NCLEX Genitourinary Disorders

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NCLEX Genitourinary Disorders - 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.


Questions and Answers
  • 1. 

    After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an I.V. infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output?

    • A.

      It's a normal finding caused by blood loss during surgery.

    • B.

      It's a normal finding associated with the client's nothing-by-mouth status.

    • C.

      It's an abnormal finding that requires further assessment.

    • D.

      It's an abnormal finding that will correct itself when the client ambulates

    Correct Answer
    C. It's an abnormal finding that requires further assessment.
    Explanation
    RATIONALE: The drop in urine output to less than 30 ml/hour is abnormal and requires further assessment. The reduction in urine output may be caused by an obstruction in the urinary catheter tubing or deficient fluid volume from blood loss. The client's nothing-by-mouth status isn't the cause of the low urine output because the client is receiving I.V. fluid to compensate for the lack of oral intake. Ambulation promotes urination; however, the client should produce at least 30 ml of urine/hour.

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  • 2. 

    A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?

    • A.

      This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.

    • B.

      The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days.

    • C.

      The potential for transmission to her sexual partner will be eliminated if condoms are used every time she and her partner have sexual intercourse.

    • D.

      The human papillomavirus (HPV), which causes condylomata acuminata, can't be transmitted during oral sex.

    Correct Answer
    A. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.
    Explanation
    RATIONALE: Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

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  • 3. 

    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.

      The client sets the drainage bag on the floor while sitting down.

    • B.

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

    • C.

      The client clamps the catheter drainage tubing while visiting with the family.

    • D.

      The client loops the drainage tubing below its point of entry into the drainage bag.

    Correct Answer
    B. 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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  • 4. 

    A nurse is caring for a client with chronic renal failure. The laboratory results indicate hypocalcemia and hyperphosphatemia. When assessing the client, the nurse should be alert for which signs and symptoms? Select all that apply.

    • A.

      Trousseau's sign

    • B.

      Cardiac arrhythmias

    • C.

      Constipation

    • D.

      Decreased clotting time

    • E.

      Drowsiness and lethargy

    • F.

      Fractures

    Correct Answer(s)
    A. Trousseau's sign
    B. Cardiac arrhythmias
    F. Fractures
    Explanation
    RATIONALE: Hypocalcemia is a calcium deficit that causes nerve fiber irritability and repetitive muscle spasms. Signs and symptoms of hypocalcemia include Trousseau's sign, cardiac arrhythmias, diarrhea, increased clotting times, anxiety, and irritability. The calcium-phosphorus imbalance leads to brittle bones and pathologic fractures.

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  • 5. 

    Which statement describing urinary incontinence in an elderly client is true?

    • A.

      Urinary incontinence is a normal part of aging.

    • B.

      Urinary incontinence isn't a disease.

    • C.

      Urinary incontinence in the elderly population can't be treated.

    • D.

      Urinary incontinence is a disease.

    Correct Answer
    B. Urinary incontinence isn't a disease.
    Explanation
    RATIONALE: Urinary incontinence isn't a normal part of aging nor is it a disease. It may be caused by confusion, dehydration, fecal impaction, restricted mobility, or other causes. Certain medications, including diuretics, hypnotics, sedatives, anticholinergics, and antihypertensives, may trigger urinary incontinence. Most clients with urinary incontinence can be treated; some can be cured.

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  • 6. 

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

    • A.

      With pinkish mucus discharge in the appliance bag 2 days after an ileal conduit.

    • B.

      Who has a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L 7 days after a kidney transplant.

    • C.

      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.

    • D.

      Who is experiencing mild pain from urolithiasis.

    Correct Answer
    C. 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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  • 7. 

    A client receiving total parenteral nutrition is ordered a 24-hour urine test. When initiating a 24-hour urine specimen, the collection time should:

    • A.

      Start with the first voiding.

    • B.

      Start after a known voiding.

    • C.

      Always be with the first morning urine.

    • D.

      Always be the evening's last void as the last sample.

    Correct Answer
    B. Start after a known voiding.
    Explanation
    RATIONALE: When initiating a 24-hour urine specimen, have the client void, then start the timing. The collection should start on an empty bladder. The exact time the test starts isn't important but the test is commonly started in the morning.

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  • 8. 

    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:

    • A.

      Initiate a stream of urine.

    • B.

      Breathe deeply.

    • C.

      Turn to the side.

    • D.

      Hold the labia or shaft of the penis.

    Correct Answer
    B. Breathe deeply.
    Explanation
    RATIONALE: When inserting a urinary catheter, the nurse can facilitate insertion by asking the client to breathe deeply. Breathing deeply will relax the urinary sphincter. Initiating a stream of urine isn't recommended during catheter insertion. 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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  • 9. 

    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.

      Increase the I.V. flow rate.

    • B.

      Notify the physician immediately.

    • C.

      Assess the irrigation catheter for patency and drainage.

    • D.

      Administer morphine sulfate, 2 mg I.V., as ordered.

    Correct Answer
    C. 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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  • 10. 

    A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in:

    • A.

      1 minute.

    • B.

      30 minutes.

    • C.

      1 hour.

    • D.

      24 hours.

    Correct Answer
    A. 1 minute.
    Explanation
    RATIONALE: The creatinine clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.

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  • 11. 

    Which clinical finding should a nurse look for in a client with chronic renal failure?

    • A.

      Hypotension

    • B.

      Uremia

    • C.

      Metabolic alkalosis

    • D.

      Polycythemia

    Correct Answer
    B. Uremia
    Explanation
    RATIONALE: Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.

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  • 12. 

    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.

      Chronic, excessive acetaminophen use.

    • B.

      Recent streptococcal infection.

    • C.

      Childhood asthma.

    • D.

      Family history of pernicious anemia.

    Correct Answer
    B. 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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  • 13. 

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

    • A.

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

    • B.

      A decreased serum phosphate level secondary to kidney failure.

    • C.

      An increased serum calcium level secondary to kidney failure.

    • D.

      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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  • 14. 

    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.

      Blood glucose level of 200 mg/dl

    • B.

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

    • C.

      Potassium level of 3.5 mEq/L

    • D.

      Hematocrit (HCT) of 35%

    Correct Answer
    B. 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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  • 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?

    • A.

      Kidney

    • B.

      Ureter

    • C.

      Bladder

    • D.

      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. 

    Which statement best describes the therapeutic action of loop diuretics?

    • A.

      They block reabsorption of potassium on the collecting tubule.

    • B.

      They promote sodium secretion into the distal tubule.

    • C.

      They block sodium reabsorption in the ascending loop and dilate renal vessels.

    • D.

      They promote potassium secretion into the distal tubule and constrict renal vessels.

    Correct Answer
    C. They block sodium reabsorption in the ascending loop and dilate renal vessels.
    Explanation
    RATIONALE: Loop diuretics block sodium reabsorption in the ascending loop of Henle, which promotes water diuresis. They also dilate renal vessels. Although loop diuretics block potassium reabsorption, this isn't a therapeutic action. Thiazide diuretics, not loop diuretics, promote sodium secretion into the distal tubule.

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  • 17. 

    A nurse is explaining menstruation to a class. Place the steps of the menstrual cycle listed below in the correct order. Use all options.
    1. 1. The level of estrogen in the blood peaks.
    2. 2. Peak endometrial thickening occurs.
    3. 3. Estrogen and progesterone levels increase.
    4. 4. Top layer of the endometrium breaks occurs.
    5. 5. Afollicle matures and ovulation occurs.
    6. 6. The endometrium begins thickening.

    Correct Answer
    461523
    Explanation
    Correct answer is 4,6,1,5,2,3
    RATIONALE: The menstrual cycle begins with the first day of menstruation, when the top layer of the endometrium breaks down and sloughs. The endometrium thickens and the level of estrogen in the blood peaks. Next, a follicle matures and ovulation occurs. Peak endometrial thickening occurs and the estrogen and progesterone levels increase, inhibiting luteinizing hormone.

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  • 18. 

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

    • A.

      Administering a sitz bath twice per day

    • B.

      Increasing fluid intake to 3 L/day

    • C.

      Using an indwelling urinary catheter to measure urine output accurately

    • D.

      Encouraging the client to drink cranberry juice to acidify the urine

    Correct Answer
    B. 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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  • 19. 

    A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to:

    • A.

      Assess whether the client is a good candidate for surgery.

    • B.

      Help the client cope with the anxiety associated with changes in body image.

    • C.

      Assess suicidal risk postoperatively.

    • D.

      Evaluate the client's need for mental health intervention.

    Correct Answer
    B. Help the client cope with the anxiety associated with changes in body image.
    Explanation
    RATIONALE: Many clients who undergo surgery for creation of an ileal conduit experience anxiety associated with changes in body image. The mental health practitioner can help the client cope with these feelings of anxiety. Mental health practitioners don't evaluate whether the client is a surgical candidate. None of the evidence suggests that urinary diversion surgery, such as creation of an ileal conduit, places the client at risk for suicide. Although evaluating the need for mental health intervention is always important, this client displays no behavioral changes that suggest intervention is necessary at this time.

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  • 20. 

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

    • A.

      Limit fluid intake to reduce the need to urinate.

    • B.

      Take medication ordered for a UTI until the symptoms subside.

    • C.

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

    • D.

      Wear only nylon underwear to reduce the chance of irritation.

    Correct Answer
    C. 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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  • 21. 

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

    • A.

      Increased pH with decreased hydrogen ions

    • B.

      Increased serum levels of potassium, magnesium, and calcium

    • C.

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

    • D.

      Uric acid analysis 3.5 mg/dl and phenolsulfonphthalein (PSP) excretion 75%

    Correct Answer
    C. 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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  • 22. 

    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.

      A client who underwent surgery 12 hours ago whose suprapubic catheter is draining burgundy-colored urine

    • B.

      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

    • C.

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

    • D.

      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
    C. 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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  • 23. 

    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.

      Functional incontinence.

    • B.

      Reflex incontinence.

    • C.

      Stress incontinence.

    • D.

      Total incontinence.

    Correct Answer
    C. 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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  • 24. 

    When performing a scrotal examination, a nurse finds a nodule. What should the nurse do next?

    • A.

      Notify the physician.

    • B.

      Change the client's position and repeat the examination.

    • C.

      Perform a rectal examination.

    • D.

      Transilluminate the scrotum.

    Correct Answer
    D. Transilluminate the scrotum.
    Explanation
    RATIONALE: The nurse who discovers a nodule, swelling, or other abnormal finding during a scrotal examination should transilluminate the scrotum by darkening the room and shining a flashlight through the scrotum behind the mass. A scrotum filled with serous fluid transilluminates as a red glow; a more solid lesion, such as a hematoma or mass, doesn't transilluminate and may appear as a dark shadow. Although the nurse should notify the physician of the abnormal finding, performing transillumination first provides the physician with additional information. The nurse can't uncover more information about a scrotal mass by changing the client's position and repeating the examination or by performing a rectal examination.

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  • 25. 

    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.

      Continuous inflow and outflow of irrigation solution.

    • B.

      Intermittent inflow and continuous outflow of irrigation solution.

    • C.

      Continuous inflow and intermittent outflow of irrigation solution.

    • D.

      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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  • 26. 

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

    • A.

      Fluid intake should be double the urine output.

    • B.

      Fluid intake should be about equal to the urine output.

    • C.

      Fluid intake should be half the urine output.

    • D.

      Fluid intake should be inversely proportional to the urine output.

    Correct Answer
    B. 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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  • 27. 

    After a retropubic prostatectomy, a client needs continuous bladder irrigation. The client has an I.V. of dextrose 5% in water infusing at 40 ml/hour, and a triple-lumen urinary catheter with normal saline solution infusing at 200 ml/hour. The nurse empties the urinary catheter drainage bag three times during an 8-hour period for a total of 2,780 ml. How many milliliters does the nurse calculate as urine? Record your answer using a whole number.

    Correct Answer
    1180
    Explanation
    Correct answer is 1180.
    RATIONALE: During 8 hours, 1,600 ml of bladder irrigation has been infused (200 ml × 8 hour = 1,600 ml/8 hour). The nurse then subtracts this amount of infused bladder irrigation from the total volume in the drainage bag (2,780 ml − 1,600 ml = 1,180 ml) to determine urinary output.

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  • 28. 

    To treat a urinary tract infection, a client is ordered trimethoprim-sulfamethoxazole (Bactrim). The nurse should teach the client that trimethoprim-sulfamethoxazole is most likely to cause which adverse effect?

    • A.

      Anxiety

    • B.

      Headache

    • C.

      Diarrhea

    • D.

      Dizziness

    Correct Answer
    C. Diarrhea
    Explanation
    RATIONALE: Trimethoprim-sulfamethoxazole is most likely to cause diarrhea. Nausea and vomiting are other common adverse effects. This drug rarely causes anxiety, headache, or dizziness.

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  • 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?

    • A.

      Kegel exercises

    • B.

      Fluid restriction

    • C.

      Artificial sphincter use

    • D.

      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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  • 30. 

    After undergoing a total cystectomy and urinary diversion, a client has a Kock pouch (continent internal reservoir) in place. Which statement by the client indicates a need for further teaching?

    • A.

      I'll have to wear an external collection pouch for the rest of my life.

    • B.

      I should eat foods from all the food groups.

    • C.

      I'll need to drink at least eight glasses of water a day.

    • D.

      I'll have to catheterize my pouch every 2 hours.

    Correct Answer
    A. I'll have to wear an external collection pouch for the rest of my life.
    Explanation
    RATIONALE: The client requires additional teaching if he states that he'll have to wear an external collection pouch for the rest of his life. An internal collection pouch, such as the Kock pouch, allows the client to perform self-catheterization for ileal drainage. This pouch is an internal reservoir, eliminating the need for an external collection pouch. A well-balanced diet is essential for healing; the client need not include or exclude particular foods. The client should drink at least eight glasses of fluid daily to prevent calculi formation and urinary tract infection. Intervals between pouch drainings should be increased gradually until the pouch is emptied two to four times daily.

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  • 31. 

    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:

    • A.

      Keep the client's knee on the affected side bent for 6 hours.

    • B.

      Apply pressure to the puncture site for 30 minutes.

    • C.

      Check the client's pedal pulses frequently.

    • D.

      Remove the dressing on the puncture site after vital signs stabilize.

    Correct Answer
    C. 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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  • 32. 

    A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include:

    • A.

      Periorbital edema.

    • B.

      Green-tinged urine.

    • C.

      Moderate to severe hypotension.

    • D.

      Polyuria.

    Correct Answer
    A. Periorbital edema.
    Explanation
    RATIONALE: Periorbital edema is a classic sign of acute glomerulonephritis of sudden onset. Other classic signs and symptoms of this disorder include hematuria (not green-tinged urine), proteinuria, fever, chills, weakness, pallor, anorexia, nausea, and vomiting. The client also may have moderate to severe hypertension (not hypotension), oliguria or anuria (not polyuria), headache, reduced visual acuity, and abdominal or flank pain.

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  • 33. 

    A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?

    • A.

      Encourage oral fluids.

    • B.

      Administer furosemide (Lasix) 20 mg I.V.

    • C.

      Start hemodialysis after a temporary access is obtained.

    • D.

      Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.

    Correct Answer
    D. Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.
    Explanation
    RATIONALE: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.

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  • 34. 

    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.

      I should wipe from back to front.

    • B.

      I should take a tub bath at least 3 times per week.

    • C.

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

    • D.

      I should limit my fluid intake to limit my trips to the bathroom.

    Correct Answer
    C. 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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  • 35. 

    A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?

    • A.

      GI absorption rate

    • B.

      Therapeutic index

    • C.

      Creatinine clearance

    • D.

      Liver function studies

    Correct Answer
    C. Creatinine clearance
    Explanation
    RATIONALE: The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

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  • 36. 

    A nurse preceptor is observing a new graduate during care of a client in contact isolation. Which action by the new graduate indicates a need for further teaching about handling infectious materials?

    • A.

      The nurse wears gloves during each client contact.

    • B.

      The nurse washes her hands when entering and exiting the room.

    • C.

      The nurse disposes of articles contaminated with blood in the room's biohazard container.

    • D.

      The nurse uses alcohol gel to clean her hands after changing linen soiled with urine and feces.

    Correct Answer
    D. The nurse uses alcohol gel to clean her hands after changing linen soiled with urine and feces.
    Explanation
    RATIONALE: Using alcohol gel isn't acceptable after the nurse has been in contact with soiled material. The nurse should wash her hands with soap and water. The nurse demonstrates appropriate handling of infectious materials by wearing gloves with each client contact, washing her hands with soap and water when she enters and exits the room, and disposing contaminated articles in the room's biohazard container.

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  • 37. 

    A nurse is caring for an elderly male client who complains that he can't pass urine. A bladder scan reveals 600 ml of urine present in the bladder. The nurse attempts to place the indwelling catheter the physician ordered, but resistance prevents her from placing it. A serum prostate-specific antigen (PSA) test indicates a level of 29 g/L. The physician places an indwelling catheter and the urine specimen returns positive for nitrites, leukocytes, and bacteriuria. Which conditions should the nurse suspect? Select all that apply.

    • A.

      Prostate problems

    • B.

      Urinary tract infection (UTI)

    • C.

      Acute renal failure

    • D.

      Vitamin K deficiency

    • E.

      Liver failure

    Correct Answer(s)
    A. Prostate problems
    B. Urinary tract infection (UTI)
    Explanation
    RATIONALE: An elevated PSA level and lower urinary tract symptoms may indicate a prostate problem. A urine specimen positive for leukocytes, nitrites, and bacteriuria indicates UTI. The client's signs and symptoms don't indicate acute renal failure, liver failure, or a vitamin K deficiency.

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  • 38. 

    Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with benign prostatic hyperplasia (BpH)?

    • A.

      Voiding pattern

    • B.

      Size of the prostate

    • C.

      Creatinine clearance

    • D.

      Serum testosterone level

    Correct Answer
    A. Voiding pattern
    Explanation
    RATIONALE: The client's voiding pattern should be checked to evaluate the effectiveness of alpha-adrenergic blockers. These drugs relax the smooth muscle of the bladder neck and prostate, so the urinary symptoms of BPH are reduced in many clients. These drugs don't affect the size of the prostate, production or metabolism of testosterone, or renal function.

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  • 39. 

    A client scheduled for a vasectomy asks the nurse how soon after the procedure he can have sexual intercourse without using an alternative birth control method. How should the nurse respond?

    • A.

      You can safely have unprotected intercourse after 6 to 10 ejaculations.

    • B.

      You can safely have unprotected intercourse when your sperm count indicates sterilization.

    • C.

      You can safely have unprotected intercourse immediately after the procedure.

    • D.

      You can safely have unprotected intercourse as soon as discomfort from the procedure disappears.

    Correct Answer
    B. You can safely have unprotected intercourse when your sperm count indicates sterilization.
    Explanation
    RATIONALE: After a vasectomy, sterilization isn't ensured until the client's sperm count measures zero. This usually requires 6 to 36 ejaculations. Having intercourse immediately after the procedure or as soon as discomfort disappears may lead to pregnancy.

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  • 40. 

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

    • A.

      Take your temperature every 4 hours.

    • B.

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

    • C.

      Apply an antibacterial dressing to the incision daily.

    • D.

      Be aware that your urine will be cherry-red for 5 to 7 days.

    Correct Answer
    B. 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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  • 41. 

    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:

    • A.

      Appropriate because the irrigation just checks for patency.

    • B.

      Inappropriate because irrigation requires strict sterile technique.

    • C.

      Appropriate because the irrigation set will be used only during an 8-hour period.

    • D.

      Inappropriate because the sterile drape must be cloth, not paper.

    Correct Answer
    B. 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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  • 42. 

    A physician orders a single dose of trimethoprim/sulfamethoxazole (Bactrim) by mouth for a client diagnosed with an uncomplicated urinary tract infection. The pharmacy sends three unit-dose tablets. The nurse verifies the physician's order. What should the nurse do next?

    • A.

      Administer the three tablets as the single dose.

    • B.

      Call the physician to verify the order.

    • C.

      Give one tablet, three times per day.

    • D.

      Call the hospital pharmacist and question the medication supplied.

    Correct Answer
    D. Call the hospital pharmacist and question the medication supplied.
    Explanation
    RATIONALE: The nurse should call the hospital pharmacy and question the medication supplied. The hospital pharmacist should be able to tell the nurse whether three tablets are necessary for the single dose or whether a dispensing error occurred. It isn't clear whether the three tablets are the single dose because they were packaged as a unit-dose. The physician's order was clearly written, so clarifying the order with the physician isn't necessary. Administering the tablets without clarification might cause a medication error.

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  • 43. 

    A nurse is providing inservice education for staff members about evidence collection after sexual assault. The educational session is successful when staff members focus their initial care on which step?

    • A.

      Collecting semen

    • B.

      Performing the pelvic examination

    • C.

      Obtaining consent for examination

    • D.

      Supporting the client's emotional status

    Correct Answer
    D. Supporting the client's emotional status
    Explanation
    RATIONALE: The teaching session is successful when staff members focus first on supporting the client's emotional status. Next, staff members should gain consent to perform the pelvic examination, perform the examination, and collect evidence, such as semen if present.

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  • 44. 

    A nurse is caring for a client who also works in the hospital, has recently received a diagnosis of genital herpes, and is being treated for a urinary tract infection (UTI). While on lunch break in the cafeteria, the nurse sees the client's coworkers, who voice concern over his condition. The nurse's best response would be:

    • A.

      He must be upset that everyone knows he has herpes.

    • B.

      I'll be sure to tell him you're thinking of him.

    • C.

      He's really upset about his medical condition. I'll get you the chart so you can review his laboratory values.

    • D.

      The antibiotics are really helping with his UTI. He should be back to work in no time.

    Correct Answer
    B. I'll be sure to tell him you're thinking of him.
    Explanation
    RATIONALE: Offering to tell the client that his coworkers are thinking of him is the only appropriate response. Discussing his diagnosis or condition violates his right to privacy.

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  • 45. 

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

    • A.

      Cottage cheese–like discharge

    • B.

      Yellow-green discharge

    • C.

      Gray-white discharge

    • D.

      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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  • 46. 

    Which nursing diagnosis is appropriate for a client with renal calculi?

    • A.

      Ineffective tissue perfusion (renal)

    • B.

      Functional urinary incontinence

    • C.

      Risk for infection

    • D.

      Decreased cardiac output

    Correct Answer
    C. Risk for infection
    Explanation
    RATIONALE: Infection can occur with renal calculi from urine stasis caused by obstruction. Ineffective tissue perfusion (renal) and Decreased cardiac output aren't appropriate for this client, and retention of urine, rather than incontinence, usually occurs.

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  • 47. 

    A female client seeks care for a possible infection. Her symptoms include burning on urination and frequent, urgent voiding of small amounts of urine. She's placed on trimethoprim-sulfamethoxazole (Bactrim) to treat the infection. Another medication is ordered to decrease the pain and frequency. Which is the most likely medication ordered for the pain?

    • A.

      Nitrofurantoin (Macrodantin)

    • B.

      Ibuprofen (Motrin)

    • C.

      Acetaminophen with codeine

    • D.

      Phenazopyridine (Pyridium)

    Correct Answer
    D. Phenazopyridine (Pyridium)
    Explanation
    RATIONALE: Phenazopyridine may be ordered in conjunction with an antibiotic for painful bladder infections to promote comfort. Because of its local anesthetic action on the urinary mucosa, phenazopyridine specifically relieves bladder pain. Nitrofurantoin is a urinary antiseptic with no analgesic properties. Although ibuprofen and acetaminophen with codeine are analgesics, they don't exert a direct effect on the urinary mucosa.

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  • 48. 

    A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis?

    • A.

      Acute pain

    • B.

      Risk for infection

    • C.

      Impaired urinary elimination

    • D.

      Imbalanced nutrition: Less than body requirements

    Correct Answer
    A. Acute pain
    Explanation
    RATIONALE: Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of Acute pain takes highest priority. Diagnoses of Risk for infection and Impaired urinary elimination are appropriate when the client's pain is controlled. A diagnosis of Imbalanced nutrition: Less than body requirements isn't pertinent at this time.

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  • 49. 

    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.

      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
    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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  • 50. 

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

    • A.

      Neutral

    • B.

      Alkaline

    • C.

      Acidic

    • D.

      Basic

    Correct Answer
    C. 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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Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Aug 22, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Sep 05, 2015
    Quiz Created by
    Suarezenriquec1
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