Urinary System Disorders | NCLEX Quiz 112

1. The nurse is preparing to care for the client following a renal scan. Which of the following would the nurse include in the plan of care?

Place the client on radiation precautions for 18 hours

Save all urine in a radiation safe container for 18 hours

Limit contact with the client to 20 minutes per hour.

No special precautions except to wear gloves if in contact with the client’s urine.

No specific precautions are necessary following a renal scan. Urination into a commode is acceptable without risk from the small amount of radioactive material to be excreted. The nurse wears gloves to maintain body secretion precautions.

Explanation

No specific precautions are necessary following a renal scan. Urination into a commode is acceptable without risk from the small amount of radioactive material to be excreted. The nurse wears gloves to maintain body secretion precautions.

2. A client has passed a renal calculus. The nurse sends the specimen to the laboratory so it can be analyzed for which of the following factors?

Antibodies

Type of infection

Composition of calculus

Size and number of calculi

Painless hematuria is the most common clinical finding in bladder cancer. Other symptoms include frequency. dysuria. and urgency. but these are not as common as the hematuria.Options A and D: Suprapubic pain and urinary retention do not occur in bladder cancer.

Explanation

Painless hematuria is the most common clinical finding in bladder cancer. Other symptoms include frequency. dysuria. and urgency. but these are not as common as the hematuria.Options A and D: Suprapubic pain and urinary retention do not occur in bladder cancer.

3. A week after kidney transplantation the client develops a temperature of 101. the blood pressure is elevated. and the kidney is tender. The X-ray results the transplanted kidney is enlarged. Based on these assessment findings. the nurse would suspect which of the following?

Acute rejection

Chronic rejection

Kidney infection

Kidney obstruction

Acute rejection most often occurs in the first two (2) weeks after transplant. Clinical manifestations include fever. malaise. elevated WBC count. acute hypertension. graft tenderness. and manifestations of deteriorating renal function.Option B: Chronic rejection occurs gradually during a period of months to years.Options C and D: Although kidney infection or obstruction can occur. the symptoms presented in the question do not relate specifically to these disorders.

Explanation

Acute rejection most often occurs in the first two (2) weeks after transplant. Clinical manifestations include fever. malaise. elevated WBC count. acute hypertension. graft tenderness. and manifestations of deteriorating renal function.Option B: Chronic rejection occurs gradually during a period of months to years.Options C and D: Although kidney infection or obstruction can occur. the symptoms presented in the question do not relate specifically to these disorders.

4. The client is admitted to the hospital with BPH. and a transurethral resection of the prostate is performed. Four hours after surgery the nurse takes the client's VS and empties the urinary drainage bag. Which of the following assessment findings would indicate the need to notify the physician?

Red bloody urine

Urinary output of 200 ml greater than intake

Blood pressure of 100/50 and pulse 130.

Pain related to bladder spasms.

A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The physician should be notified.Option A: Frank bleeding (arterial or venous) may occur during the first few days after surgery.Option B: Some hematuria is usual for several days after surgery. A urinary output of 200 ml of greater than intake is adequate.Options D: Bladder spasms are expected to occur after surgery.

Explanation

A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The physician should be notified.Option A: Frank bleeding (arterial or venous) may occur during the first few days after surgery.Option B: Some hematuria is usual for several days after surgery. A urinary output of 200 ml of greater than intake is adequate.Options D: Bladder spasms are expected to occur after surgery.

5. The nurse is caring for a client following a kidney transplant. The client develops oliguria. Which of the following would the nurse anticipate to be prescribed as the treatment of oliguria?

Encourage fluid intake

Administration of diuretics

Irrigation of Foley catheter

Restricting fluids

To increase urinary output. diuretics and osmotic agents are considered. The client should be monitored closely because fluid overload can cause hypertension. congestive heart failure. and pulmonary edema.Options A and D: Fluid intake would not be encouraged or restricted.Option C: Irrigation of the Foley catheter will not assist in alleviating this oliguria.

Explanation

To increase urinary output. diuretics and osmotic agents are considered. The client should be monitored closely because fluid overload can cause hypertension. congestive heart failure. and pulmonary edema.Options A and D: Fluid intake would not be encouraged or restricted.Option C: Irrigation of the Foley catheter will not assist in alleviating this oliguria.

6. The client passes a urinary stone. and lab analysis of the stone indicates that it is composed of calcium oxalate. Based on this analysis. which of the following would the nurse specifically include in the dietary instructions?

Increase intake of meat. fish. plums. and cranberries

Avoid citrus fruits and citrus juices

Avoid green. leafy vegetables such as spinach.

Increase intake of dairy products.

Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb. strawberries. chocolate. wheat bran. nuts. beets. and tea.

Explanation

Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb. strawberries. chocolate. wheat bran. nuts. beets. and tea.

7. The client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. A Penrose drain is in place. Which of the following would the nurse include in the client's postoperative care?

Sterile irrigation of the Penrose drain

Frequent dressing changes around the Penrose drain

Weighing the dressings

Maintaining the client’s position on the affected side

Frequent dressing changes around the Penrose drain is required to protect the skin against breakdown from urinary drainage. If urinary drainage is excessive. an ostomy pouch may be placed over the drain to protect the skin.Option A: A Penrose drain is not irrigated.Option C: Weighing the dressings is not necessary.Option D: Placing the client on the affected side will prevent a free flow of urine through the drain.

Explanation

Frequent dressing changes around the Penrose drain is required to protect the skin against breakdown from urinary drainage. If urinary drainage is excessive. an ostomy pouch may be placed over the drain to protect the skin.Option A: A Penrose drain is not irrigated.Option C: Weighing the dressings is not necessary.Option D: Placing the client on the affected side will prevent a free flow of urine through the drain.

8. 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:

Is a temporary procedure that can be reversed later.

Diverts urine into the sigmoid colon. where it is expelled through the rectum.

Conveys urine from the ureters to a stoma opening in the abdomen.

Creates an opening in the bladder that allows urine to drain into an external pouch.

An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected and one end of the segment is closed. The ureters are surgically attached to this segment of the ileum. and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma. The client must wear a pouch to collect the urine that continually flows through the conduit. The bladder is removed during the surgical procedure and the ileal conduit is not reversible.Option B: Diversion of the urine to the sigmoid colon is called a ureter ileosigmoidostomy.Option D: An opening in the bladder that allows urine to drain externally is called a cystostomy.

Explanation

An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected and one end of the segment is closed. The ureters are surgically attached to this segment of the ileum. and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma. The client must wear a pouch to collect the urine that continually flows through the conduit. The bladder is removed during the surgical procedure and the ileal conduit is not reversible.Option B: Diversion of the urine to the sigmoid colon is called a ureter ileosigmoidostomy.Option D: An opening in the bladder that allows urine to drain externally is called a cystostomy.

9. The client with BPH undergoes a transurethral resection of the prostate. Postoperatively. the client is receiving continuous bladder irrigations. The nurse assesses the client for signs of transurethral resection syndrome. Which of the following assessment data would indicate the onset of this syndrome?

Bradycardia and confusion

Tachycardia and diarrhea

Decreased urinary output and bladder spasms

Increased urinary output and anemia

Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure. bradycardia. confusion. disorientation. muscle twitching. visual disturbances. and nausea and vomiting.

Explanation

Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure. bradycardia. confusion. disorientation. muscle twitching. visual disturbances. and nausea and vomiting.

10. After surgery for an ileal conduit. the nurse should closely evaluate the client for the occurrence of which of the following complications related to pelvic surgery?

Peritonitis

Thrombophlebitis

Ascites

Inguinal hernia

After pelvic surgery. there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis.Option A: Peritonitis is a potential complication of any abdominal surgery. not just pelvic surgery.Option C: Ascites is most frequently an indication of liver disease.Option D: Inguinal hernia may be caused by an increase in abdominal pressure or a congenital weakness of the abdominal wall; a ventral hernia occurs at the site of a previous abdominal surgery.

Explanation

After pelvic surgery. there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis.Option A: Peritonitis is a potential complication of any abdominal surgery. not just pelvic surgery.Option C: Ascites is most frequently an indication of liver disease.Option D: Inguinal hernia may be caused by an increase in abdominal pressure or a congenital weakness of the abdominal wall; a ventral hernia occurs at the site of a previous abdominal surgery.