Chapter 61: Concepts of Care for Patients
with Urinary Problems
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client with pneumonia and dementia is admitted with an indwelling urinary catheter
in place. During interprofessional rounds the following day, which question would 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. “May we discontinue the indwelling catheter?”
d. “Should we get another chest x-ray today?”
ANS: C
An indwelling urinary 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 would inquire about removing
the catheter. All other questions might be appropriate, but because of client safety,
this question takes priority.
DIF: Applying TOP: Integrated Process: Nursing Process: Analysis
KEY: Infection control MSC: Client Needs Category:
Physiological Integrity: Reduction of Risk Potential
2. 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 L 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 would 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.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Urolithiasis MSC: Client Needs Category: Health Promotion
and Maintenance
3. A nurse cares for a client who has kidney stones from gout ricemia. Which medication
does the nurse anticipate administering?
a. Phenazopyridine
b. Doxycyline
c. Tolterodine
d. Allopurinol
ANS: D
Stones caused by hyperuricmia caused by gout or other reason respond to allopurinol.
Phenazopyridine is given to clients with urinary tract infections. Doxycycline is an
antibiotic. Tolterodine is an anticholinergic with smooth muscle-relaxant properties.
, DIF: Applying TOP: Integrated Process: Nursing Process: Planning and
Implementation KEY: Urolithiasis, Drug therapy MSC: Client
Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
4. 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. What action would 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.
DIF: Applying TOP: Integrated Process: Nursing Process: Planning and
Implementation KEY: Urolithiasis, Management MSC: Client
Needs Category: Physiological Integrity: Reduction of Risk Potential
5. A nurse obtains the health history of a client with a suspected diagnosis of bladder
cancer. Which question would 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?”
with Urinary Problems
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client with pneumonia and dementia is admitted with an indwelling urinary catheter
in place. During interprofessional rounds the following day, which question would 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. “May we discontinue the indwelling catheter?”
d. “Should we get another chest x-ray today?”
ANS: C
An indwelling urinary 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 would inquire about removing
the catheter. All other questions might be appropriate, but because of client safety,
this question takes priority.
DIF: Applying TOP: Integrated Process: Nursing Process: Analysis
KEY: Infection control MSC: Client Needs Category:
Physiological Integrity: Reduction of Risk Potential
2. 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 L 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 would 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.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Urolithiasis MSC: Client Needs Category: Health Promotion
and Maintenance
3. A nurse cares for a client who has kidney stones from gout ricemia. Which medication
does the nurse anticipate administering?
a. Phenazopyridine
b. Doxycyline
c. Tolterodine
d. Allopurinol
ANS: D
Stones caused by hyperuricmia caused by gout or other reason respond to allopurinol.
Phenazopyridine is given to clients with urinary tract infections. Doxycycline is an
antibiotic. Tolterodine is an anticholinergic with smooth muscle-relaxant properties.
, DIF: Applying TOP: Integrated Process: Nursing Process: Planning and
Implementation KEY: Urolithiasis, Drug therapy MSC: Client
Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
4. 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. What action would 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.
DIF: Applying TOP: Integrated Process: Nursing Process: Planning and
Implementation KEY: Urolithiasis, Management MSC: Client
Needs Category: Physiological Integrity: Reduction of Risk Potential
5. A nurse obtains the health history of a client with a suspected diagnosis of bladder
cancer. Which question would 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?”
