 30

ANS: A
Childbirth is most likely to result in stress incontinence. No evidence indicates that childbirth is likely to result in the development of urge, reflex, or overflow incontinence.

Question 31

31. A client has functional urinary incontinence. Which instruction by the nurse to the client and family helps meet an expected outcome for this condition?
    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.”

Answer 31

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.

Question 32

32. A client in the emergency department reports extreme dry mouth, constipation, and an inability to void. The client’s history includes incontinence. Which question by the nurse is most important?
    a. “Are you drinking plenty of water?”
    b. “Do you take anticholinergic medication?”
    c. “Have you tried laxatives or enemas?”
    d. “Has this type of thing ever happened before?”

Answer 32

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 know whether the client is on this type of medication because the client’s symptoms can be a manifestation of a simple side effect or an overdose. The other questions are not as helpful.

Question 33

33. A client is beginning to undergo urinary bladder training. Which is an effective instruction to give this client?
    a. “Use the toilet at the first 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 24 hours.”
    d. “The toileting interval can be increased once you have been continent for 1 week.”

Answer 33

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.

Question 34

1. A client has had two episodes of bacterial cystitis in the last 6 months. Which questions should the nurse ask? (Select all that apply.)
   a. “How much water do you drink every day?”
   b. “Do you take estrogen replacement?”
   c. “Does anyone in your family have a history of cystitis?”
   d. “Do you have any condition that affects your immune system?”
   e. “Are you on steroids or other immune suppressant drugs?”
   f. “Do you drink grapefruit juice every day?”

Answer 34

ANS: A, B, D, E
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 juice, has been found to increase the acidic pH and reduce the risk for bacterial cystitis.

Question 35

2. The nurse is teaching a client about self-catheterization in the home setting. Which instructions are applicable? (Select all that apply.)
   a. “Wash your hands before and after self-catheterization.”
   b. “Use a large-lumen catheter for each catheterization.”
   c. “Use lubricant on the tip of the catheter before insertion.”
   d. “Self-catheterize every 12 hours.”
   e. “Use sterile gloves for the procedure.”
   f. “Maintain a specific schedule for catheterization.”

Answer 35

ANS: A, C, F
The key points in self-catheterization include washing hands, using lubricants, and maintaining a regular schedule to avoid distention and retention of urine that leads to bacterial growth. A smaller rather than a larger lumen catheter is preferred. The client needs to catheterize more often than every 12 hours. Self-catheterization in the home is a clean procedure.

Question 36

3. Which statements about urge incontinence and stress incontinence are true? (Select all that apply.)
   a. Urge incontinence involves a post-voiding residual volume less than 50 mL.
   b. Stress incontinence occurs because of weak pelvic floor muscles.
   c. Stress incontinence usually occurs in people with dementia.
   d. Urge incontinence can be managed by increasing fluid intake.
   e. Urge incontinence occurs because of abnormal bladder contractions.

Answer 36

ANS: B, E
Clients who suffer from stress incontinence have weak pelvic floor muscles or urethral sphincter and cannot tighten their urethra sufficiently to overcome the increased detrusor pressure. Stress incontinence is common after childbirth, when the pelvic muscles are stretched and weakened from pregnancy and delivery. Urge incontinence occurs in people who cannot suppress the contraction signal from the detrusor muscle. Abnormal detrusor contractions may be a result of neurologic abnormalities or may occur with no known abnormality.

Question 37

Which client with an indwelling urinary catheter does a nurse re-assess to determine whether the catheterization needs to be continued or can be discontinued? Select all that apply.

a. Three-day postoperative client
b. Client in the step-down unit
c. Comatose client with careful monitoring of intake and output (I&O)
d. Incontinent client with perineal skin breakdown
e. Incontinent long-term care older adult

Answer 37

Ans: A, B, E

Question 38

Which nursing activity illustrates proper aseptic technique during catheter care?

a. Applying Betadine ointment to the perineal area after catheterization
b. Irrigating the catheter daily
c. Positioning the collection bag below the height of the bladder
d. Sending a urine specimen to the laboratory for testing

Answer 38

Ans: C
Keep urine collection bags below the level of the bladder at all times. Elevating the collection bag above the bladder causes reflux of pathogens from the bag into the urinary tract.

Question 39

A nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective?

a. “I must avoid drinking carbonated beverages.”
b. “I need to douche vaginally once a week.”
c. “I should drink 2½ liters of fluid every day.”
d. “I will not drink fluids after 8 PM each evening.”

Answer 39

Ans: C

Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis.

Question 40

A nurse is educating a female about hygiene measures to reduce her risk for urinary tract infection. What does the nurse instruct the client to do?
“Douche-but only once a month.”
“Use only white toilet paper.”
“Wipe from your front to your back.”
“Wipe with the softest toilet paper available.”

Answer 40

“Wipe from your front to your back.” Correct
Correct: Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection.

Question 41

A nurse is teaching a client about pelvic muscle exercises. What information does the nurse include?
“For the best effect, perform all your exercises while you are seated on the toilet.”
“Limit your exercises to 5 minutes twice a day, or you will injure yourself.”
“Results should be visible to you within 72 hours.”
“You know that you are exercising correct muscles if you can stop urine flow in midstream.”

Answer 41

“You know that you are exercising correct muscles if you can stop urine flow in midstream.” Correct
Correct: When the client can start and stop the urine stream, the pelvic muscles are being used.

Question 42

Which interventions are helpful in preventing bladder cancer? Select all that apply.
Drinking 2½ liters of fluid a day
Showering after working with or around chemicals
Stopping the use of tobacco
Using pelvic floor muscle exercises
Wearing a lead apron when working with chemicals
Wearing gloves and a mask when working around chemicals and fumes

Answer 42

• Showering after working with or around chemicals Correct
• Stopping the use of tobacco Correct
• Wearing gloves and a mask when working around chemicals and fumes Correct

Question 43

A nurse is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client’s reproductive body parts?
Children’s terms that are easily understood
Slang words and terms that are heard “socially”
Technical and medical terminology
Words that the client uses

Answer 43

Words that the client uses Correct
Correct: The nurse should use the terms with which the client is most familiar, so there is no chance for the client to misunderstand information. Using the client’s language ensures the comfort level for the client.

Question 44

An older adult woman confides to a nurse, “I am so embarrassed about buying adult diapers for myself.” How does the nurse respond?
“Don’t worry about it. You need them.”
“Shop at night-when stores are less crowded.”
“Tell everyone that they are for your husband.”
“That is tough. What do you think might help?”

Answer 44

“That is tough. What do you think might help?” Correct
Correct: This response acknowledges the client’s concerns and attempts to help the client think of methods to solve her problem.

Question 45

A nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates correct understanding of these procedures?
“If I restrict my oral intake of fluids, the adjustment will be easier.”
“I must go to the restroom more often because my urine will be excreted through my anus.”
“I need to wear loose-fitting pants so the urine can flow into my ostomy bag.”
“I will have to drain my pouch with a catheter.”

Answer 45

“I will have to drain my pouch with a catheter.” Correct
Correct: For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter.

Question 46

Which client with a long-term urinary problem does the nurse refer to community resources and support groups? Select all that apply.
  32-year-old with a cystectomy
  44-year-old with a Kock pouch
  48-year-old with urinary calculi
  78-year-old with urinary incontinence
  80-year-old with dementia

Answer 46

32-year-old with a cystectomy Correct
44-year-old with a Kock pouch Correct
78-year-old with urinary incontinence Correct

Question 47

.
Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients?
Encouraging them to drink fluids
Irrigating all catheters daily with sterile saline
Recommending catheters should be placed in all clients
Re-evaluating periodically the need for indwelling catheters

Answer 47

Re-evaluating periodically the need for indwelling catheters Correct
Correct: Studies have shown that re-evaluating the need for indwelling catheters in clients is the most effective way to prevent UTI in the hospital setting.

Question 48

Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise?
  Functional
  Overflow
  Stress
  Urge

Answer 48

Stress Correct
Correct: Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence.

Question 49

13.
The certified wound, ostomy, continence nurse (CWOCN) or enterostomal therapist (ET) teaches a client who has had a cystectomy about which care principles for the client's post-discharge activities?
  Nutritional and dietary care
  Respiratory care
  Stoma and pouch care
  Wiping from front to back (asepsis)

Answer 49

Stoma and pouch care Correct
Correct: The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms.

Question 50

A nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? Select all that apply.
  Dysuria
  Enuresis
  Frequency
  Nocturia
  Urgency
  Polyuria

Answer 50

Dysuria Correct
Frequency Correct
Nocturia Correct
Urgency Correct

Question 51

15.
A nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences of them. Which client statement shows correct understanding of what the nurse has taught?
“I should be drinking at least 1.5 to 2.5 liters of fluids every day.”
“It is a good idea for me to reduce germs by taking a tub bath daily.”
“Trying to get to the bathroom to urinate every 6 hours is important for me.”
“Urinating 1000 mL on a daily basis is a good amount for me.”

Answer 51

“I should be drinking at least 1.5 to 2.5 liters of fluids every day.” Correct
Correct: To reduce the number of UTIs, clients should be drinking a minimum of 1.5 to 2.5 liters of fluid (mostly water) each day.

Question 52

A nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification?
“A small-lumen catheter will help prevent injury to my urethra.”
“I will use a new, sterile catheter each time I do the procedure.”
“My family members can be taught to help me if I need it.”
“Proper handwashing before I start the procedure is very important.”

Answer 52

“I will use a new, sterile catheter each time I do the procedure.” Correct
Correct: Catheters are cleaned and re-used. Proper handwashing and cleaning of the catheter have shown no increase in bacterial complications. Catheters are replaced when they show signs of deteriorating.

Question 53

A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instructions does the nurse provide for postprocedure home care?
“After 12 hours, your toilet should be cleaned with a 10% solution of bleach.”
“Do not share your toilet with family members for the next 24 hours.”
“Please be sure to stand when you are urinating.”
“Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded.”

Answer 53

“Do not share your toilet with family members for the next 24 hours.” Correct
Correct: The toilet should not be shared for 24 hours following the procedure because others using the toilet could be infected with the live virus that was instilled into the client. If the toilet must be shared, then specific cleaning precautions need to be taken each time the client uses the toilet. The best scenario is for the client not to share the toilet.

Question 54

Which client does the nurse manager on a medical unit assign to an experienced LPN/LVN?
42-year-old with painless hematuria who needs an admission assessment
46-year-old scheduled for cystectomy who needs help in selecting a stoma site
48-year-old receiving intravesical chemotherapy for bladder cancer
55-year-old with incontinence who has intermittent catheterization prescribed

Answer 54

55-year-old with incontinence who has intermittent catheterization prescribed Correct
Correct: Insertion of catheters is within the education and legal scope of practice for LPNs/LVNs.

Question 55

A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection (UTI). Which nursing action can the home health RN delegate to a home health aide (unlicensed assistive personnel [UAP])?
Assisting the client in developing a schedule for when to take prescribed antibiotics
Inserting a straight catheter as necessary if the client is unable to empty the bladder
Teaching the client how to use the Credé maneuver to empty the bladder more fully
Using a bladder scanner (with training) to check residual bladder volume after the client voids

Answer 55

Using a bladder scanner (with training) to check residual bladder volume after the client voids Correct
Correct: Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (UAP) who has been trained and evaluated in this skill.

Question 56

A client who is admitted with urolithiasis reports “spasms of intense flank pain, nausea, and severe dizziness.” Which intervention does the nurse implement first?
Administers morphine sulfate 4 mg IV
Begins an infusion of metoclopramide (Reglan) 10 mg IV
Obtains a urine specimen for urinalysis
Starts an infusion of 0.9% normal saline at 100 mL/hr

Answer 56

Administers morphine sulfate 4 mg IV Correct
Correct: Morphine administered IV will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension.

Question 57

A nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first?
26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C)
28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours
32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy
40-year-old with noninfectious urethritis who is reporting “burning” and has estrogen cream prescribed

Answer 57

28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours Correct
Correct: Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client may be oversedated and may not be aware of any discomfort caused by bladder distention.

Question 58

A cognitively impaired client has urge incontinence. Which method for achieving continence does a nurse include in the client's care plan?
  Bladder training
  Credé method
  Habit training
  Kegel exercises

Answer 58

Habit training Correct
Correct: Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis.

Question 59

A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins?
“Blood in my urine has become less noticeable; maybe I don’t need this procedure.”
“I have been taking cephalexin (Keflex) for an infection.”
“I previously had several ESWL procedures performed.”
“I take over-the-counter naproxen (Aleve) twice a day for joint pain.”

Answer 59

“I take over-the-counter naproxen (Aleve) twice a day for joint pain.” Correct
Correct: Because a high risk for bleeding during ESWL has been noted, clients should not take NSAIDs before this procedure. The ESWL will have to be rescheduled for this client.

Question 60

A client who is 6 months pregnant comes to the Prenatal Clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this client?
Discharges the client to her home for strict bedrest for the duration of the pregnancy
Instructs the client to drink a minimum of 3 liters of fluids, especially water, every day to “flush out” bacteria
Recommends that the client refrain from having sexual intercourse until after she has delivered her baby
Refers the client to the Clinic Nurse Practitioner (CNP) for immediate follow-up

Answer 60

Refers the client to the Clinic Nurse Practitioner (CNP) for immediate follow-up Correct
Correct: Pregnant women with UTI require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor-with adverse effects for the fetus.

Question 61

Situation: A 53-year-old postmenopausal woman reports “leaking urine” when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her stress incontinence?
“They can relieve your anxiety associated with incontinence.”
“They help your bladder to empty.”
“They may be used to improve urethral resistance.”
“They decrease your bladder’s tone.”

Answer 61

“They may be used to improve urethral resistance.” Correct

Correct: Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance.

Question 62

Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. Which drug does the nurse expect the health care provider to prescribe?
  Nitrofurantoin after intercourse
  Premarin
  Trimethoprim/sulfamethoxazole
  Trimethoprim with intercourse

Answer 62

Trimethoprim/sulfamethoxazole Correct
Correct: Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole or fosfomycin is effective in treating uncomplicated, community-acquired UTI in women.

Question 63

Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. She is started on antibiotics and sent home. She returns to the clinic 3 days later-with the same symptoms. When asked about the previous UTI and medication regimen, she states, “I only took the first dose because after that, I felt better.” How does the nurse respond?
“Not completing your medication can lead to return of your infection.”
“That means your treatment will be prolonged with this new infection.”
“This means you will now have to take two drugs instead of one.”
“What you did was okay; however, let’s get you started on something else.”

Answer 63

“Not completing your medication can lead to return of your infection.” Correct
Correct: Not completing the drug regimen can lead to recurrence of an infection and to bacterial drug resistance.

Question 64

Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence. The health care provider prescribes the drug, estrogen (Premarin). Which risks does the nurse tell the client to expect? Select all that apply.
  Dry mouth
  Endometrial cancer
  Increased intraocular pressure
  Thrombophlebitis
  Vaginitis

Answer 64

Endometrial cancer Correct

Thrombophlebitis Correct

Question 65

Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence and is started on propantheline (Pro-Banthine). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? Select all that apply.
  Administer the drug at bedtime.
  Encourage increased fluids.
  Increase fiber.
  Limit the intake of dairy products.
  Offer hard candy for "dry" mouth.

Answer 65

Encourage increased fluids. Correct
Increase fiber. Correct
Offer hard candy for “dry” mouth. Correct

Question 66

Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. What information does a nurse provide to this client about taking her prescribed trimethoprim/sulfamethoxazole (Bactrim)? Select all that apply.
“Be certain to wear sunscreen and protective clothing.”
“Drink at least 3 liters of fluids every day.”
“Take this drug with 8 ounces of water.”
“Try to urinate frequently to keep your bladder empty.”
“You will need to take all of this drug to get the benefits.”

Answer 66

“Be certain to wear sunscreen and protective clothing.” Correct
“Drink at least 3 liters of fluids every day.” Correct
“Take this drug with 8 ounces of water.” Correct
“You will need to take all of this drug to get the benefits.” Correct

Question 67

A nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by a health care provider, for a client with a urinary tract infection (UTI) does the nurse question?
  Bactrim
  Cipro
  Noroxin
  Tegretol

Answer 67

Tegretol Correct
Correct: Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs Tequin and Tegretol. The former is used for UTI, and the latter is prescribed as an oral anticonvulsant.

Question 68

A health care provider requests phenazopyridine (Pyridium) for a client with cystitis. What does the nurse tell the client about the drug?
“It will act as an antibacterial drug.”
“This drug will treat your infection, not the symptoms of it.”
“You need to take the drug on an empty stomach.”
“Your urine will turn red or orange while on the drug.”

Answer 68

“Your urine will turn red or orange while on the drug.” Correct
Correct: Phenazopyridine (Pyridium) will turn the client’s urine red or orange. Care should be taken because it will stain undergarments. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed.