Adult Health Exam 4-Renal, Urinary, Gastrointestinal & Metabolic Diseases, &
Central Lines
Urinary Diseases
1. A female patient has been experiencing recurrent urinary tract infections. What health education
should the nurse provide to this patient?
A. Bathe daily and keep the perineal region clean.
B. Avoid voiding immediately after sexual intercourse.
C. Drink liberal amounts of fluids.
D. Void at least every 6 to 8 hours.
Ans: C. The patient is encouraged to drink liberal amounts of fluids (water is the best choice) to
increase urine production and flow, which flushes the bacteria from the urinary tract. Frequent voiding
(every 2 to 3 hours) is encouraged to empty the bladder completely because this can significantly lower
urine bacterial counts, reduce urinary stasis, and prevent reinfection. The patient should be
encouraged to shower rather than bathe.
2. A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she
sneezes. The clinic nurse should recognize what type of incontinence?
A. Stress incontinence
B. Reflex incontinence
C. Overflow incontinence
D. Functional incontinence
Ans: A. Stress incontinence is the involuntary loss of urine through an intact urethra as a result of
sudden increase in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia
or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding.
Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder.
Functional incontinence refers to those instances in which the function of the lower urinary tract is
intact, but other factors (outside the urinary system) make it difficult or impossible for the patient to
reach the toilet in time for voiding.
3. A nurse is caring for a female patient whose urinary retention has not responded to
conservative treatment. When educating this patient about self-catheterization, the nurse
should encourage what practice?
Page 1 of 176
, A. Assuming a supine position for self-
catheterization B. Using clean technique at home to
catheterize
C. Inserting the catheter 1 to 2 inches into the urethra
D. Self-catheterizing every 2 hours at home
Ans: B. The patient may use a clean (nonsterile) technique at home, where the risk of cross-
contamination is reduced. The average daytime clean intermittent catheterization schedule is
every 4 to 6 hours and just before bedtime. The female patient assumes a Fowlers position and
uses a mirror to help locate the urinary meatus. The nurse teaches her to catheterize herself by
inserting a catheter 7.5 cm (3 inches) into the urethra, in a downward and backward direction.
4. A 52-year-old patient is scheduled to undergo ileal conduit surgery. When planning this patients
discharge education, what is the most plausible nursing diagnosis that the nurse should
address?
A. Impaired mobility related to limitations posed by the ileal
conduit B. Deficient knowledge related to care of the ileal conduit
C. Risk for deficient fluid volume related to urinary diversion
D. Risk for autonomic dysreflexia related to disruption of the sacral plexus
Ans: B. The patient will most likely require extensive teaching about the care and maintenance of a
new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is
unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus I not threatened
by the creation of a urinary diversion.
1
Page 2 of 176
,Adult Health Exam 4- Renal, Urinary, Gastrointestinal & Metabolic Diseases, & Central
Lines
5. The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal
calculi. When planning this patients health education, what nutritional guidelines should the nurse
provide?
A. Restrict protein intake as ordered.
B. Increase intake of potassium-rich foods.
C. Follow a low-calcium diet.
D. Encourage intake of food containing oxalates.
Ans: A. Protein is restricted to 60 g/d, while sodium is restricted to 3 to 4 g/d. Low-calcium diets are
generally not recommended except for true absorptive hypercalciuria. The patient should avoid
intake of oxalate- containing foods and there is no need to increase potassium intake.
6. The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day.
What instruction should the nurse give the patient?
A. Limit oral fluid intake for 1 to 2 days.
B. Report the presence of fine, sand like particles through the nephrostomy
tube. C. Notify the physician about cloudy or foul-smelling urine.
D. Report any pink-tinged urine within 24 hours after the procedure.
Ans: C. The patient should report the presence of foul-smelling or cloudy urine since this is suggestive
of a UTI. Unless contraindicated, the patient should be instructed to drink large quantities of fluid each
day to flush the kidneys. Sand like debris is normal due to residual stone products. Hematuria is
common after lithotripsy.
7. A female patients most recent urinalysis results are suggestive of bacteriuria. When assessing
this patient, the nurses data analysis should be informed by what principle?
A. Most UTIs in female patients are caused by viruses and do not cause obvious symptoms.
B. A diagnosis of bacteriuria requires three consecutive positive results.
C. Urine contains varying levels of healthy bacterial flora.
D. Urine samples are frequently contaminated by bacteria normally present in the
urethral area.
Ans: D. Because urine samples (especially in women) are commonly contaminated by the
5
bacteria normally present in the urethral area, a bacterial count exceeding01
colonies/mL of clean-
catch, midstream urine is the measure that distinguishes true bacteriuria from
contamination. A diagnosis does not require three consecutive positive results and urine
does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology.
2
, Adult Health Exam 4- Renal, Urinary, Gastrointestinal & Metabolic Diseases, & Central
Lines8. The clinic nurse is preparing a plan of care for a patient with a history of stress incontinence. What
role will the nurse have in implementing a behavioral therapy approach?
A. Provide medication teaching related to pseudoephedrine
sulfate. B. Teach the patient to perform pelvic floor muscle
exercises.
C. Prepare the patient for an anterior vaginal repair procedure.
D. Provide information on periurethral bulking.
Ans: B. Pelvic floor muscle exercises (sometimes called Kegel exercises) represent the cornerstone of
behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence. None of the
other listed interventions has a behavioral approach.
9. The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic
obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain
the patients bladder?
3
Central Lines
Urinary Diseases
1. A female patient has been experiencing recurrent urinary tract infections. What health education
should the nurse provide to this patient?
A. Bathe daily and keep the perineal region clean.
B. Avoid voiding immediately after sexual intercourse.
C. Drink liberal amounts of fluids.
D. Void at least every 6 to 8 hours.
Ans: C. The patient is encouraged to drink liberal amounts of fluids (water is the best choice) to
increase urine production and flow, which flushes the bacteria from the urinary tract. Frequent voiding
(every 2 to 3 hours) is encouraged to empty the bladder completely because this can significantly lower
urine bacterial counts, reduce urinary stasis, and prevent reinfection. The patient should be
encouraged to shower rather than bathe.
2. A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she
sneezes. The clinic nurse should recognize what type of incontinence?
A. Stress incontinence
B. Reflex incontinence
C. Overflow incontinence
D. Functional incontinence
Ans: A. Stress incontinence is the involuntary loss of urine through an intact urethra as a result of
sudden increase in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia
or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding.
Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder.
Functional incontinence refers to those instances in which the function of the lower urinary tract is
intact, but other factors (outside the urinary system) make it difficult or impossible for the patient to
reach the toilet in time for voiding.
3. A nurse is caring for a female patient whose urinary retention has not responded to
conservative treatment. When educating this patient about self-catheterization, the nurse
should encourage what practice?
Page 1 of 176
, A. Assuming a supine position for self-
catheterization B. Using clean technique at home to
catheterize
C. Inserting the catheter 1 to 2 inches into the urethra
D. Self-catheterizing every 2 hours at home
Ans: B. The patient may use a clean (nonsterile) technique at home, where the risk of cross-
contamination is reduced. The average daytime clean intermittent catheterization schedule is
every 4 to 6 hours and just before bedtime. The female patient assumes a Fowlers position and
uses a mirror to help locate the urinary meatus. The nurse teaches her to catheterize herself by
inserting a catheter 7.5 cm (3 inches) into the urethra, in a downward and backward direction.
4. A 52-year-old patient is scheduled to undergo ileal conduit surgery. When planning this patients
discharge education, what is the most plausible nursing diagnosis that the nurse should
address?
A. Impaired mobility related to limitations posed by the ileal
conduit B. Deficient knowledge related to care of the ileal conduit
C. Risk for deficient fluid volume related to urinary diversion
D. Risk for autonomic dysreflexia related to disruption of the sacral plexus
Ans: B. The patient will most likely require extensive teaching about the care and maintenance of a
new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is
unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus I not threatened
by the creation of a urinary diversion.
1
Page 2 of 176
,Adult Health Exam 4- Renal, Urinary, Gastrointestinal & Metabolic Diseases, & Central
Lines
5. The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal
calculi. When planning this patients health education, what nutritional guidelines should the nurse
provide?
A. Restrict protein intake as ordered.
B. Increase intake of potassium-rich foods.
C. Follow a low-calcium diet.
D. Encourage intake of food containing oxalates.
Ans: A. Protein is restricted to 60 g/d, while sodium is restricted to 3 to 4 g/d. Low-calcium diets are
generally not recommended except for true absorptive hypercalciuria. The patient should avoid
intake of oxalate- containing foods and there is no need to increase potassium intake.
6. The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day.
What instruction should the nurse give the patient?
A. Limit oral fluid intake for 1 to 2 days.
B. Report the presence of fine, sand like particles through the nephrostomy
tube. C. Notify the physician about cloudy or foul-smelling urine.
D. Report any pink-tinged urine within 24 hours after the procedure.
Ans: C. The patient should report the presence of foul-smelling or cloudy urine since this is suggestive
of a UTI. Unless contraindicated, the patient should be instructed to drink large quantities of fluid each
day to flush the kidneys. Sand like debris is normal due to residual stone products. Hematuria is
common after lithotripsy.
7. A female patients most recent urinalysis results are suggestive of bacteriuria. When assessing
this patient, the nurses data analysis should be informed by what principle?
A. Most UTIs in female patients are caused by viruses and do not cause obvious symptoms.
B. A diagnosis of bacteriuria requires three consecutive positive results.
C. Urine contains varying levels of healthy bacterial flora.
D. Urine samples are frequently contaminated by bacteria normally present in the
urethral area.
Ans: D. Because urine samples (especially in women) are commonly contaminated by the
5
bacteria normally present in the urethral area, a bacterial count exceeding01
colonies/mL of clean-
catch, midstream urine is the measure that distinguishes true bacteriuria from
contamination. A diagnosis does not require three consecutive positive results and urine
does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology.
2
, Adult Health Exam 4- Renal, Urinary, Gastrointestinal & Metabolic Diseases, & Central
Lines8. The clinic nurse is preparing a plan of care for a patient with a history of stress incontinence. What
role will the nurse have in implementing a behavioral therapy approach?
A. Provide medication teaching related to pseudoephedrine
sulfate. B. Teach the patient to perform pelvic floor muscle
exercises.
C. Prepare the patient for an anterior vaginal repair procedure.
D. Provide information on periurethral bulking.
Ans: B. Pelvic floor muscle exercises (sometimes called Kegel exercises) represent the cornerstone of
behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence. None of the
other listed interventions has a behavioral approach.
9. The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic
obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain
the patients bladder?
3
