Adamson University – College of Nursing NCM118 – Nursing Care of Clients with Life Threatening Condition Genito-Urinary Disorders Instructions: Multiple Choice – Choose the best answer among the given choices by encircling the letter. Reminder: No alterations/super impositions and erasure is allowed. 1. After the physician orders a culture and sensitivity test, why would the nurse instruct the patient to obtain a clean-catch midstream urine specimen? A. the urinary tract normally harbors some microorganisms B. microorganisms on the patient's external genitalia may contaminate the specimen C. the nurse does not want to catheterize the patient D. a midstream specimen obtains the largest number of microorganisms in the lower tract 2. The nurse monitors for significant changes by focusing on which of the following laboratory tests in a patient whose renal function is deteriorating? A. increase in BUN B. decrease in serum creatinine levels C. increase in urine creatinine clearance D. decrease in serum potassium levels 3. The patient is complaining of dribbling, urgency, and inability to get to the bathroom before urinating starts. The nurse suspects which of the following? A. urinary tract infection B. renal calculi C. acute renal failure D. urinary incontinence 4. The nurse knows the patient understands how to do Kegel exercises when the patient states... A. I should pretend like I am starting and stopping my urine stream B. I should do exercises three times a week C. I can only do the Kegel exercises when I am lying down D. this will help me prevent urinary retention 5. Clinical manifestations and assessment findings that supports a diagnosis of acute pyelonephritis include... A. urinary stress incontinence and abdominal pain B. flank pain, fever, and dysuria C. burning on urination and inflamed urinary meatus D. acute, sharp, intermittent pain and anuria 6. A 65-year-old man is hospitalized for bladder cancer. He is scheduled for ileal loop surgery to create a urostomy. Which information is most important for the nurse to include in a teaching plan for this patient when learning to change his urostomy appliance? A. change the appliance before going to bed B. cut the wafer 1/2 inch larger than the stoma C. cleanse the peristomal skin with soap and water D. use firm pressure to attach the wafer to the skin 7. Which nursing intervention best prevents urinary infections in a person who has an ileal conduit? A. allowing the bag to fill completely B. attaching a larger bag at night C. restricting fluids to less than 1000 ml daily D. changing the appliance every 8 hours 8. A 74-year-old man has just returned to the nursing unit after a transurethral resection. He has a three-way foley catheter for continuous bladder irrigation connected to straight drainage. Immediately after surgery, the nurse would expect his urine to be... A. Clear B. light yellow C. pink or dark red D. bright red 9. An elderly patient has just returned to the nursing care unit following a transurethral resection. He has a three-way indwelling catheter with continuous bladder irrigation. He tells the nurse he has to void. The most appropriate nursing action is to... A. allow him to void around the catheter B. irrigate the catheter C. notify the physician D. remove the catheter 10. The nurse is teaching a patient with an L-3 spinal cord injury regarding a bladder training regimen. Which of the following instructions should be included in the bladder training process? A. drink 1200-1500 ml of water per day B. drink adequate fluids until 10 pm at night C. tighten the abdominal muscles to void D. pour cool water on the perineum 11. Mr. Cy underwent major surgery yesterday. He is on strict intake and output. Calculate his intake and output for eight-hour period. Intake: IV-D5LR at 125 ml/hr, PO-1 ounce ice chips, NG irrigant-NS 15 ml q 2 hr; Output: Foley urine output 850 ml, NG tube- 200 ml A. I=170 ml; O=1050 ml B. I=1090 ml; O=1050 ml C. I=141 ml; O=1000 ml D. I=1000 ml; O=990 ml 12. An adult is scheduled for an intravenous pyelogram. Before sending her to have the test the nurse should... A. ask if she is allergic to barium B. ask if she is allergic to shellfish C. give her a full of glass water D. instruct her not to urinate until after the test 13. An adult patient who has had an abdominal perineal resection asks the nurse when he can expect his bowel function to return. The nurse explains that the earliest that normal bowel function can be expected to return post-op is.. A. B. C. D. six hours 12 hours 3 days 1 week 14. Type of Cytoclysis that is for frequent intermittent irrigations or continuous irrigation without disrupting the sterile alignment of the catheter and drainage system through use of a three-way catheter A. open bladder irrigation system B. manual bladder irrigation system C. closed bladder irrigation system D. continuous intermittent bladder irrigation system 15. An adult woman had a cystectomy with ileal conduit for a diagnosis of bladder cancer. During the first 48 hours post-op which symptoms should be reported to the physician? A. absence of urinary output over a period of 1-2 hours B. swelling of the abdominal stoma C. pain along the incision site D. absent bowel sounds 16. The nurse is teaching an adult who had a cystectomy and ileal conduit. Which statement made by the patient indicates a need for further instruction? A. "Now that I've had the surgery, I'll have to be careful that I don't get frequent urinary tract infections B. "My stoma is 1 1/2 inches in size now, but I understand it will get smaller. Therefore, I need to measure it again in several weeks" C. "I'm glad that once I get home and am better regulated, I will only have to wear an appliance at night" D. "I certainly don't want my stoma to close up so I will gently dilate it with my finger once a week" 17. A 24-hour urine specimen is ordered for an adult patient. The nurse goes to the patient at 8:00 AM to start the specimen collection. The nurse instructs the patient to... A. empty her bladder and save the specimen. Collect all urine until 8:00 AM tomorrow B. drink large amounts of fluid during the test. Collect all urine for the next 24 hours C. empty her bladder and discard the specimen. Collect all urine for 24 hours including that voided at 8:00 AM tomorrow D. note the time when she next voids and collect urine for 24 hours from that time. Notify the nurse when the collection is completed 18. The nurse is caring for a woman who had a vaginal hysterectomy 2 days ago. The indwelling catheter has been removed. The nurse has performed a catheterization for residual urine. Which finding indicates the patient does not have a problem? The urine volume obtained was... A. 30 ml B. 150 ml C. 300 ml D. 500 ml 19. For which procedure would the nurse use aseptic technique, and which would require the nurse to use sterile technique? A. aseptic technique for changing the patient's linen and sterile technique for placing a central line B. aseptic technique for urinary catheterization in the hospital and sterile technique for cleaning surgical wound C. aseptic technique for spinal tap and sterile technique for surgery D. aseptic technique for food preparation and sterile technique for starting an IV line 20. A female patient is to have a urine culture collected. The nurse instructs the patient on the procedure for collecting a clean catch urine specimen by telling the patient to... A. separate the labia, clean from the front to back with three wipes impregnated with cleaning solution, and then start to void in the toilet. Stop, and finally continue to void into the sterile container B. retract the foreskin, cleanse with three cleansing sponges, and start to void. stop, and finally continue to void into the sterile container C. separate the labia, clean from back to front with the three wipes impregnated with the cleaning solution, and then start to void in the toilet. Stop, and finally continue to void in the sterile container D. retract the foreskin, clean with soap and water, and then start to void. Stop, and finally continue to void in the sterile container 21. The nurse is to collect a urine culture specimen from a catheterized patient. Which one of the following statements describes the nurse's actions for this procedure? A. with a sterile syringe, the nurse aspirates 50 ml of urine from the silicone catheter tubing B. with a sterile syringe, the nurse aspirates 1-3 ml from the distal end of the catheter after cleaning the sampling port with alcohol C. with a sterile syringe, the nurse aspirates 1-3 ml from the distal end of the catheter after first cleaning the sampling port with soap and water D. the nurse disconnects the catheter from the tubing and allow small volume of urine to drain into a sterile container 22. The nurse is ordered to perform a urinary catheterization for post-void residual volume on a patient with urinary incontinence. Several minutes after the patient voids, the nurse obtains a residual urine of 30 ml. The nurse interprets this residual volume of urine to be ... A. adequate bladder emptying B. inadequate bladder emptying C. decreased urethral pressure D. increased urethral pressure 23. A post-op patient is unable to void and is ordered to have an indwelling catheter inserted immediately. The nurse performing the catheterization is extremely concerned with A. teaching the patient deep breathing techniques to decrease post-op pain, pre-procedure B. maintaining strict aseptic technique C. medicating the patient for pain, before the procedure D. teaching the patient, the signs and symptoms of urinary tract infection 24. The nurse assessing a patient with an indwelling catheter and finds the catheter is not draining and the patient's bladder is distended. The nurse should immediately plan to... A. notify the physician B. assess catheter tubing for kinks and position so downhill flow is initiated C. change the catheter D. aspirate urine for culture 25. A three-day post-op patient for a ureterosigmoidostomy is complaining of cramping in lower extremities and occasional dizziness. The nurse should give highest priority to... A. assessing for electrolyte imbalance B. assessing for cardiac dysrhythmias C. observing the patient's response to surgery D. verifying the temperature of the patient's lower extremities 26. Following a prostatectomy, the patient has a three-way, indwelling catheter for continuous bladder irrigation. During evening shift, 2400 ml of irrigant was instilled. At the end of the shift, the drainage bag was drained of 2900 ml of fluid. The nurse calculates the urine output to be... A. 5300 ml B. 2900ml C. 240 ml D. 500 ml 27. The nurse who is caring for a patient with an ileal conduit should plan to teach the patient about... A. decreasing the patient's sexual encounters B. adhering to catheterization schedules C. decreasing fluid intake to avoid embarrassing situations D. decreasing fluid intake to manage the urinary diversion 28. A patient's foley catheter is to be discontinued in the AM. After explaining the procedure, the next thing the nurse should do before removing the catheter is... A. deflate the balloon B. gently remove the catheter C. place a towel under buttocks D. empty the urine from the bag 29. A priority nursing intervention following removal of an indwelling catheter is... A. Ambulation B. restrict fluid C. force fluids D. pain management 30. Which record of urinary output is minimally acceptable, but would alert the nurse to problems? A. less than 30 ml/hr B. less than 60 ml/hr C. less than 90 ml/hr D. less than 120 ml/hr 31. How much urine can the bladder normally hold? A. 100 ml B. 200 ml C. 1000 ml D. 500 ml 32. The doctor orders a clean, voided specimen. What does the nurse instruct the patient to do when obtaining this specimen? A. B. C. D. collect the first urine voided collect urine during midstream voiding sterilize the meatus as much as possible void completely into a clean urine cup 33. In planning care, the nurse is aware that the greatest risk of urinary catheterization is... A. bladder irritation B. meatal swelling C. bladder puncture D. urinary tract infection 34. The nurse assesses the renal patient's mental status. If there is a problem, what condition is most likely to be assessed? A. Aggression B. Delirium C. Confusion D. intense anger 35. This is a type of Urinary Diversion that often involve creation of a pouch inside the body from part of the intestines to hold urine – there are two types: those that have stoma brought out of the abdomen and those in which a neobladder is made. A. continent urinary diversion B. incontinent urinary diversion C. nephrostomy D. bladder catheterization 36. Why should the nurse plan to address malnutrition for client with renal failure? A. Anemia causes increased absorption of water-soluble vitamins B. The client requires increased carbohydrate intake C. Increased anabolism occurs in renal failure D. Anemia often causes anorexia, nausea, and vomiting 37. Nursing interventions for client diagnosed with renal calculi would include A. Decreasing fluid intake to less than 1000 ml/day B. Encouraging the client to ambulate as much as possible C. Medicating the client with intravenous Demerol as needed as prescribed D. Applying cold compresses to the flank area 38. Clinical manifestations and assessment findings that support a diagnosis of acute pyelonephritis include A. Urinary stress incontinence and abdominal pain B. Flank pain, fever, and dysuria C. Burning on urination and inflamed urinary meatus D. Acute, sharp, intermittent pain and anuria 39. A 20-year-old renal transplantation client has expressed frustration about feeling alone in the hospital room. “I wish I could be out in the waiting room visiting with my friends.” Which of the following responses would be most appropriate by the nurse? A. Allow client to go to the waiting room for 10 minutes only B. Allow client’s friends to come into the room for a short visit C. Allow client to verbalize feeling of isolation D. Discuss activities that client can do to combat isolation. 40. A client who is in acute renal failure develops pulmonary edema. Nursing interventions for this client include all of the following except A. Administering oxygen B. Encouraging coughing and deep breathing C. Placing the client in semi-fowler’s position D. Replacing fluid lost
