NCLEX Genitourinary Disorders

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Quizzes Created: 12 | Total Attempts: 16,792

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1/115 Questions

A nurse 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:
- Initiate a stream of urine.
- Breathe deeply.
- Turn to the side.
- Hold the labia or shaft of the penis.

About This Quiz

The NCLEX Genitourinary Disorder is an exam taken by practitioners who have specialized in the treatment of the urinary and the genital organs. Are you in this line of duty and preparing for the exam? Use this quiz to revise.

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2.

A 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, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal?
- Transurethral resection of the prostate (TURP)
- Suprapubic prostatectomy
- Retropubic prostatectomy
- Transurethral laser incision of the prostate
Correct Answer

A. Transurethral resection of the prostate (TURP)

Explanation

RATIONALE: 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. Suprapubic prostatectomy, retropubic prostatectomy, and transurethral laser incision of the prostate are less common procedures; each requires an incision.

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3.

A nurse is caring for an 8-year-old girl with multiple chronic urinary tract infections. The child's parents appear protective, never leaving their daughter's side. While the nurse helps the child's mother provide morning care, the child states, "My uncle doesn't clean me that way." Her mother becomes visibly upset and gives the girl a stern warning not to discuss the matter. She states, "Don't tell anyone about that again." The nurse has a legal responsibility to:
- Notify the nursing supervisor and the authorities of the possibility of abuse.
- Offer to clean the child the way her uncle does.
- Leave the room so the mother and daughter can have privacy.
- Note on the child's chart that the mother is overprotective.
Correct Answer

A. Notify the nursing supervisor and the authorities of the possibility of abuse.

Explanation

RATIONALE: The nurse has a legal responsibility to report suspected abuse of a child or an elderly person. It's inappropriate to offer to clean the child in the same way as the suspected abuser. Leaving the room doesn't fulfill that responsibility. A chart entry about the parent's behavior reflects the nurse's opinion and isn't based on subjective assessment and objective data.

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4.

A client on the genitourinary floor has refused all medications for 3 days. A nurse caring for this client asks why he isn't complying with his medication. The client states, "I don't want to take those pills anymore." The nurse informs the client that he must take all the medication the physician orders. With this statement, the nurse has violated the:
- Health Insurance Portability and Accountability Act and the client's privacy.
- Client's right to refuse medication.
- Client's advance directive.
- Client's right to accurate medication administration.
Correct Answer

A. Client's right to refuse medication.

Explanation

RATIONALE: The nurse has violated the client's right to refuse medication by telling him that he must take all ordered medication. The nurse hasn't violated client privacy because she didn't share any information. An advance directive states a client's wishes if he's in a terminal condition and can't express them, which doesn't apply at this time. The nurse hasn't violated the client's right to accurate medication administration.

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5
5.

When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?
- The client sets the drainage bag on the floor while sitting down.
- The client keeps the drainage bag below the bladder at all times.
- The client clamps the catheter drainage tubing while visiting with the family.
- The client loops the drainage tubing below its point of entry into the drainage bag.
Correct Answer

A. The client keeps the drainage bag below the bladder at all times.

Explanation

RATIONALE: To maintain effective drainage, the client should keep the drainage bag below the bladder; doing so allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldn't lay the drainage bag on the floor because the bag could become grossly contaminated. The client shouldn't clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the client may loop the drainage tubing above — not below — its point of entry into the drainage bag.

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6.

A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence?
- Encouraging intake of at least 2 L of fluid daily
- Giving the client a glass of soda before bedtime
- Taking the client to the bathroom twice per day
- Consulting with a dietitian
Correct Answer

A. Encouraging intake of at least 2 L of fluid daily

Explanation

RATIONALE: Encouraging a daily fluid intake of at least 2 L helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn't give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won't address the problem of urinary incontinence.

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7.

After undergoing transurethral resection of the prostate to treat benign prostatic hyperplasia, a client returns to the room with continuous bladder irrigation. On the first day after surgery, the client reports bladder pain. What should the nurse do first?
- Increase the I.V. flow rate.
- Notify the physician immediately.
- Assess the irrigation catheter for patency and drainage.
- Administer morphine sulfate, 2 mg I.V., as ordered.
Correct Answer

A. Assess the irrigation catheter for patency and drainage.

Explanation

RATIONALE: Although postoperative pain is expected, the nurse should make sure that other factors, such as an obstructed irrigation catheter, aren't the cause of the pain. After assessing catheter patency, the nurse should administer an analgesic, such as morphine sulfate, as ordered. Increasing the I.V. flow rate may worsen the pain. Notifying the physician isn't necessary unless the pain is severe or unrelieved by the ordered medication.

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8.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
- Water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
- A decreased serum phosphate level secondary to kidney failure.
- An increased serum calcium level secondary to kidney failure.
- Metabolic alkalosis secondary to retention of hydrogen ions.
Correct Answer

A. Water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

Explanation

RATIONALE: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

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9.

An elderly client with a diagnosis of chronic renal failure is being discharged to home with his wife. The home health nurse visits the hospital before discharge to discuss home safety with the client, who reports decreased mobility and a need for greater assistance with activities of daily living. The nurse focuses her home-safety teaching on:
- Having adequate lighting, removing cluttered paths, and using nonskid bathroom surfaces.
- Avoiding unsteady ladders, overloaded electrical outlets, and pesticides.
- Properly storing plastic bags and guns and replacing steps without handrails.
- Replacing defective smoke detectors, storing flammable liquids properly, and repairing steps with broken concrete.
Correct Answer

A. Having adequate lighting, removing cluttered paths, and using nonskid bathroom surfaces.

Explanation

RATIONALE: The home health nurse should focus her safety teaching on factors that promote mobility, such as having adequate lighting, removing cluttered paths, and using nonskid bathroom surfaces. Child safety hazards, such as unsteady ladders, overloaded electrical outlets, and improperly stored plastic bags, guns, flammable liquids, and pesticides aren't applicable to this client. Although factors such as defective smoke detectors and steps with broken concrete or without handrails are important, they aren't the teaching priority at this time.

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10.

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?
- Increased pH with decreased hydrogen ions
- Increased serum levels of potassium, magnesium, and calcium
- Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl
- Uric acid analysis 3.5 mg/dl and phenolsulfonphthalein (PSP) excretion 75%
Correct Answer

A. Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl

Explanation

RATIONALE: The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl. A BUN level of 100 mg/dl and a serum creatinine of 6.5 mg/dl are abnormally elevated results, reflecting CRF and the kidneys' decreased ability to remove nonprotein nitrogen waste from the blood. CRF causes decreased pH and increased hydrogen ions — not vice versa. CRF also increases serum levels of potassium, magnesium, and phosphorous, and decreases serum levels of calcium. A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls within the normal range of 60% to 75%.

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11.

Which client is at highest risk for developing a hospital-acquired infection?
- A client with a laceration to the left hand
- A client who's taking prednisone (Deltasone)
- A client with an indwelling urinary catheter
- A client with Crohn's disease
Correct Answer

A. A client with an indwelling urinary catheter

Explanation

RATIONALE: The invasive nature of an indwelling urinary catheter increases the client's risk of a hospital-acquired infection. The nurse must perform careful, frequent catheter care to minimize the client's risk. Although the client with a laceration, the client who's taking prednisone, and the client with Crohn's disease have a risk of infection, the one with an indwelling catheter is at the greatest risk.

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12.

After having transurethral resection of the prostate (TURP), a client 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?
- The urine in the drainage bag appears red to pink.
- The client reports bladder spasms and the urge to void.
- The normal saline irrigant is infusing at a rate of 50 drops/minute.
- About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned.
Correct Answer

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

Explanation

RATIONALE: Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. After TURP, urine normally appears red to pink, and normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility protocol. The amount of returned 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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13.

A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs." How should the nurse proceed?
- Educate the client about why it's important to inform sexual contacts so they can receive treatment.
- Inform the health department that this client contracted an STD.
- Inform the client's sexual contacts of their possible exposure to chlamydia.
- Do nothing because the client's sexual habits place him at risk for contracting other STDs.
Correct Answer

A. Educate the client about why it's important to inform sexual contacts so they can receive treatment.

Explanation

RATIONALE: The nurse should educate the client about the disease and how it impacts a person's health. Further education allows the client to make an informed decision about notifying sexual contacts. The nurse must maintain client confidentiality unless law mandates reporting the illness; contacting sexual contacts breaches client confidentiality. Doing nothing for the client is judgmental; everyone is entitled to health care regardless of his health habits.

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14.

A nurse is caring for a male client with gonorrhea. The client asks how he can reduce his risk of contracting another sexually transmitted disease (STD). The nurse should instruct the client to:
- Ask all potential sexual partners if they have an STD.
- Wear a condom every time he has intercourse.
- Consider intercourse safe if his partner has no visible discharge, lesions, or rashes.
- Expect to limit the number of sexual partners to less than five over his lifetime.
Correct Answer

A. Wear a condom every time he has intercourse.

Explanation

RATIONALE: Wearing a condom during intercourse considerably reduces the risk of contracting STDs. Asking all potential sexual partners if they have an STD; considering intercourse safe if his partner has no visible discharge, lesions, or rashes; and expecting to limit the number of sexual partners won't reduce the risk of contracting an STD to the extent wearing a condom will. A monogamous relationship also reduces the risk of contracting STDs.

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15.

A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses 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?
- Kidney
- Ureter
- Bladder
- Urethra
Correct Answer

A. Kidney

Explanation

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

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16.

A nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way?
- Fluid intake should be double the urine output.
- Fluid intake should be about equal to the urine output.
- Fluid intake should be half the urine output.
- Fluid intake should be inversely proportional to the urine output.
Correct Answer

A. Fluid intake should be about equal to the urine output.

Explanation

RATIONALE: Normally, fluid intake is about equal to the urine output. Any other relationship signals an abnormality. For example, fluid intake that is double the urine output indicates fluid retention; fluid intake that is half the urine output indicates dehydration. Normally, fluid intake isn't inversely proportional to the urine output.

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17.

A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?
- Keep the AV fistula site dry.
- Keep the AV fistula wrapped in gauze.
- Take the client's blood pressure in the left arm.
- Assess the AV fistula for a bruit and thrill.
Correct Answer

A. Assess the AV fistula for a bruit and thrill.

Explanation

RATIONALE: The nurse needs to assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.

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18.

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?
- Be sure to eat meat at every meal.
- Eat plenty of bananas.
- Increase your carbohydrate intake.
- Drink plenty of fluids, and use a salt substitute.
Correct Answer

A. Increase your carbohydrate intake.

Explanation

RATIONALE: A client with CRF requires extra carbohydrates to prevent protein catabolism. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Salt substitutes are high in potassium and should be avoided.

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19.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?
- Blood glucose level of 200 mg/dl
- White blood cell (WBC) count of 20,000/mm3
- Potassium level of 3.5 mEq/L
- Hematocrit (HCT) of 35%
Correct Answer

A. White blood cell (WBC) count of 20,000/mm3

Explanation

RATIONALE: An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

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20.

A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important?
- Administering a sitz bath twice per day
- Increasing fluid intake to 3 L/day
- Using an indwelling urinary catheter to measure urine output accurately
- Encouraging the client to drink cranberry juice to acidify the urine
Correct Answer

A. Increasing fluid intake to 3 L/day

Explanation

RATIONALE: Acute pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both kidneys. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. Pyelonephritis may result from procedures that involve the use of instruments (such as catheterization, cystoscopy, and urologic surgery) or from hematogenic infection. The most important nursing intervention is to increase fluid intake to 3 L/day. Doing so helps empty the bladder of contaminated urine and prevents calculus formation. Administering a sitz bath would increase the likelihood of fecal contamination. Using an indwelling urinary catheter could cause further contamination. Encouraging the client to drink cranberry juice to acidify urine is helpful but isn't the most important intervention.

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21.

A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point should the nurse include?
- Limit fluid intake to reduce the need to urinate.
- Take medication ordered for a UTI until the symptoms subside.
- Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.
- Wear only nylon underwear to reduce the chance of irritation.
Correct Answer

A. Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.

Explanation

RATIONALE: Urgency, burning, frequency, and difficulty urinating are all common symptoms of a UTI. The client should notify the physician so that a microscopic urinalysis can be done and appropriate treatment can be initiated. The client should be instructed to drink 2 to 3 L of fluid per day to dilute the urine and reduce irritation of the bladder mucosa. To prevent UTI recurrence, the full amount of antibiotics ordered must be taken despite the fact that the symptoms may have subsided. Women are told to avoid scented toilet tissue and bubble baths and to wear cotton underwear, not nylon, to reduce the chance of irritation.

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22.

A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should:
- Keep the client's knee on the affected side bent for 6 hours.
- Apply pressure to the puncture site for 30 minutes.
- Check the client's pedal pulses frequently.
- Remove the dressing on the puncture site after vital signs stabilize.
Correct Answer

A. Check the client's pedal pulses frequently.

Explanation

RATIONALE: After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the client's knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse should leave this dressing in place for several hours — and only remove it if instructed to do so.

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1
23.

During rounds, a client admitted with gross hematuria asks the nurse about the physician's diagnosis. To facilitate effective communication, what should the nurse do?
- Ask why the client is concerned about the diagnosis.
- Change the subject to something more pleasant.
- Provide privacy for the conversation.
- Give the client some good advice.
Correct Answer

A. Provide privacy for the conversation.

Explanation

RATIONALE: Providing privacy for the conversation is a form of active listening, which focuses solely on the client's needs. Asking why the client is concerned, changing the subject, or giving advice tends to block therapeutic communication.

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24.

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?
- Take your temperature every 4 hours.
- Increase your fluid intake to 2 to 3 L per day.
- Apply an antibacterial dressing to the incision daily.
- Be aware that your urine will be cherry-red for 5 to 7 days.
Correct Answer

A. Increase your fluid intake to 2 to 3 L per day.

Explanation

RATIONALE: The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.

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25.

A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?
- Rashes on the palms of the hands and soles of the feet
- Cauliflower-like warts on the penis
- Painful red papules on the shaft of the penis
- Foul-smelling discharge from the penis
Correct Answer

A. Foul-smelling discharge from the penis

Explanation

RATIONALE: Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.

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26.

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:
- Hematuria.
- Weight loss.
- Increased urine output.
- Increased blood pressure.
Correct Answer

A. Weight loss.

Explanation

RATIONALE: Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

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27.

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation?
- Specific gravity of 1.03
- Urine pH of 3.0
- Absence of protein
- Absence of glucose
Correct Answer

A. Urine pH of 3.0

Explanation

RATIONALE: Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal and requires further investigation. Urine specific gravity normally ranges from 1.002 to 1.035, making this client's value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, with color ranging from pale yellow to deep amber.

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28.

A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?
- Tell the client to try to urinate around the catheter to remove blood clots.
- Restrict fluids to prevent the client's bladder from becoming distended.
- Prepare to remove the catheter.
- Use sterile technique when irrigating the catheter.
Correct Answer

A. Use sterile technique when irrigating the catheter.

Explanation

RATIONALE: If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. The nurse should encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is removed only with a physician's order.

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1
29.

After a radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. The client then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first?
- Kegel exercises
- Fluid restriction
- Artificial sphincter use
- Self-catheterization
Correct Answer

A. Kegel exercises

Explanation

RATIONALE: Kegel exercises are noninvasive and are recommended as the initial intervention for incontinence. Fluid restriction is useful for the client with increased detrusor contraction related to acidic urine. Artificial sphincter use isn't a primary intervention for post-prostatectomy incontinence. Self-catheterization may be used as a temporary measure but isn't a primary intervention.

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1
30.

A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans?
- Cottage cheese–like discharge
- Yellow-green discharge
- Gray-white discharge
- Discharge with a fishy odor
Correct Answer

A. Cottage cheese–like discharge

Explanation

RATIONALE: The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of Trichomonas vaginalis. Gray-white discharge and a fishy odor are signs of Gardnerella vaginalis.

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31.

A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution?
- Neutral
- Alkaline
- Acidic
- Basic
Correct Answer

A. Acidic

Explanation

RATIONALE: Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals acidic urine pH. A pH above 7.0 is considered an alkaline or basic solution. A pH of 7.0 is considered neutral.

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32.

A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders diagnostic testing of the vaginal discharge. Which STD must be reported to the public health department?
- Bacterial vaginitis
- Gonorrhea
- Genital herpes
- Human papillomavirus (HPV)
Correct Answer

A. Gonorrhea

Explanation

RATIONALE: Gonorrhea must be reported to the public health department. Bacterial vaginitis, genital herpes, and HPV aren't reportable diseases.

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33.

A nurse is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 6.2 mEq/L. Correct administration and the effects of this enema should include having the client:
- Retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.
- Retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea.
- Retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn't necessary to reduce the potassium level.
- Retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn't necessary to reduce the potassium level.
Correct Answer

A. Retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.

Explanation

RATIONALE: Kayexalate is a sodium-exchange resin. Thus, the client will gain sodium as potassium is lost in the bowel. For the exchange to occur, Kayexalate must be in contact with the bowel for at least 30 minutes. Sorbitol in the Kayexalate enema causes diarrhea, which increases potassium loss and decreases the potential for Kayexalate retention.

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34.

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first?
- Blood pressure
- Respirations
- Temperature
- Pulse
Correct Answer

A. Pulse

Explanation

RATIONALE: An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. In addition to assessing the client's pulse, the nurse should place the client on a cardiac monitor because an arrythmia can occur suddenly. The client's blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also may delay assessing respirations and temperature because these aren't affected by the serum potassium level.

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1
35.

A nurse is caring for a client diagnosed with ovarian cancer. Diagnostic testing reveals that the cancer has spread outside the pelvis. The client has previously undergone a right oophorectomy and received chemotherapy. The client now wants palliative care instead of aggressive therapy. The nurse determines that the care plan's priority nursing diagnosis should be:
- Acute pain
- Impaired home maintenance
- Noncompliance
- Ineffective breast-feeding
Correct Answer

A. Acute pain

Explanation

RATIONALE: Palliative care for the client with advanced cancer includes pain management, emotional support, and comfort measures. The client is in the hospital, so home maintenance doesn't apply at this time. The client has chosen palliative care, so she isn't noncompliant. The client isn't breast-feeding, so the diagnosis of Ineffective breast-feeding doesn't apply.

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36.

A nurse receives her client care assignment. Following the report, she should give priority assessment to the client:
- With pinkish mucus discharge in the appliance bag 2 days after an ileal conduit.
- Who has a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L 7 days after a kidney transplant.
- Who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L.
- Who is experiencing mild pain from urolithiasis.
Correct Answer

A. Who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L.

Explanation

RATIONALE: A sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L in a client immediately following dialysis should be the priority assessment. Pinkish mucus discharge in the appliance bag is a normal finding for a client who's had an ileal conduit, as are a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L in a client who's had a kidney transplant. Although the nurse should further assess mild pain from urolithiasis, this is an expected finding and not a priority in relation to the client with abnormal sodium and potassium levels.

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37.

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about:
- Chronic, excessive acetaminophen use.
- Recent streptococcal infection.
- Childhood asthma.
- Family history of pernicious anemia.
Correct Answer

A. Recent streptococcal infection.

Explanation

RATIONALE: A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction

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1
38.

A female client reports to a nurse that she experiences a loss of urine when she jogs. The nurse's assessment reveals no nocturia, burning, discomfort when voiding, or urine leakage before reaching the bathroom. The nurse explains to the client that this type of problem is called:
- Functional incontinence.
- Reflex incontinence.
- Stress incontinence.
- Total incontinence.
Correct Answer

A. Stress incontinence.

Explanation

RATIONALE: Stress incontinence is a small loss of urine with activities that increase intra-abdominal pressure, such as running, laughing, sneezing, jumping, coughing, and bending. These symptoms occur only in the daytime. Functional incontinence is the inability of a usually continent client to reach the toilet in time to avoid unintentional loss of urine. Reflex incontinence is an involuntary loss of urine at predictable intervals when a specific bladder volume is reached. Total incontinence occurs when a client experiences a continuous and unpredictable loss of urine.

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39.

A physician enters a computer order for a nurse to irrigate a client's nephrostomy tube every 4 hours to maintain patency. The nurse irrigates the tube using sterile technique. After irrigating the tube, the nurse decides that she can safely use the same irrigation set for her 8-hour shift if she covers the set with a paper, sterile drape. This action by the nurse is:
- Appropriate because the irrigation just checks for patency.
- Inappropriate because irrigation requires strict sterile technique.
- Appropriate because the irrigation set will be used only during an 8-hour period.
- Inappropriate because the sterile drape must be cloth, not paper.
Correct Answer

A. Inappropriate because irrigation requires strict sterile technique.

Explanation

RATIONALE: Irrigating a nephrostomy tube requires strict sterile technique; therefore, reusing the irrigation set (even if covered by a sterile drape) is inappropriate. Bacteria can proliferate inside the syringe and irrigation container. Although this procedure checks patency, it requires sterile technique to prevent the introduction of bacteria into the kidney. The material of which the sterile drape is made is irrelevant because a sterile drape doesn't deter bacterial growth in the irrigation equipment.

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40.

A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address?
- I've had diabetes for 4 years.
- I'm allergic to shellfish.
- I haven't eaten since midnight.
- My physician diagnosed me with hypertension 3 months ago.
Correct Answer

A. I'm allergic to shellfish.

Explanation

RATIONALE: An allergy to iodine, shellfish, or other seafood should immediately be investigated because the contrast agent used in the procedure may contain iodine, which can cause a severe allergic reaction. Although contrast agents should be used cautiously in clients with diabetes mellitus, investigating this isn't the nurse's priority if the client also has a shellfish allergy. It's appropriate for the client to not eat after midnight before the procedure. The client's hypertension isn't a priority because this condition is the likely reason the renal angiography was ordered.

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41.

A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is:
- Renal calculi.
- An overdistended bladder.
- Interstitial cystitis.
- Acute prostatitis.
Correct Answer

A. Renal calculi.

Explanation

RATIONALE: Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void. The client with acute prostatitis presents with a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria.

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42.

A client with a urinary tract infection is ordered co-trimoxazole (trimethoprim-sulfamethoxazole). The nurse should provide which medication instruction?
- Take the medication with food.
- Drink at least eight 8-oz glasses of fluid daily.
- Avoid taking antacids during co-trimoxazole therapy.
- Don't be afraid to go out in the sun.
Correct Answer

A. Drink at least eight 8-oz glasses of fluid daily.

Explanation

RATIONALE: The nurse should instruct a client receiving a sulfonamide such as co-trimoxazole to drink at least eight 8-oz glasses of fluid daily to maintain a urine output of at least 1,500 ml/day. Otherwise, inadequate urine output may lead to crystalluria or tubular deposits. For maximum absorption, the client should take this drug at least 1 hour before or 2 hours after meals. No evidence indicates that antacids interfere with the effects of sulfonamides. To prevent a photosensitivity reaction, the client should avoid direct sunlight during co-trimoxazole therapy.

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43.

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes:
- Confusion, headache, and seizures.
- Acute bone pain and confusion.
- Weakness, tingling, and cardiac arrhythmias.
- Hypotension, tachycardia, and tachypnea.
Correct Answer

A. Confusion, headache, and seizures.

Explanation

RATIONALE: 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 physiological functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication.

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44.

A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:
- Continuous inflow and outflow of irrigation solution.
- Intermittent inflow and continuous outflow of irrigation solution.
- Continuous inflow and intermittent outflow of irrigation solution.
- Intermittent flow of irrigation solution and prevention of hemorrhage.
Correct Answer

A. Continuous inflow and outflow of irrigation solution.

Explanation

RATIONALE: When preparing for continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

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45.

A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs?
- I should wipe from back to front.
- I should take a tub bath at least 3 times per week.
- I should take at least 1,000 mg of vitamin C each day.
- I should limit my fluid intake to limit my trips to the bathroom.
Correct Answer

A. I should take at least 1,000 mg of vitamin C each day.

Explanation

RATIONALE: The client demonstrates understanding of teaching when she states that she should take vitamin C each day. Increasing vitamin C intake to at least 1,000 mg per day helps acidify the urine, decreasing the amount of bacteria that can grow. The client should wipe from front to back to avoid introducing bacteria from the anal area into the urethra. The client should shower, not bathe, to minimize the amount of bacteria that can enter the urethra. The client should increase her fluid intake, and void every 2 to 3 hours and completely empty her bladder. Holding urine in the bladder can cause the bladder to become distended, which places the client at further risk for UTI.

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46.

A nurse is teaching a client with genital herpes. Education for this client should include an explanation of:
- The need for the use of petroleum products.
- Why the disease is transmittable only when visible lesions are present.
- The option of disregarding safer-sex practices now that he's already infected.
- The importance of informing his partners of the disease.
Correct Answer

A. The importance of informing his partners of the disease.

Explanation

RATIONALE: Clients with genital herpes should inform their partners of the disease to help prevent transmission. Petroleum products should be avoided because they can cause the virus to spread. The notion that genital herpes is only transmittable when visible lesions are present is false. Anyone not in a long-term, monogamous relationship, regardless of current health status, should follow safer-sex practices.

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47.

A registered nurse and a nursing assistant are caring for a group of clients. Which client's care may safely be delegated to the nursing assistant?
- A client who underwent surgery 12 hours ago whose suprapubic catheter is draining burgundy-colored urine
- A client with uncontrolled diabetes mellitus who underwent radical suprapubic prostatectomy 1 day ago and has an indwelling urinary catheter draining yellow urine with clots
- A client diagnosed with renal calculi who must ambulate four times daily and drink plenty of fluids.
- A client who requires neurological assessment every 4 hours after sustaining a spinal cord injury in a motor vehicle accident that left him with paraplegia
Correct Answer

A. A client diagnosed with renal calculi who must ambulate four times daily and drink plenty of fluids.

Explanation

RATIONALE: The care of the client diagnosed with renal calculi may safely be delegated to the nursing assistant. The registered nurse should care for the client who had surgery 12 hours ago because the client requires close assessment. The client with uncontrolled diabetes mellitus also requires careful assessment by the registered nurse. In addition, the registered nurse should care for the client who requires neurological assessment, which isn't within the scope of practice for the nursing assistant.

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48.

Which laboratory value supports a diagnosis of pyelonephritis?
- Myoglobinuria
- Ketonuria
- Pyuria
- Low white blood cell (WBC) count
Correct Answer

A. Pyuria

Explanation

RATIONALE: Pyelonephritis is diagnosed by the presence of pyuria, leukocytosis, hematuria, and bacteriuria. The client exhibits fever, chills, and flank pain. Myoglobinuria is seen with any disease process that destroys muscle. Ketonuria indicates a diabetic state. Because the client with pyelonephritis typically has signs of infection, the WBC count is more likely to be high rather than low.

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49.

A client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude?
- The skin wasn't lubricated before the pouch was applied.
- The pouch faceplate doesn't fit the stoma.
- A skin barrier was applied properly.
- Stoma dilation wasn't performed.
Correct Answer

A. The pouch faceplate doesn't fit the stoma.

Explanation

RATIONALE: If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn't be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn't performed with an ileal conduit, although it may be done with a colostomy if ordered.

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NCLEX Genitourinary Disorders

A nurse 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:

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When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?

A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence?

After undergoing transurethral resection of the prostate to treat benign prostatic hyperplasia, a client returns to the room with continuous bladder irrigation. On the first day after surgery, the client reports bladder pain. What should the nurse do first?

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?

Which client is at highest risk for developing a hospital-acquired infection?

After having transurethral resection of the prostate (TURP), a client 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 nurse is caring for a male client with gonorrhea. The client asks how he can reduce his risk of contracting another sexually transmitted disease (STD). The nurse should instruct the client to:

A nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way?

A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?

A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important?

A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point should the nurse include?

A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should:

During rounds, a client admitted with gross hematuria asks the nurse about the physician's diagnosis. To facilitate effective communication, what should the nurse do?

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?

A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation?

A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?

After a radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. The client then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first?

A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans?

A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution?

A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders diagnostic testing of the vaginal discharge. Which STD must be reported to the public health department?

A nurse is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 6.2 mEq/L. Correct administration and the effects of this enema should include having the client:

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first?

A nurse receives her client care assignment. Following the report, she should give priority assessment to the client:

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about:

A female client reports to a nurse that she experiences a loss of urine when she jogs. The nurse's assessment reveals no nocturia, burning, discomfort when voiding, or urine leakage before reaching the bathroom. The nurse explains to the client that this type of problem is called:

A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address?

A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is:

A client with a urinary tract infection is ordered co-trimoxazole (trimethoprim-sulfamethoxazole). The nurse should provide which medication instruction?

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

A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:

A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs?

A nurse is teaching a client with genital herpes. Education for this client should include an explanation of:

A registered nurse and a nursing assistant are caring for a group of clients. Which client's care may safely be delegated to the nursing assistant?

Which laboratory value supports a diagnosis of pyelonephritis?

A client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude?