N4 - test - Urinary Problems

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition

Chapter 70: Interventions for Clients with Urinary Problems

1. Which clinical manifestation alerts you to the possibility of cystitis? The client has:

A. frequent, painless voiding of large amounts of urine.
B. infrequent, painless voiding of dark-colored urine.
C. infrequent voiding of large amounts of urine, and difficulty starting the urine stream.
D. frequent, painful urination and feelings of an immediate need to urinate.

2. The 25-year-old woman has had three episodes of cystitis with coliform bacteria in the past six months. Which intervention should you teach this client to prevent future urinary tract infections?

A. “After using the toilet, always clean yourself from front to back.”
B. “Avoid wearing tight clothing, especially slacks or jeans.”
C. “Try to drink at least 3 liters of fluids each day.”
D. “Avoid carbonated or caffeinated beverages.”

3. Which client condition suggests to you a problem with urge incontinence?

A. A lack of awareness of the need to void
B. The continuous “dribbling” of urine even when bladder volume is low
C. The inability to control the act of urination when the need is perceived
D. The loss of small amounts of urine whenever intra-abdominal pressure is increased

4. The client with a urinary tract infection is prescribed to take a trimethoprim/sulfamethoxazole combination antibiotic (Septra, Bactrim). Which precaution should you teach this client?

A. “Avoid drinking coffee and other caffeinated beverages.”
B. “Avoid aluminum or magnesium-containing antacids.”
C. “Drink at least 3 liters of fluid each day.”
D. “Take this medication with food.”

5. Which method should you use to evaluate pelvic muscle strength for the client who has a problem “leaking” urine?

A. Observe for urine leakage when the client coughs or bears down in the standing position.
B. Ask the client to stop the stream of urine during the middle of urination.
C. Percuss the lower abdomen for dull sounds indicating a distended bladder.
D. Ask the client if fullness is perceived immediately after urination.

6. Which description by the client indicates correct understanding of the nature and performance of exercises to strengthen pelvic floor muscles?

A. “Tighten the muscles of my pelvis and buttocks, then attempt to urinate while maintaining a strong contraction of these muscles.”
B. “Sit on the toilet and start my stream of urine. Try to stop the stream of urine by tightening my pelvic muscles without squeezing my legs together.”
C. “Get down on my hands and knees. Take a deep breath and hold it. Rock or tilt my pelvis first in an upward motion then in a downward motion. Repeat this movement 10 times.”
D. “Lie on the floor. Bring my knees up to my chest. Squeeze my buttocks together and hold my breath. Attempt to rock forward while maintaining my muscles in a contracted state.”

7. The client with urinary incontinence has been prescribed to take the anticholinergic agent oxybutynin (Ditropan) for this problem. She asks you how this drug decreases incontinence. What is your best response?

A. “This drug improves muscle tone in the bladder neck and urethra, enabling you to hold the urine in your bladder longer.”
B. “This drug reduces the rate that the kidneys make urine so your bladder does not fill as rapidly with normal fluid intake.”
C. “This drug relaxes the bladder muscle, allowing the bladder to hold more without stimulating the sensation of needing to urinate.”
D. “This drug works at the level of your brain, increasing your awareness of bladder filling and making the timing of urination more predictable.”

8. What is the priority nursing diagnosis for a client with renal colic?

A. Acute pain
B. Risk for infection
C. Fluid volume excess
D. Knowledge deficit

9. The 60-year-old male client has gross hematuria. What is your best next response?

A. “Have you noticed any other change in the urine or urine patterns?”
B. “Have any other members of your family ever had bladder cancer?”
C. “Are you ever incontinent of urine?”
D. “How often do you have sex?”

10. Which instruction should you teach the male client who has had a Kock pouch urinary diversion for bladder cancer? “You will need to:

A. sit to urinate.”
B. learn how to drain the urine from the pouch with a catheter.”
C. adjust your diet and fluid intake to prevent frequent dehydration.”
D. use special precautions to prevent skin breakdown from the adhesives used to hold the pouch to the skin.”