NCLEX Practice Test On Urinary System Disorders

1. The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. Which of the following findings would be most important for the nurse to report to the physician?

Temperature. 99.8

Urine output. 20 ml/hour

Absence of bowel sounds

A 2×2 inch area of serous sanguineous drainage on the flank dressing.

The decrease in urinary output may indicate inadequate renal perfusion and should be reported immediately. Urine output of 30 ml/hour or greater is considered acceptable.Option A: A slight elevation in temperature is expected after surgery.Option C: Peristalsis returns gradually. usually the second or third day after surgery. Bowel sounds will be absent until then.Option D: A small amount of serous sanguineous drainage is to be expected.

Explanation

The decrease in urinary output may indicate inadequate renal perfusion and should be reported immediately. Urine output of 30 ml/hour or greater is considered acceptable.Option A: A slight elevation in temperature is expected after surgery.Option C: Peristalsis returns gradually. usually the second or third day after surgery. Bowel sounds will be absent until then.Option D: A small amount of serous sanguineous drainage is to be expected.

2. The client has a clinic appointment scheduled 10 days after discharge. Which laboratory finding at that time would indicate that allopurinol (Zyloprim) has had a therapeutic effect?

Decreased urinary alkaline phosphatase level

Increased urinary calcium excretion

Increased serum calcium level

Decreased serum uric acid level

By inhibiting uric acid synthesis. allopurinol decreases its excretion. The drug’s effectiveness is assessed by evaluating for a decreased serum uric acid concentration.Options A. B. and C: Allopurinol does not alter the level of alkaline phosphatase. not does it affect urinary calcium excretion or the serum calcium level.

Explanation

By inhibiting uric acid synthesis. allopurinol decreases its excretion. The drug’s effectiveness is assessed by evaluating for a decreased serum uric acid concentration.Options A. B. and C: Allopurinol does not alter the level of alkaline phosphatase. not does it affect urinary calcium excretion or the serum calcium level.

3. Which of the following assessment data would most likely be related to a client's current complaint of stress incontinence?

The client’s intake of 2 to 3 L of fluid per day.

The client’s history of three full-term pregnancies

The client’s age of 45 years

The client’s history of competitive swimming

The history of three pregnancies is most likely the cause of the client’s current episodes of stress incontinence. The client’s fluid intake. age. or history of swimming would not create an increase in intra-abdominal pressure.

Explanation

The history of three pregnancies is most likely the cause of the client’s current episodes of stress incontinence. The client’s fluid intake. age. or history of swimming would not create an increase in intra-abdominal pressure.

4. When developing a plan of care for the client with stress incontinence. the nurse should take into consideration that stress incontinence is best defined as the involuntary loss of urine associated with:

A strong urge to urinate

Overdistention of the bladder

Activities that increase abdominal pressure

Obstruction of the urethra

Stress incontinence is the involuntary loss of urine during such activities as coughing. sneezing. laughing. or physical exertion. These activities increase abdominal and detrusor pressure.Option A: A strong urge to urinate is associated with urge incontinence.Option B: Overdistention of the bladder can lead to overflow incontinence.Option D: Obstruction of the urethra can lead to urinary retention.

Explanation

Stress incontinence is the involuntary loss of urine during such activities as coughing. sneezing. laughing. or physical exertion. These activities increase abdominal and detrusor pressure.Option A: A strong urge to urinate is associated with urge incontinence.Option B: Overdistention of the bladder can lead to overflow incontinence.Option D: Obstruction of the urethra can lead to urinary retention.

5. Because a client's renal stone was found to be composed to 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 modifications?

Milk. apples. tomatoes. and corn

Eggs. spinach. dried peas. and gravy.

Salmon. chicken. caviar. and asparagus

Grapes. corn. cereals. and liver.

Because a high-purine diet contributes to the formation of uric acid. a low-purine diet is advocated. An alkaline ash diet is also advocated because uric acid crystals are more likely to develop in acid urine. Foods that may be eaten as desired in a low-purine diet include milk. all fruits. tomatoes. cereals. and corn. Food allowed on an alkaline ash diet include milk. fruits (except cranberries. plums. and prunes). and vegetables (especially legumes and green vegetables). Gravy. chicken. and liver are high in purine.

Explanation

Because a high-purine diet contributes to the formation of uric acid. a low-purine diet is advocated. An alkaline ash diet is also advocated because uric acid crystals are more likely to develop in acid urine. Foods that may be eaten as desired in a low-purine diet include milk. all fruits. tomatoes. cereals. and corn. Food allowed on an alkaline ash diet include milk. fruits (except cranberries. plums. and prunes). and vegetables (especially legumes and green vegetables). Gravy. chicken. and liver are high in purine.

6. A client has urge incontinence. Which of the following signs and symptoms would the nurse expect to find in this client?

Inability to empty the bladder

Loss of urine when coughing

Involuntary urination with minimal warning

Frequent dribbling of urine

A characteristic of urge incontinence is involuntary urination with little or no warning. Option A: The inability to empty the bladder is urinary retention. Option B: Loss of urine when coughing occurs with stress incontinence. Option D: Frequent dribbling of urine is common in male clients after some types of prostate surgery . Option A: The inability to empty the bladder is urinary retention.Option B: Loss of urine when coughing occurs with stress incontinence.Option D: Frequent dribbling of urine is common in male clients after some types of prostate surgery or may occur in women after the development of a vesicovaginal or ureterovaginal fistula.

Explanation

A characteristic of urge incontinence is involuntary urination with little or no warning. Option A: The inability to empty the bladder is urinary retention. Option B: Loss of urine when coughing occurs with stress incontinence. Option D: Frequent dribbling of urine is common in male clients after some types of prostate surgery . Option A: The inability to empty the bladder is urinary retention.Option B: Loss of urine when coughing occurs with stress incontinence.Option D: Frequent dribbling of urine is common in male clients after some types of prostate surgery or may occur in women after the development of a vesicovaginal or ureterovaginal fistula.

7. A 72-year old male client is brought to the emergency room by his son. The client is extremely uncomfortable and has been unable to void for the past 12 hours. He has known for some time that he has an enlarged prostate but has wanted to avoid surgery. The best method for the nurse to use when assessing for bladder distention in a male client is to check for:

A rounded swelling above the pubis.

Dullness in the lower left quadrant

Rebound tenderness below the symphysis

Urine discharge from the urethral meatus

The best way to assess for a distended bladder in either a male or female client is to check for a rounded swelling above the pubis. The swelling represents the distended bladder rising above the pubis into the abdominal cavity.Option B: Dullness does not indicate a distended bladder.Option C: The client might experience tenderness or pressure above the symphysis.Option D: No urine discharge is expected; the urine flow is blocked by the enlarged prostate.

Explanation

The best way to assess for a distended bladder in either a male or female client is to check for a rounded swelling above the pubis. The swelling represents the distended bladder rising above the pubis into the abdominal cavity.Option B: Dullness does not indicate a distended bladder.Option C: The client might experience tenderness or pressure above the symphysis.Option D: No urine discharge is expected; the urine flow is blocked by the enlarged prostate.

8. The nurse is developing a teaching plan for a client with stress incontinence. Which of the following instructions should be included?

Avoid activities that are stressful and upsetting

Avoid caffeine and alcohol

Do not wear a girdle

Limit physical exertion

Client’s with stress incontinence are encouraged to avoid substances such as caffeine and alcohol which are bladder irritants.Option A: Emotional stressors do not cause stress incontinence. It is caused most commonly be relaxed pelvic musculature.Option C: Wearing Girdles is not contraindicated.Option D: Although clients may be inclined to limit physical exertion to avoid incontinence episodes; they should be encouraged to seek treatment instead of limiting their activities.

Explanation

Client’s with stress incontinence are encouraged to avoid substances such as caffeine and alcohol which are bladder irritants.Option A: Emotional stressors do not cause stress incontinence. It is caused most commonly be relaxed pelvic musculature.Option C: Wearing Girdles is not contraindicated.Option D: Although clients may be inclined to limit physical exertion to avoid incontinence episodes; they should be encouraged to seek treatment instead of limiting their activities.

9. Allopurinol (Zyloprim). 200 mg/day. is prescribed for the client with renal calculi to take home. The nurse should teach the client about which of the following side effects of this medication?

Retinopathy

Maculopapular rash

Nasal congestion

Dizziness

Allopurinol is used to treat renal calculi composed of uric acid. Side effects of allopurinol include drowsiness. maculopapular rash. anemia. abdominal pain. nausea. vomiting. and bone marrow depression. Clients should be instructed to report skin rashes and any unusual bleeding or bruising.Options A. C. and D: Retinopathy. nasal congestion. and dizziness are not side effects of allopurinol.

Explanation

Allopurinol is used to treat renal calculi composed of uric acid. Side effects of allopurinol include drowsiness. maculopapular rash. anemia. abdominal pain. nausea. vomiting. and bone marrow depression. Clients should be instructed to report skin rashes and any unusual bleeding or bruising.Options A. C. and D: Retinopathy. nasal congestion. and dizziness are not side effects of allopurinol.

10. During a client's urinary bladder catheterization. the bladder is emptied gradually. The best rationale for the nurse's action is that completely emptying an overdistended bladder at one time tends to cause:

Renal failure

Abdominal cramping

Possible shock

Atrophy of bladder musculature

Rapid emptying of an overdistended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. Previously. removing no more than 1.000 ml at one time was the standard of practice. but this is no longer thought to be necessary as long as the overdistended bladder is emptied slowly.

Explanation

Rapid emptying of an overdistended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. Previously. removing no more than 1.000 ml at one time was the standard of practice. but this is no longer thought to be necessary as long as the overdistended bladder is emptied slowly.