The Client with Urinary Tract Health Problems
The Client with Cancer of the Bladder
■ The Client with Renal Calculi
■ The Client with Acute Renal Failure
■ The Client with Urinary Tract Infection
■ The Client with Pyelonephritis
■ The Client with Chronic Renal Failure
■ The Client with Urinary Incontinence
■ Managing Care Quality and Safety
■ Answers, Rationales, and Test Taking Strategies
The Client with Cancer of the
Bladder
1. A client has undergone a cystectomy and
an ileal conduit diversion. What should the nurse
incorporate into the discharge instructions? Select
all that apply.
■ 1. Drink at least 3,000 mL of fl uid each day.
■ 2. Minimize daily activities.
■ 3. Keep urine alkaline to prevent urinary tract
infections.
■ 4. Avoid odor-producing foods, such as onions,
fi sh, eggs, and cheese.
■ 5. Wear snug clothing over the stoma to encourage
urine fl ow into the drainage bag.
2. A nurse is caring for a client with an ileal
conduit. When assessing the stoma, which of the
following outcomes are undesirable? Select all that
apply.
■ 1. Dermatitis.
■ 2. Bleeding.
■ 3. Fungal infection.
■ 4. Flow of adhesive solvent into the stoma.
■ 5. Partial obstruction of the stoma from skin
cement.
3. The nurse should assess the client with bladder
cancer for which of the following?
■ 1. Suprapubic pain.
■ 2. Dysuria.
■ 3. Painless hematuria.
■ 4. Urine retention.
4. A client is to have a cystoscopy to rule out
cancer of the bladder. Which of the following indicate
that the client has developed a complication
after the cystoscopy?
■ 1. Dizziness.
■ 2. Chills.
■ 3. Pink-tinged urine.
■ 4. Bladder spasms.
5. If the client develops lower abdominal pain
after a cystoscopy, the nurse should instruct the client
to do which of the following?
■ 1. Apply an ice pack to the pubic area.
■ 2. Massage the abdomen gently.
■ 3. Ambulate as much as possible.
■ 4. Sit in a tub of warm water.
6. A client who has been diagnosed with
bladder cancer is scheduled for an ileal conduit.
Preoperatively, the nurse reinforces the client’s
understanding of the surgical procedure by explaining
that an ileal conduit:
■ 1. Is a temporary procedure that can be reversed
later.
■ 2. Diverts urine into the sigmoid colon, where it
is expelled through the rectum.
■ 3. Conveys urine from the ureters to a stoma
opening on the abdomen.
■ 4. Creates an opening in the bladder that allows
urine to drain into an external pouch.
7. After surgery for an ileal conduit, the nurse
should closely assess the client for the occurrence
of which of the following complications related to
pelvic surgery?
■ 1. Peritonitis.
■ 2. Thrombophlebitis.
■ 3. Ascites.
■ 4. Inguinal hernia.
■ The Client with Cancer of the Bladder
■ The Client with Renal Calculi
■ The Client with Acute Renal Failure
■ The Client with Urinary Tract Infection
■ The Client with Pyelonephritis
■ The Client with Chronic Renal Failure
■ The Client with Urinary Incontinence
■ Managing Care Quality and Safety
■ Answers, Rationales, and Test Taking Strategies
The Client with Urinary Tract Health
9 Problems TEST
502 The Nursing Care of Adults with Medical and Surgical Health Problems
8. The nurse is assessing the urine of a client
who has had an ileal conduit and notes that the
urine is yellow with a moderate amount of mucus.
Based on the data, the nurse should?
■ 1. Change the appliance bag.
■ 2. Notify the physician.
■ 3. Obtain a urine specimen for culture.
■ 4. Encourage a high fl uid intake.
9. When teaching the client to care for an ileal
conduit, the nurse instructs the client to empty the
appliance frequently. Which of the following indicate
that the client is following instructions?
■ 1. The skin around the stoma is red.
■ 2. The urine is a deep yellow.
■ 3. There is no odor present.
■ 4. The seal around the stoma is intact.
10. The nurse should teach the client with an
ileal conduit to prevent urine leakage when changing
the appliance by using which of the following
procedures?
■ 1. Insert a gauze wick into the stoma.
■ 2. Close the opening temporarily with a cellophane
seal.
■ 3. Suction the stoma before changing the appliance.
■ 4. Avoid oral fl uids for several hours before
changing the appliance.
11. The client with an ileal conduit will be using
a reusable appliance at home. The nurse should
teach the client to clean the appliance routinely
with which product?
■ 1. Baking soda.
■ 2. Soap.
■ 3. Hydrogen peroxide.
■ 4. Alcohol.
12. The nurse is evaluating the discharge teaching
for a client who has an ileal conduit. Which of
the following statements indicates that the client has
correctly understood the teaching? Select all that
apply.
■ 1. “If I limit my fl uid intake, I will not have to
empty my ostomy pouch as often.”
■ 2. “I can place an aspirin tablet in my pouch to
decrease odor.”
■ 3. “I can usually keep my ostomy pouch on for 3
to 7 days before changing it.”
■ 4. “I must use a skin barrier to protect my skin
from urine.”
■ 5. “I should empty my ostomy pouch of urine
when it is full.”
13. A client has an ileal conduit. Which of the
following solutions will be useful to help control
odor in the urine collecting bag after it has been
cleaned?
■ 1. Salt water.
■ 2. Vinegar.
■ 3. Ammonia.
■ 4. Bleach.
14. A female client who has a urinary diversion
tells the nurse, “This urinary pouch is embarrassing.
Everyone will know that I’m not normal. I don’t
see how I can go out in public anymore.” The most
appropriate nursing diagnosis for this client is:
■ 1. Anxiety related to the presence of a urinary
diversion.
■ 2. Defi cient knowledge about how to care for the
urinary diversion.
■ 3. Low self-esteem related to feelings of worthlessness.
■ 4. Disturbed body image related to creation of a
urinary diversion.
15. The nurse teaches the client with a urinary
diversion to attach the appliance to a standard urine
collection bag at night. The most important reason
for doing this is to prevent:
■ 1. Urine refl ux into the stoma.
■ 2. Appliance separation.
■ 3. Urine leakage.
■ 4. The need to restrict fl uids.
16. The nurse teaches the client with an ileal
conduit measures to prevent a urinary tract infection.
Which of the following measures would be
most effective?
■ 1. Avoid people with respiratory tract infections.
■ 2. Maintain a daily fl uid intake of 2,000 to 3,000
mL.
■ 3. Use sterile technique to change the appliance.
■ 4. Irrigate the stoma daily.
17. The nurse evaluates the effectiveness of the
client’s postoperative plan of care. Which of the following
would be an expected outcome for a client
with an ileal conduit?
■ 1. The client verbalizes the understanding that
his physical activity must be curtailed.
■ 2. The client states that he will place an aspirin
in the drainage pouch to help control odor.
■ 3. The client demonstrates how to catheterize
the stoma.
■ 4. The client states that he will empty the drainage
pouch frequently throughout the day.
The Client with Urinary Tract Health Problems 503
18. A nurse is planning care for a client who
underwent a percutaneous needle biopsy of the kidney.
What should the nurse plan to do immediately
after the biopsy? Select all that apply.
■ 1. Assess the biopsy site.
■ 2. Take vital signs every hour.
■ 3. Assess urine for hematuria.
■ 4. Place the client in a prone position.
■ 5. Assess the client for chest pain.
The Client with Renal Calculi
19. A client has renal colic due to renal lithiasis.
What is the nurse’s fi rst priority in managing care
for this client?
■ 1. Do not allow the client to ingest fl uids.
■ 2. Encourage the client to drink at least 500 mL
of water each hour.
■ 3. Request the central supply department to
send supplies for straining urine.
■ 4. Administer an opioid analgesic as prescribed.
20. A client is admitted to the hospital with a
diagnosis of renal calculi. The client is experiencing
severe fl ank pain and nausea; the temperature is
100.6° F (38.1° C). Which of the following would be
a priority outcome for this client?
■ 1. Prevention of urinary tract complications.
■ 2. Alleviation of nausea.
■ 3. Alleviation of pain.
■ 4. Maintenance of fl uid and electrolyte balance.
21. The client is scheduled to have a kidney, ureter,
and bladder (KUB) radiograph. To prepare the
client for this procedure, the nurse should explain
to the client that:
■ 1. Fluid and food will be withheld the morning
of the examination.
■ 2. A tranquilizer will be given before the examination.
■ 3. An enema will be given before the examination.
■ 4. No special preparation is required for the
examination.
22. In addition to nausea and severe fl ank pain, a
female client with renal calculi has pain in the groin
and bladder. The nurse should assess the client further
for signs of:
■ 1. Nephritis.
■ 2. Referred pain.
■ 3. Urine retention.
■ 4. Additional stone formation.
23. Which of the following nursing interventions
is likely to provide the most relief from the pain
associated with renal colic?
■ 1. Applying moist heat to the fl ank area.
■ 2. Administering meperidine (Demerol).
■ 3. Encouraging high fl uid intake.
■ 4. Maintaining complete bed rest.
24. A client who has been diagnosed with renal
calculi reports that the pain is intermittent and less
colicky. Which of the following nursing actions is
most important at this time?
■ 1. Report hematuria to the physician.
■ 2. Strain the urine carefully.
■ 3. Administer meperidine (Demerol) every
3 hours.
■ 4. Apply warm compresses to the fl ank area.
25. The client is scheduled for an intravenous
pyelogram (IVP) to determine the location of the
renal calculi. Which of the following measures
would be most important for the nurse to include in
pretest preparation?
■ 1. Ensuring adequate fl uid intake on the day of
the test.
■ 2. Preparing the client for the possibility of bladder
spasms during the test.
■ 3. Checking the client’s history for allergy to
iodine.
■ 4. Determining when the client last had a bowel
movement.
26. After an intravenous pyelogram (IVP), the
nurse should anticipate incorporating which of the
following measures into the client’s plan of care?
■ 1. Maintaining bed rest.
■ 2. Encouraging adequate fl uid intake.
■ 3. Assessing for hematuria.
■ 4. Administering a laxative.
27. A client has a ureteral catheter in place after
renal surgery. A priority nursing action for care of
the ureteral catheter would be to:
■ 1. Irrigate the catheter with 30 mL of normal
saline every 8 hours.
■ 2. Ensure that the catheter is draining freely.
■ 3. Clamp the catheter every 2 hours for 30 minutes.
■ 4. Ensure that the catheter drains at least 30 mL/
hour.
28. Which of the following interventions would
be the most appropriate for preventing the development
of a paralytic ileus in a client who has undergone
renal surgery?
■ 1. Encourage the client to ambulate every 2 to 4
hours.
■ 2. Offer 3 to 4 oz of a carbonated beverage periodically.
■ 3. Encourage use of a stool softener.
■ 4. Continue I.V. fl uid therapy.
29. The nurse is conducting a postoperative
assessment of a client on the fi rst day after renal surgery.
Which of the following fi ndings would be most
important for the nurse to report to the physician?
■ 1. Temperature, 99.8° F (37.7° C).
■ 2. Urine output, 20 mL/hour.
■ 3. Absence of bowel sounds.
■ 4. A 2″ × 2″ area of serosanguineous drainage on
the fl ank dressing.
30. A client with a history of renal calculi formation
is being discharged after surgery to remove
the calculus. What instructions should the nurse
include in the client’s discharge teaching plan?
■ 1. Increase daily fl uid intake to at least 2 to 3 L.
■ 2. Strain urine at home regularly.
■ 3. Eliminate dairy products from the diet.
■ 4. Follow measures to alkalinize the urine.
31. Because a client’s renal stone was found to
be composed of uric acid, a low-purine, alkaline-ash
diet was ordered. Incorporation of which of the following
food items into the home diet would indicate
that the client understands the necessary diet
modifi cations?
■ 1. Milk, apples, tomatoes, and corn.
■ 2. Eggs, spinach, dried peas, and gravy.
■ 3. Salmon, chicken, caviar, and asparagus.
■ 4. Grapes, corn, cereals, and liver.
32. Allopurinol (Zyloprim), 200 mg/day, is
prescribed for the client with renal calculi to take
at home. The nurse should teach the client about
which of the following adverse effects of this medication?
■ 1. Retinopathy.
■ 2. Maculopapular rash.
■ 3. Nasal congestion.
■ 4. Dizziness.
33. A client has been prescribed allopurinol
(Zyloprim) for renal calculi that are caused by high
uric acid levels. Which of the following indicate the
client is experiencing adverse effect(s) of this drug?
Select all that apply.
■ 1. Nausea.
■ 2. Rash.
■ 3. Constipation.
■ 4. Flushed skin.
■ 5. Bone marrow depression.
34. The nurse is reviewing laboratory reports for
a client who is taking allopurinol (Zyloprim). Which
of the following indicate that the drug has had a
therapeutic effect?
■ 1. Decreased urine alkaline phosphatase level.
■ 2. Increased urine calcium excretion.
■ 3. Increased serum calcium level.
■ 4. Decreased serum uric acid level.
The Client with Acute Renal
Failure
35. A client is to receive peritoneal dialysis. To
prepare for the procedure, the nurse should?
■ 1. Assess the dialysis access for a bruit and
thrill.
■ 2. Insert an indwelling urinary catheter and
drain all urine from the bladder.
■ 3. Ask the client to turn toward the left side.
■ 4. Warm the solution in the warmer.
36. A client has been admitted with acute renal
failure. What should the nurse do? Select all that
apply.
■ 1. Elevate the head of the bed 30 to 45 degrees.
■ 2. Take vital signs.
■ 3. Establish an I.V. access site.
■ 4. Call the admitting physician for orders.
■ 5. Contact the hemodialysis unit.
37. Which of the following is the most common
initial manifestation of acute renal failure?
■ 1. Dysuria.
■ 2. Anuria.
■ 3. Hematuria.
■ 4. Oliguria.
38. A client developed shock after a severe
myocardial infarction and has now developed acute
renal failure. The client’s family asks the nurse why
the client has developed acute renal failure. The
nurse should base the response on the knowledge
that there was:
■ 1. A decrease in the blood fl ow through the kidneys.
■ 2. An obstruction of urine fl ow from the kidneys.
■ 3. A blood clot formed in the kidneys.
■ 4. Structural damage to the kidney resulting in
acute tubular necrosis.
39. The client’s blood urea nitrogen (BUN) concentration
is elevated in acute renal failure. What is
the likely cause of this fi nding?
■ 1. Fluid retention.
■ 2. Hemolysis of red blood cells.
■ 3. Below-normal metabolic rate.
■ 4. Reduced renal blood fl ow.
40. The client’s serum potassium level is elevated