66 Care of Patients With Urinary Problems

Chapter 66: Care of Patients with Urinary Problems
Ignatavicius: Medical-Surgical Nursing, 8th Edition
MULTIPLE CHOICE
1. A nurse assesses clients on the medical-surgical unit.

Which client is at greatest risk for the development of bacterial
cystitis?
a.
A 36-year-old female who has never been pregnant
b.
A 42-year-old male who is prescribed cyclophosphamide
c.
A 58-year-old female who is not taking estrogen replacement
d.
A 77-year-old male with mild congestive heart failure
ANS: C
Females at any age are more susceptible to cystitis than men
because of the shorter urethra in women. Postmenopausal
women who are not on hormone replacement therapy are at
increased risk for bacterial cystitis because of changes in the
cells of the urethra and vagina. The middle-aged woman who has
never been pregnant would not have a risk potential as high as
the older woman who is not using hormone replacement therapy.
DIF: Understanding/Comprehension REF: 1367

KEY: Cystitis| health screening
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care
Environment: Management of Care
2. A nurse reviews the laboratory findings of a client

with a urinary tract infection. The laboratory report notes a “shift
to the left” in a client’s white blood cell count. Which action
should the nurse take?
a.
Request that the laboratory perform a differential analysis on the
white blood cells.
b.
Notify the provider and start an intravenous line for parenteral
antibiotics.
c.
Collaborate with the unlicensed assistive personnel (UAP) to
strain the client’s urine for renal calculi.
d.
Assess the client for a potential allergic reaction and
anaphylactic shock.
ANS: B
An increase in band cells creates a “shift to the left.” A left shift
most commonly occurs with urosepsis and is seen rarely with
uncomplicated urinary tract infections. The nurse will be
administering antibiotics, most likely via IV, so he or she should
notify the provider and prepare to give the antibiotics. The shift
to the left is part of a differential white blood cell count. The
nurse would not need to strain urine for stones. Allergic reactions
are associated with elevated eosinophil cells, not band cells.
DIF: Applying/Application REF: 1370

KEY: Cystitis| assessment/diagnostic examination
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity:
Physiological Adaptation
3. A nurse cares for a postmenopausal client who has

had two episodes of bacterial urethritis in the last 6 months. The
client asks, “I never have urinary tract infections. Why is this
happening now?” How should the nurse respond?
a.
“Your immune system becomes less effective as you age.”
b.
“Low estrogen levels can make the tissue more susceptible to
infection.”
c.
“You should be more careful with your personal hygiene in this
area.”
d.
“It is likely that you have an untreated sexually transmitted
disease.”
ANS: B
Low estrogen levels decrease moisture and secretions in the
perineal area and cause other tissue changes, predisposing it to
the development of infection. Urethritis is most common in
postmenopausal women for this reason. Although immune
function does decrease with aging and sexually transmitted
diseases are a known cause of urethritis, the most likely reason
in this client is low estrogen levels. Personal hygiene usually
does not contribute to this disease process.

KEY: Cystitis| patient education MSC: Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance
4. After teaching a client with bacterial cystitis who is

prescribed phenazopyridine (Pyridium), the nurse assesses the
client’s understanding. Which statement made by the client
indicates a correct understanding of the teaching?
a.
“I will not take this drug with food or milk.”
b.
“If I think I am pregnant, I will stop the drug.”
c.
“An orange color in my urine should not alarm me.”
d.
“I will drink two glasses of cranberry juice daily.”
ANS: C
Phenazopyridine discolors urine, most commonly to a deep
reddish orange. Many clients think they have blood in their urine
when they see this. In addition, the urine can permanently stain
clothing. Phenazopyridine is safe to take if the client is pregnant.
There are no dietary restrictions or needs while taking this
medication.
KEY: Cystitis| medication safety MSC: Integrated Process:
Teaching/Learning
Pharmacological and Parenteral Therapies
5. After teaching a client who has stress incontinence,

the nurse assesses the client’s understanding. Which statement
made by the client indicates a need for additional teaching?
a.
“I will limit my total intake of fluids.”
b.
“I must avoid drinking alcoholic beverages.”
c.
“I must avoid drinking caffeinated beverages.”
d.
“I shall try to lose about 10% of my body weight.”
ANS: A
Limiting fluids concentrates urine and can irritate tissues,
leading to increased incontinence. Many people try to manage
incontinence by limiting fluids. Alcoholic and caffeinated
beverages are bladder stimulants. Obesity increases intra-
abdominal pressure, causing incontinence.
DIF: Applying/Application REF: 1380 KEY: Cystitis|

hydration
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Basic Care
and Comfort
6. A nurse cares for adult clients who experience urge

incontinence. For which client should the nurse plan a habit
training program?
a.
A 78-year-old female who is confused
b.
A 65-year-old male with diabetes mellitus
c.
A 52-year-old female with kidney failure
d.
A 47-year-old male with arthritis
ANS: A
For a bladder training program to succeed in a client with urge
incontinence, the client must be alert, aware, and able to resist
the urge to urinate. Habit training will work best for a confused
client. This includes going to the bathroom (or being assisted to
the bathroom) at set times. The other clients may benefit from
another type of bladder training.

KEY: Urinary incontinence| health screening
7. After delegating care to an unlicensed assistive

personnel (UAP) for a client who is prescribed habit training to
manage incontinence, a nurse evaluates the UAP’s
understanding. Which action indicates the UAP needs additional
teaching?
a.
Toileting the client after breakfast
b.
Changing the client’s incontinence brief when wet
c.
Encouraging the client to drink fluids
d.
Recording the client’s incontinence episodes
ANS: B
Habit training is undermined by the use of absorbent
incontinence briefs or pads. The nurse should re-educate the UAP
on the technique of habit training. The UAP should continue to
toilet the client after meals, encourage the client to drink fluids,
and record incontinent episodes.

KEY: Urinary incontinence| delegation| supervision| unlicensed
assistive personnel (UAP)
8. A nurse plans care for a client with overflow

incontinence. Which intervention should the nurse include in this
client’s plan of care to assist with elimination?
a.
Stroke the medial aspect of the thigh.
b.
Use intermittent catheterization.
c.
Provide digital anal stimulation.
d.
Use the Valsalva maneuver.
ANS: D
In clients with overflow incontinence, the voiding reflex arc is not
intact. Mechanical pressure, such as that achieved through the
Valsalva maneuver (holding the breath and bearing down as if to
defecate), can initiate voiding. Stroking the medial aspect of the
thigh or providing digital anal stimulation requires the reflex arc
to be intact to initiate elimination. Due to the high risk for
infection, intermittent catheterization should only be
implemented when other interventions are not successful.

KEY: Urinary incontinence
and Comfort
9. A confused client with pneumonia is admitted with an

indwelling catheter in place. During interdisciplinary rounds the
following day, which question should the nurse ask the primary
health care provider?
a.
“Do you want daily weights on this client?”
b.
“Will the client be able to return home?”
c.
“Can we discontinue the indwelling catheter?”
d.
“Should we get another chest x-ray today?”
ANS: C
An indwelling catheter dramatically increases the risks of urinary
tract infection and urosepsis. Nursing staff should ensure that
catheters are left in place only as long as they are medically
needed. The nurse should inquire about removing the catheter. All
other questions might be appropriate, but because of client
safety, this question takes priority.
DIF: Applying/Application REF: 1368 KEY: Infection

control
NOT: Client Needs Category: Physiological Integrity: Reduction of
Risk Potential
10. After teaching a client with a history of renal calculi,

the nurse assesses the client’s understanding. Which statement
made by the client indicates a correct understanding of the
teaching?
a.
“I should drink at least 3 liters of fluid every day.”
b.
“I will eliminate all dairy or sources of calcium from my diet.”
c.
“Aspirin and aspirin-containing products can lead to stones.”
d.
“The doctor can give me antibiotics at the first sign of a stone.”
ANS: A
Dehydration contributes to the precipitation of minerals to form a
stone. Although increased intake of calcium causes
hypercalcemia and leads to excessive calcium filtered into the
urine, if the client is well hydrated the calcium will be excreted
without issues. Dehydration increases the risk for
supersaturation of calcium in the urine, which contributes to
stone formation. The nurse should encourage the client to drink
more fluids, not decrease calcium intake. Ingestion of aspirin or
aspirin-containing products does not cause a stone. Antibiotics
neither prevent nor treat a stone.

KEY: Urolithiasis| hydration
MSC: Integrated Process: Nursing Process: Evaluation
11. A nurse cares for a client who has kidney stones from
secondary hyperoxaluria. Which medication should the nurse
anticipate administering?
a.
Phenazopyridine (Pyridium)
b.
Propantheline (Pro-Banthine)
c.
Tolterodine (Detrol LA)
d.
Allopurinol (Zyloprim)
ANS: D
Stones caused by secondary hyperoxaluria respond to allopurinol
(Zyloprim). Phenazopyridine is given to clients with urinary tract
infections. Propantheline is an anticholinergic. Tolterodine is an
anticholinergic with smooth muscle relaxant properties.

KEY: Urolithiasis| medications
MSC: Integrated Process: Nursing Process: Planning
12. A nurse assesses a client who is recovering from

extracorporeal shock wave lithotripsy for renal calculi. The nurse
notes an ecchymotic area on the client’s right lower back. Which
action should the nurse take?
a.
Administer fresh-frozen plasma.
b.
Apply an ice pack to the site.
c.
Place the client in the prone position.
d.
Obtain serum coagulation test results.
ANS: B
The shock waves from lithotripsy can cause bleeding into the
tissues through which the waves pass. Application of ice can
reduce the extent and discomfort of the bruising. Although
coagulation test results and fresh-frozen plasma are used to
assess and treat bleeding disorders, ecchymosis after this
procedure is not unusual and does not warrant a higher level of
intervention. Changing the client’s position will not decrease
bleeding.

KEY: Urolithiasis| postoperative nursing
Risk Potential
13. A nurse cares for a client admitted from a nursing

home after several recent falls. What prescription should the
nurse complete first?
a.
Obtain urine sample for culture and sensitivity.
b.
Administer intravenous antibiotics.
c.
Encourage protein intake and additional fluids.
d.
Consult physical therapy for gait training.
ANS: A
Although all interventions are or might be important, obtaining a
urine sample for urinalysis takes priority. Often urinary tract
infection (UTI) symptoms in older adults are atypical, and a UTI
may present with new onset of confusion or falling. The urine
sample should be obtained before starting antibiotics. Dietary
requirements and gait training should be implemented after
obtaining the urine sample.

KEY: Cystitis| assessment/diagnostic examination| older adult
14. A nurse assesses clients on the medical-surgical unit.

Which client is at greatest risk for bladder cancer?
a.
A 25-year-old female with a history of sexually transmitted
diseases
b.
A 42-year-old male who has worked in a lumber yard for 10 years
c.
A 55-year-old female who has had numerous episodes of bacterial
cystitis
d.
An 86-year-old male with a 50–pack-year cigarette smoking
history
ANS: D
The greatest risk factor for bladder cancer is a long history of
tobacco use. The other factors would not necessarily contribute
to the development of this specific type of cancer.
DIF: Remembering/Knowledge REF: 1388
KEY: Urothelial cancer| health screening
15. A nurse assesses a client with bladder cancer who is

recovering from a complete cystectomy with ileal conduit. Which
assessment finding should alert the nurse to urgently contact the
health care provider?
a.
The ileostomy is draining blood-tinged urine.
b.
There is serous sanguineous drainage present on the surgical
dressing.
c.
The ileostomy stoma is pale and cyanotic in appearance.
d.
Oxygen saturations are 92% on room air.
ANS: C
A pale or cyanotic stoma indicates impaired circulation to the
stoma and must be treated to prevent necrosis. Blood-tinged
urine and serous sanguineous drainage are expected after this
type of surgery. Oxygen saturation of 92% on room air is at the
low limit of normal.

KEY: Urothelial cancer| postoperative nursing
16. A nurse obtains the health history of a client with a

suspected diagnosis of bladder cancer. Which question should
the nurse ask when determining this client’s risk factors?
a.
“Do you smoke cigarettes?”
b.
“Do you use any alcohol?”
c.
“Do you use recreational drugs?”
d.
“Do you take any prescription drugs?”
ANS: A
Smoking is known to be a factor that greatly increases the risk of
bladder cancer. Alcohol use, recreational drug use, and
prescription drug use (except medications that contain
phenacetin) are not known to increase the risk of developing
bladder cancer.

KEY: Urothelial cancer| health screening
17. A nurse cares for a client who is scheduled for the

surgical creation of an ileal conduit. The client states, “I am
anxious about having an ileal conduit. What is it like to have this
drainage tube?” How should the nurse respond?
a.
“I will ask the provider to prescribe you an antianxiety
medication.”
b.
“Would you like to discuss the procedure with your doctor once
more?”
c.
“I think it would be nice to not have to worry about finding a
bathroom.”
d.
“Would you like to speak with someone who has an ileal
conduit?”
ANS: D
The goal for the client who is scheduled to undergo a procedure
such as an ileal conduit is to have a positive self-image and a
positive attitude about his or her body. Discussing the procedure
candidly with someone who has undergone the same procedure
will foster such feelings, especially when the current client has
an opportunity to ask questions and voice concerns to someone
with first-hand knowledge. Medications for anxiety will not
promote a positive self-image and a positive attitude, nor will
discussing the procedure once more with the physician or
hearing the nurse’s opinion.

KEY: Urothelial cancer| psychosocial response| coping
MSC: Integrated Process: Caring
NOT: Client Needs Category: Psychosocial Integrity
18. A nurse teaches a young female client who is

prescribed amoxicillin (Amoxil) for a urinary tract infection.
Which statement should the nurse include in this client’s
teaching?
a.
“Use a second form of birth control while on this medication.”
b.
“You will experience increased menstrual bleeding while on this
drug.”
c.
“You may experience an irregular heartbeat while on this drug.”
d.
“Watch for blood in your urine while taking this medication.”
ANS: A
The client should use a second form of birth control because
penicillin seems to reduce the effectiveness of estrogen-
containing contraceptives. She should not experience increased
menstrual bleeding, an irregular heartbeat, or blood in her urine
while taking the medication.

KEY: Cystitis| medication safety MSC: Integrated Process:
Teaching/Learning
19. A nurse teaches a client with functional urinary

incontinence. Which statement should the nurse include in this
client’s teaching?
a.
“You must clean around your catheter daily with soap and water.”
b.
“Wash the vaginal weights with a 10% bleach solution after each
use.”
c.
“Operations to repair your bladder are available, and you can
consider these.”
d.
“Buy slacks with elastic waistbands that are easy to pull down.”
ANS: D
Functional urinary incontinence occurs as the result of problems
not related to the client’s bladder, such as trouble ambulating or
difficulty accessing the toilet. One goal is that the client will be
able to manage his or her clothing independently. Elastic
waistband slacks that are easy to pull down can help the client
get on the toilet in time to void. The other instructions do not
relate to functional urinary incontinence.

KEY: Urinary incontinence MSC: Integrated Process:
Teaching/Learning
and Comfort
20. An emergency department nurse assesses a client

with a history of urinary incontinence who presents with extreme
dry mouth, constipation, and an inability to void. Which question
should the nurse ask first?
a.
“Are you drinking plenty of water?”
b.
“What medications are you taking?”
c.
“Have you tried laxatives or enemas?”
d.
“Has this type of thing ever happened before?”
ANS: B
Some types of incontinence are treated with anticholinergic
medications such as propantheline (Pro-Banthine).
Anticholinergic side effects include dry mouth, constipation, and
urinary retention. The nurse needs to assess the client’s
medication list to determine whether the client is taking an
anticholinergic medication. If he or she is taking anticholinergics,
the nurse should further assess the client’s manifestations to
determine if they are related to a simple side effect or an
overdose. The other questions are not as helpful to understanding
the current situation.

KEY: Urinary incontinence| medication safety
21. A nurse teaches a client who is starting urinary

bladder training. Which statement should the nurse include in
this client’s teaching?
a.
“Use the toilet when you first feel the urge, rather than at
specific intervals.”
b.
“Try to consciously hold your urine until the scheduled toileting
time.”
c.
“Initially try to use the toilet at least every half hour for the first
24 hours.”
d.
“The toileting interval can be increased once you have been
continent for a week.”
ANS: B
The client should try to hold the urine consciously until the next
scheduled toileting time. Toileting should occur at specific
intervals during the training. The toileting interval should be no
less than every hour. The interval can be increased once the
client becomes comfortable with the interval.

KEY: Urinary incontinence| patient education
22. A nurse plans care for clients with urinary

incontinence. Which client is correctly paired with the
appropriate intervention?
a.
A 29-year-old client after a difficult vaginal delivery – Habit
training
b.
A 58-year-old postmenopausal client who is not taking estrogen
therapy – Electrical stimulation
c.
A 64-year-old female with Alzheimer’s-type senile dementia –
Bladder training
d.
A 77-year-old female who has difficulty ambulating – Exercise
therapy
ANS: B
Exercise therapy and electrical stimulation are used for clients
with stress incontinence related to childbirth or low levels of
estrogen after menopause. Exercise therapy increases pelvic
wall strength; it does not improve ambulation. Physical therapy
and a bedside commode would be appropriate interventions for
the client who has difficulty ambulating. Habit training is the
type of bladder training that will be most effective with
cognitively impaired clients. Bladder training can be used only
with a client who is alert, aware, and able to resist the urge to
urinate.

and Comfort
23. A nurse assesses a client who presents with renal

calculi. Which question should the nurse ask?
a.
“Do any of your family members have this problem?”
b.
“Do you drink any cranberry juice?”
c.
“Do you urinate after sexual intercourse?”
d.
“Do you experience burning with urination?”
ANS: A
There is a strong association between family history and stone
formation and recurrence. Nephrolithiasis is associated with
many genetic variations; therefore, the nurse should ask whether
other family members have also had renal stones. The other
questions do not refer to renal calculi but instead are questions
that should be asked of a client with a urinary tract infection.

KEY: Urolithiasis| health screening
24. A nurse assesses a male client who is recovering from

a urologic procedure. Which assessment finding indicates an
obstruction of urine flow?
a.
Severe pain
b.
Overflow incontinence
c.
Hypotension
d.
Blood-tinged urine
ANS: B
The most common manifestation of urethral stricture after a
urologic procedure is obstruction of urine flow. This rarely causes
pain and has no impact on blood pressure. The client may
experience overflow incontinence with the involuntary loss of
urine when the bladder is distended. Blood in the urine is not a
manifestation of the obstruction of urine flow.

KEY: Urethral strictures| urinary incontinence| postoperative
nursing
25. A nurse cares for a client with urinary incontinence.

The client states, “I am so embarrassed. My bladder leaks like a
young child’s bladder.” How should the nurse respond?
a.
“I understand how you feel. I would be mortified.”
b.
“Incontinence pads will minimize leaks in public.”
c.
“I can teach you strategies to help control your incontinence.”
d.
“More women experience incontinence than you might think.”
ANS: C
The nurse should accept and acknowledge the client’s concerns,
and assist the client to learn techniques that will allow control of
urinary incontinence. The nurse should not diminish the client’s
concerns with the use of pads or stating statistics about the
occurrence of incontinence.

KEY: Urinary incontinence| psychosocial response| coping
MSC: Integrated Process: Caring
NOT: Client Needs Category: Psychosocial Integrity
26. A nurse provides phone triage to a pregnant client.

The client states, “I am experiencing a burning pain when I
urinate.” How should the nurse respond?
a.
“This means labor will start soon. Prepare to go to the hospital.”
b.
“You probably have a urinary tract infection. Drink more
cranberry juice.”
c.
“Make an appointment with your provider to have your infection
treated.”
d.
“Your pelvic wall is weakening. Pelvic muscle exercises should
help.”
ANS: C
Pregnant clients with a urinary tract infection require prompt and
aggressive treatment because cystitis can lead to acute
pyelonephritis during pregnancy. The nurse should encourage the
client to make an appointment and have the infection treated.
Burning pain when urinating does not indicate the start of labor
or weakening of pelvic muscles.
DIF: Applying/Application REF: 1369 KEY: Cystitis

Risk Potential
MULTIPLE RESPONSE
1. A nurse assesses a client who has had two episodes

of bacterial cystitis in the last 6 months. Which questions should
the nurse ask? (Select all that apply.)
a.
“How much water do you drink every day?”
b.
“Do you take estrogen replacement therapy?”
c.
“Does anyone in your family have a history of cystitis?”
d.
“Are you on steroids or other immune-suppressing drugs?”
e.
“Do you drink grapefruit juice or orange juice daily?”
ANS: A, B, D
Fluid intake, estrogen levels, and immune suppression all can
increase the chance of recurrent cystitis. Family history is
usually insignificant, and cranberry juice, not grapefruit or
orange juice, has been found to increase the acidic pH and
reduce the risk for bacterial cystitis.

2. A nurse teaches a client about self-catheterization in

the home setting. Which statements should the nurse include in
this client’s teaching? (Select all that apply.)
a.
“Wash your hands before and after self-catheterization.”
b.
“Use a large-lumen catheter for each catheterization.”
c.
“Use lubricant on the tip of the catheter before insertion.”
d.
“Self-catheterize at least twice a day or every 12 hours.”
e.
“Use sterile gloves and sterile technique for the procedure.”
f.
“Maintain a specific schedule for catheterization.”
ANS: A, C, F
The key points in self-catheterization include washing hands,
using lubricants, and maintaining a regular schedule to avoid
distention and retention of urine that leads to bacterial growth. A
smaller rather than a larger lumen catheter is preferred. The
client needs to catheterize more often than every 12 hours. Self-
catheterization in the home is a clean procedure.

Environment: Safety and Infection Control
3. A nurse teaches clients about the difference between

urge incontinence and stress incontinence. Which statements
should the nurse include in this education? (Select all that apply.)
a.
“Urge incontinence involves a post-void residual volume less than
50 mL.”
b.
“Stress incontinence occurs due to weak pelvic floor muscles.”
c.
“Stress incontinence usually occurs in people with dementia.”
d.
“Urge incontinence can be managed by increasing fluid intake.”
e.
“Urge incontinence occurs due to abnormal bladder
contractions.”
ANS: B, E
Clients who suffer from stress incontinence have weak pelvic
floor muscles or urethral sphincter and cannot tighten their
urethra sufficiently to overcome the increased detrusor pressure.
Stress incontinence is common after childbirth, when the pelvic
muscles are stretched and weakened from pregnancy and
delivery. Urge incontinence occurs in people who cannot
suppress the contraction signal from the detrusor muscle.
Abnormal detrusor contractions may be a result of neurologic
abnormalities including dementia, or may occur with no known
abnormality. Post-void residual is associated with reflex
incontinence, not with urge incontinence or stress incontinence.
Management of urge incontinence includes decreasing fluid
intake, especially in the evening hours.

4. A nurse assesses a client with a fungal urinary tract

infection (UTI). Which assessments should the nurse complete?
(Select all that apply.)
a.
Palpate the kidneys and bladder.
b.
Assess the medical history and current medical problems.
c.
Perform a bladder scan to assess post-void residual.
d.
Inquire about recent travel to foreign countries.
e.
Obtain a current list of medications.
ANS: B, E
Clients who are severely immunocompromised or who have
diabetes mellitus are more prone to fungal UTIs. The nurse
should assess for these factors by asking about medical history,
current medical problems, and the current medication list. A
physical examination and a post-void residual may be needed, but
not until further information is obtained indicating that these
examinations are necessary. Travel to foreign countries probably
would not be important because, even if exposed, the client
needs some degree of compromised immunity to develop a fungal
UTI.

Risk Potential
5. A nurse cares for clients with urinary incontinence.

Which types of incontinence are correctly paired with their
clinical manifestation? (Select all that apply.)
a.
Stress incontinence – Urine loss with physical exertion
b.
Urge incontinence – Large amount of urine with each occurrence
c.
Functional incontinence – Urine loss results from abnormal
detrusor contractions
d.
Overflow incontinence – Constant dribbling of urine
e.
Reflex incontinence – Leakage of urine without lower urinary
tract disorder
ANS: A, B, D
Stress incontinence is a loss of urine with physical exertion,
coughing, sneezing, or exercising. Urge incontinence presents
with an abrupt and strong urge to void and usually has a large
amount of urine released with each occurrence. Overflow
incontinence occurs with bladder distention and results in a
constant dribbling of urine. Functional incontinence is the
leakage of urine caused by factors other than a disorder of the
lower urinary tract. Reflex incontinence results from abnormal
detrusor contractions from a neurologic abnormality.
DIF: Remembering/Knowledge REF: 1374

MSC: Integrated Process: Nursing Process: Analysis
6. A nurse teaches a client with a history of calcium

phosphate urinary stones. Which statements should the nurse
include in this client’s dietary teaching? (Select all that apply.)
a.
“Limit your intake of food high in animal protein.”
b.
“Read food labels to help minimize your sodium intake.”
c.
“Avoid spinach, black tea, and rhubarb.”
d.
“Drink white wine or beer instead of red wine.”
e.
“Reduce your intake of milk and other dairy products.”
ANS: A, B, E
Clients with calcium phosphate urinary stones should be taught
to limit the intake of foods high in animal protein, sodium, and
calcium. Clients with calcium oxalate stones should avoid
spinach, black tea, and rhubarb. Clients with uric acid stones
should avoid red wine.

KEY: Urolithiasis| nutritional requirements
Risk Potential
7. A nurse teaches a client about self-care after

experiencing a urinary calculus treated by lithotripsy. Which
statements should the nurse include in this client’s discharge
teaching? (Select all that apply.)
a.
“Finish the prescribed antibiotic even if you are feeling better.”
b.
“Drink at least 3 liters of fluid each day.”
c.
“The bruising on your back may take several weeks to resolve.”
d.
“Report any blood present in your urine.”
e.
“It is normal to experience pain and difficulty urinating.”
ANS: A, B, C
The client should be taught to finish the prescribed antibiotic to
ensure that he or she does not get a urinary tract infection. The
client should drink at least 3 liters of fluid daily to dilute
potential stone-forming crystals, prevent dehydration, and
promote urine flow. After lithotripsy, the client should expect
bruising that may take several weeks to resolve. The client
should also experience blood in the urine for several days. The
client should report any pain, fever, chills, or difficulty with
urination to the provider as these may signal the beginning of an
infection or the formation of another stone.

KEY: Urolithiasis| patient education MSC: Integrated Process:
Teaching/Learning
8. A nurse teaches a female client who has stress

incontinence. Which statements should the nurse include about
pelvic muscle exercises? (Select all that apply.)
a.
“When you start and stop your urine stream, you are using your
pelvic muscles.”
b.
“Tighten your pelvic muscles for a slow count of 10 and then
relax for a slow count of 10.”
c.
“Pelvic muscle exercises should only be performed sitting
upright with your feet on the floor.”
d.
“After you have been doing these exercises for a couple days,
your control of urine will improve.”
e.
“Like any other muscle in your body, you can make your pelvic
muscles stronger by contracting them.”
ANS: A, B, E
The client should be taught that the muscles used to start and
stop urination are pelvic muscles, and that pelvic muscles can be
strengthened by contracting and relaxing them. The client should
tighten pelvic muscles for a slow count of 10 and then relax the
muscles for a slow count of 10, and perform this exercise 15
times while in lying-down, sitting-up, and standing positions. The
client should begin to notice improvement in control of urine
after several weeks of exercising the pelvic muscles.


66 Care of Patients With Urinary Problems

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66 Care of Patients With Urinary Problems

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Chapter 66: Care of Patients with Urinary Problems

Ignatavicius: Medical-Surgical Nursing, 8th Edition

1. A nurse assesses clients on the medical-surgical unit.

DIF: Understanding/Comprehension REF: 1367

2. A nurse reviews the laboratory findings of a client

DIF: Applying/Application REF: 1370

3. A nurse cares for a postmenopausal client who has

DIF: Applying/Application REF: 1367

4. After teaching a client with bacterial cystitis who is

5. After teaching a client who has stress incontinence,

DIF: Applying/Application REF: 1380 KEY: Cystitis|

6. A nurse cares for adult clients who experience urge

DIF: Applying/Application REF: 1380

7. After delegating care to an unlicensed assistive

DIF: Applying/Application REF: 1381

8. A nurse plans care for a client with overflow

DIF: Applying/Application REF: 1381

9. A confused client with pneumonia is admitted with an

DIF: Applying/Application REF: 1368 KEY: Infection

10. After teaching a client with a history of renal calculi,

DIF: Applying/Application REF: 1384

DIF: Applying/Application REF: 1386

12. A nurse assesses a client who is recovering from

DIF: Applying/Application REF: 1386

13. A nurse cares for a client admitted from a nursing

DIF: Applying/Application REF: 1387

14. A nurse assesses clients on the medical-surgical unit.

15. A nurse assesses a client with bladder cancer who is

DIF: Applying/Application REF: 1390

16. A nurse obtains the health history of a client with a

DIF: Applying/Application REF: 1388

17. A nurse cares for a client who is scheduled for the

DIF: Applying/Application REF: 1390

18. A nurse teaches a young female client who is

DIF: Understanding/Comprehension REF: 1371

19. A nurse teaches a client with functional urinary

DIF: Applying/Application REF: 1382

20. An emergency department nurse assesses a client

DIF: Applying/Application REF: 1378

21. A nurse teaches a client who is starting urinary

DIF: Understanding/Comprehension REF: 1380

22. A nurse plans care for clients with urinary

DIF: Applying/Application REF: 1373

23. A nurse assesses a client who presents with renal

DIF: Applying/Application REF: 1384

24. A nurse assesses a male client who is recovering from

DIF: Applying/Application REF: 1373

25. A nurse cares for a client with urinary incontinence.

DIF: Applying/Application REF: 1376

26. A nurse provides phone triage to a pregnant client.

DIF: Applying/Application REF: 1369 KEY: Cystitis

1. A nurse assesses a client who has had two episodes

DIF: Applying/Application REF: 1367

2. A nurse teaches a client about self-catheterization in

DIF: Applying/Application REF: 1382

3. A nurse teaches clients about the difference between

DIF: Understanding/Comprehension REF: 1375

4. A nurse assesses a client with a fungal urinary tract

DIF: Applying/Application REF: 1377

5. A nurse cares for clients with urinary incontinence.

DIF: Remembering/Knowledge REF: 1374

6. A nurse teaches a client with a history of calcium

DIF: Applying/Application REF: 1388

7. A nurse teaches a client about self-care after