Urinary System Disorders | NCLEX Quiz 122

1.

A male client comes to the emergency department complaining of sudden onset of sharp. severe pain in the lumbar region. which radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale. diaphoretic. and anxious. The physician tentatively diagnosed renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site?

A.

Kidney
B.

Ureter
C.

Bladder
D.

Urethra

Correct Answer
A. Kidney

Explanation
The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and may lodge anywhere along the tract or may stay within the kidney.Options B. C. and D: The ureter. bladder. and urethra are less common sites of renal calculi formation.

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2.

A female client with acute renal failure is undergoing dialysis for the first time. The nurse in charge monitors the client closely for dialysis equilibrium syndrome. a complication that is most common during the first few dialysis sessions. Typically. dialysis equilibrium syndrome causes:

A.

Confusion. headache. and seizures.
B.

Acute bone pain and confusion.
C.

Weakness. tingling. and cardiac arrhythmias.
D.

Hypotension. tachycardia. and tachypnea.

Correct Answer
A. Confusion. headache. and seizures.

Explanation
Dialysis equilibrium syndrome causes confusion. a decreasing level of consciousness. headache. and seizures. These findings. which may last several days. probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiologic functions. To prevent this syndrome. many dialysis centers keep first-time sessions short and use a reduced blood flow rate.Option B: Acute bone pain and confusion are associated with aluminum intoxication. another potential complication of dialysis.Option C: Weakness. tingling. and cardiac arrhythmias suggest hyperkalemia. which is associated with renal failure.Option D: Hypotension. tachycardia. and tachypnea signal hemorrhage. another dialysis complication.

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3.

Dr. Grey prescribes norfloxacin (Noroxin). 400 mg P.O. twice daily. for a client with a urinary tract infection (UTI). The client asks the nurse how long to continue taking the drug. For an uncomplicated UTI. the usual duration of norfloxacin therapy is:

A.

3 to 5 days.
B.

7 to 10 days.
C.

12 to 14 days.
D.

10 to 21 days.

Correct Answer
B. 7 to 10 days.

Explanation
For an uncomplicated UTI. norfloxacin therapy usually lasts 7 to 10 days. Taking the drug for less than 7 days wouldn’t eradicate such an infection. Taking it for more than 10 days isn’t necessary.Option D: Only a client with a complicated UTI must take norfloxacin for 10 to 21 days.

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4.

Nurse Harry is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure. an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra–high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:

A.

Limit oral fluid intake for 1 to 2 weeks.
B.

Report the presence of fine. sand-like particles through the nephrostomy tube.
C.

Notify the physician about cloudy or foul-smelling urine.
D.

Report bright pink urine within 24 hours after the procedure.

Correct Answer
C. Notify the physician about cloudy or foul-smelling urine.

Explanation
The client should report the presence of foul-smelling or cloudy urine.Option A: Unless contraindicated. the client should be instructed to drink large quantities of fluid each day to flush the kidneys.Option B: Sand-like debris is normal due to residual stone products.Option D: Hematuria is common after lithotripsy.

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5.

A client is frustrated and embarrassed by urinary incontinence. Which of the following measures should Nurse Ginny include in a bladder retraining program?

A.

Establishing a predetermined fluid intake pattern for the client
B.

Encouraging the client to increase the time between voidings
C.

Restricting fluid intake to reduce the need to void
D.

Assessing present elimination patterns

Correct Answer
D. Assessing present elimination patterns

Explanation
The guidelines for initiating bladder retraining include assessing the client’s intake patterns. voiding patterns. and reasons for each accidental voiding.Option A: Lowering the client’s fluid intake won’t reduce or prevent incontinence.Option B: A voiding schedule should be established after assessment.Option C: The client should actually be encouraged to drink 1.5 to 2 L of water per day.

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6.

After having transurethral resection of the prostate (TURP). a Mr. Lim returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client’s catheter is occluded?

A.

The urine in the drainage bag appears red to pink.
B.

The client reports bladder spasms and the urge to void.
C.

The normal saline irrigant is infusing at a rate of 50 drops/minute.
D.

About 1.000 ml of irrigant have been instilled; 1.200 ml of drainage have been returned.

Correct Answer
B. The client reports bladder spasms and the urge to void.

Explanation
Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter.Option A: After TURP. urine normally appears red to pink.Option C: The normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility protocol.Option D: The amount of retained fluid (1.200 ml) should correspond to the amount of instilled fluid. plus the client’s urine output (1.000 ml + 200 ml). which reflects catheter patency.

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7.

Nurse Mary is inserting a urinary catheter into a client who is extremely anxious about the procedure. The nurse can facilitate the insertion by asking the client to:

A.

Initiate a stream of urine.
B.

Breathe deeply.
C.

Turn to the side.
D.

Hold the labia or shaft of penis.

Correct Answer
B. Breathe deeply.

Explanation
When inserting a urinary catheter. facilitate insertion by asking the client to breathe deeply. Doing this will relax the urinary sphincter.Option A: Initiating a stream of urine isn’t recommended during catheter insertion.Options C and D: Turning to the side or holding the labia or penis won’t ease insertion. and doing so may contaminate the sterile field.

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8.

Nurse Pete is reviewing the report of a client’s routine urinalysis. Which value should the nurse consider abnormal?

A.

Specific gravity of 1.03
B.

Urine pH of 3.0
C.

Absence of protein
D.

Absence of glucose

Correct Answer
D. Absence of glucose

Explanation
ARF. characterized by abrupt loss of kidney function. commonly causes oliguria. which is demonstrated by a urine output of 400 ml/24 hours.Options A and C: BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn’t result from this disorder.Option B: A serum creatinine level of 1.2 mg/dl isn’t diagnostic of ARF.

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9.

A 55-year old client with benign prostatic hyperplasia doesn’t respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client. Nurse Gerry asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal?

A.

Transurethral resection of the prostate (TURP)
B.

Suprapubic prostatectomy
C.

Retropubic prostatectomy
D.

Transurethral laser incision of the prostate

Correct Answer
A. Transurethral resection of the prostate (TURP)

Explanation
TURP is the most widely used procedure for prostate gland removal. Because it requires no incision. TURP is especially suitable for men with relatively minor prostatic enlargements and for those who are poor surgical risks.Options B. C. and D: Suprapubic prostatectomy. retropubic prostatectomy. and transurethral laser incision of the prostate are less common procedures; they all require an incision.

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10.

A female client with suspected renal dysfunction is scheduled for excretory urography. Nurse January reviews the history for conditions that may warrant changes in client preparation. Normally. a client should be mildly hypovolemic (fluid depleted) before excretory urography. Which history finding would call for the client to be well hydrated instead?

A.

Cystic fibrosis
B.

Multiple myeloma
C.

Gout
D.

Myasthenia gravis

Correct Answer
B. Multiple myeloma

Explanation
Fluid depletion before excretory urography is contraindicated in clients with multiple myeloma. severe diabetes mellitus. and uric acid nephropathy — conditions that can seriously compromise renal function in fluid-depleted clients with reduced renal perfusion. If these clients must undergo excretory urography. they should be well hydrated before the test.Options A. C. and D: Cystic fibrosis. gout. and myasthenia gravis don’t necessitate changes in client preparation for excretory urography.

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