MSN Exam for Kidney Stones, Bladder Cancer, Prostate Disorders

1. A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which of the following interventions is important?

1. Strain all urine
2. Limit fluid intake
3. Enforce strict bed rest
4. Encourage a high calcium diet

2.     A client is receiving a radiation implant for the treatment of bladder cancer. Which of the following interventions is appropriate?

1. Flush all urine down the toilet
2. Restrict the client’s fluid intake
3. Place the client in a semi-private room
4. Monitor the client for signs and symptoms of cystitis

3.     A client has just received a renal transplant and has started cyclosporine therapy to prevent graft rejection. Which of the following conditions is a major complication of this drug therapy?

1. Depression
2. Hemorrhage
3. Infection
4. Peptic ulcer disease

4.     A client received a kidney transplant 2 months ago. He’s admitted to the hospital with the diagnosis of acute rejection. Which of the following assessment findings would be expected?

1. Hypotension
2. Normal body temperature
3. Decreased WBC count
4. Elevated BUN and creatinine levels

5.     The client is to undergo kidney transplantation with a living donor. Which of the following preoperative assessments is important?

1. Urine output
2. Signs of graft rejection
3. Signs and symptoms of rejection
4. Client’s support system and understanding of lifestyle changes.

6.      A client had a transurethral prostatectomy for benign prostatic hypertrophy. He’s currently being treated with a continuous bladder irrigation and is complaining of an increase in severity of bladder spasms. Which of the interventions should be done first?

1. Administer an oral analgesic
2. Stop the irrigation and call the physician
3. Administer a belladonna and opium suppository as ordered by the physician.
4. Check for the presence of clots, and make sure the catheter is draining properly.

7.     A client is admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed and postobstructive diuresis is occurring. Which of the following interventions should be done?

1. Take vital signs every 8 hours
2. Weigh the client every other day
3. Assess for urine output every shift
4. Monitor the client’s electrolyte levels.

8.     A client has passed a renal calculus. The nurse sends the specimen to the laboratory so it can be analyzed for which of the following factors?

1. Antibodies
2. Type of infection
3. Composition of calculus
4. Size and number of calculi

9.     Which of the following symptoms indicate acute rejection of a transplanted kidney?

1. Edema, nausea
2. Fever, anorexia
3. Weight gain, pain at graft site
4. Increased WBC count, pain with voiding

10.  Adverse reactions of prednisone therapy include which of the following conditions?

1. Acne and bleeding gums
2. Sodium retention and constipation
3. Mood swings and increased temperature
4. Increased blood glucose levels and decreased wound healing.

11.  The nurse suspects that a client with polyuria is experiencing water diuresis. Which laboratory value suggests water diuresis?

1. High urine specific gravity
2. High urine osmolarity
3. Normal to low urine specific gravity
4. Elevated urine pH

12.  A client is diagnosed with prostate cancer. Which test is used to monitor progression of this disease?

1. Serum creatinine
2. Complete blood cell count (CBC)
3. Prostate specific antigen (PSA)
4. Serum potassium

13.  a 27-year old client, who became paraplegic after a swimming accident, is experiencing autonomic dysreflexia. Which condition is the most common cause of autonomic dysrelexia?

1. Upper respiratory infection
2. Incontinence
3. Bladder distention
4. Diarrhea

14.  When providing discharge teaching for a client with uric acid calculi, the nurse should an instruction to avoid which type of diet?

1. Low-calcium
2. Low-oxalate
3. High-oxalate
4. High-purine

15.  The client with urolithiasis has a history of chronic urinary tract infections. The nurse concludes that this client most likely has which of the following types of urinary stones?

1. Calcium oxalate
2. Uric acid
3. Struvite
4. Cystine

16.  The nurse is receiving in transfer from the postanesthesia care unit a client who has had a percutaneous ultrasonic lithrotripsy for calculuses in the renal pelvis. The nurse anticipates that the client’s care will involve monitoring which of the following?

1. Suprapubic tube
2. Urethral stent
3. Nephrostomy tube
4. Jackson-Pratt drain

17.  The client is admitted to the ER following a MVA. The client was wearing a lap seat belt when the accident occurred. The client has hematuria and lower abdominal pain. To determine further whether the pain is due to bladder trauma, the nurse asks the client if the pain is referred to which of the following areas?

1. Shoulder
2. Umbilicus
3. Costovertebral angle
4. Hip

18.  The client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client’s problem is related to bacterial prostatitis, the nurse would look at the results of the prostate examination, which should reveal that the prostate gland is:

1. Tender, indurated, and warm to the touch
2. Soft and swollen
3. Tender and edematous with ecchymosis
4. Reddened, swollen, and boggy.

19.  The nurse is taking the history of a client who has had benign prostatic hyperplasia in the past. To determine whether the client currently is experiencing difficulty, the nurse asks the client about the presence of which of the following early symptoms?

1. Urge incontinence
2. Nocturia
3. Decreased force in the stream of urine
4. Urinary retention

20.  The client who has a cold is seen in the emergency room with inability to void. Because the client has a history of BPH, the nurse determines that the client should be questioned about the use of which of the following medications?

1. Diuretics
2. Antibiotics
3. Antitussives
4. Decongestants

21.  The nurse is preparing to care for the client following a renal scan. Which of the following would the nurse include in the plan of care?

1. Place the client on radiation precautions for 18 hours
2. Save all urine in a radiation safe container for 18 hours
3. Limit contact with the client to 20 minutes per hour.
4. No special precautions except to wear gloves if in contact with the client’s urine.

22.  The client passes a urinary stone, and lab analysis of the stone indicates that it is composed of calcium oxalate. Based on this analysis, which of the following would the nurse specifically include in the dietary instructions?

1. Increase intake of meat, fish, plums, and cranberries
2. Avoid citrus fruits and citrus juices
3. Avoid green, leafy vegetables such as spinach.
4. Increase intake of dairy products.

23.  The client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. A Penrose drain is in place. Which of the following would the nurse include on the client’s postoperative care?

1. Sterile irrigation of the Penrose drain
2. Frequent dressing changes around the Penrose drain
3. Weighing the dressings
4. Maintaining the client’s position on the affected side

24.  The nurse is caring for a client following a kidney transplant. The client develops oliguria. Which of the following would the nurse anticipate to be prescribed as the treatment of oliguria?

1. Encourage fluid intake
2. Administration of diuretics
3. Irrigation of foley catheter
4. Restricting fluids

25.  A week after kidney transplantation the client develops a temperature of 101, the blood pressure is elevated, and the kidney is tender. The x-ray results the transplanted kidney is enlarged. Based on these assessment findings, the nurse would suspect which of the following?

1. Acute rejection
2. Chronic rejection
3. Kidney infection
4. Kidney obstruction

26.  The client with BPH undergoes a transurethral resection of the prostate. Postoperatively, the client is receiving continuous bladder irrigations. The nurse assesses the client for signs of transurethral resection syndrome. Which of the following assessment data would indicate the onset of this syndrome?

1. Bradycardia and confusion
2. Tachycardia and diarrhea
3. Decreased urinary output and bladder spasms
4. Increased urinary output and anemia

27.  The client is admitted to the hospital with BPH, and a transurethral resection of the prostate is performed. Four hours after surgery the nurse takes the client’s VS and empties the urinary drainage bag. Which of the following assessment findings would indicate the need to notify the physician?

1. Red bloody urine
2. Urinary output of 200 ml greater than intake
3. Blood pressure of 100/50 and pulse 130.
4. Pain related to bladder spasms.

28.  Which of the following symptoms is the most common clinical finding associated with bladder cancer?

1. Suprapubic pain
2. Dysuria
3. Painless hematuria
4. Urinary retention

29.  A client who has been diagnosed with bladder cancer is scheduled for an ileal conduit. Preoperatively, the nurse reinforces the client’s understanding of the surgical procedure by explaining that an ileal conduit:

1. Is a temporary procedure that can be reversed later.
2. Diverts urine into the sigmoid colon, where it is expelled through the rectum.
3. Conveys urine from the ureters to a stoma opening in the abdomen.
4. Creates an opening in the bladder that allows urine to drain into an external pouch.

30.  After surgery for an ileal conduit, the nurse should closely evaluate the client for the occurrence of which of the following complications related to pelvic surgery?

1. Peritonitis
2. Thrombophlebitis
3. Ascites
4. Inguinal hernia

31.  The nurse is assessing the urine of a client who has had an ileal conduit and notes that the urine is yellow with a moderate amount of mucus. Based on the assessment data, which of the following nursing interventions would be most appropriate at this time?

1. Change the appliance bag
2. Notify the physician
3. Obtain a urine specimen for culture
4. Encourage a high fluid intake

32.  When teaching the client to care for an ileal conduit, the nurse instructs the client to empty the appliance frequently, primarily to prevent which of the following problems?

1. Rupture of the ileal conduit
2. Interruption of urine production
3. Development of odor
4. Separation of the appliance from the skin

33.  The client with an ileal conduit will be using a reusable appliance at home. The nurse should teach the client to clean the appliance routinely with what product?

1. Baking soda
2. Soap
3. Hydrogen peroxide
4. Alcohol

34.  The nurse is evaluating the discharge teaching for a client who has an ileal conduit. Which of the following statements indicates that the client has correctly understood the teaching? Select all that apply.

1. “If I limit my fluid intake I will not have to empty my ostomy pouch as often.”
2. “I can place an aspirin tablet in my pouch to decrease odor.”
3. “I can usually keep my ostomy pouch on for 3 to 7 days before changing it.”
4. “I must use a skin barrier to protect my skin from urine.”
5. “I should empty my ostomy pouch of urine when it is full.”

35.  A female client with a urinary diversion tells the nurse, “This urinary pouch is embarrassing. Everyone will know that I’m not normal. I don’t see how I can go out in public anymore.” The most appropriate nursing diagnosis for this patient is:

1. Anxiety related to the presence of urinary diversion.
2. Deficient Knowledge about how to care for the urinary diversion.
3. Low Self-Esteem related to feelings of worthlessness
4. Disturbed Body Image related to creation of a urinary diversion.

36.  The nurse teaches the client with a urinary diversion to attach the appliance to a standard urine collection bag at night. The most important reason for doing this is to prevent:

1. Urine reflux into the stoma
2. Appliance separation
3. Urine leakage
4. The need to restrict fluids

37.  The nurse teaches the client with an ileal conduit measures to prevent a UTI. Which of the following measures would be most effective?

1. Avoid people with respiratory tract infections
2. Maintain a daily fluid intake of 2,000 to 3,000 ml
3. Use sterile technique to change the appliance
4. Irrigate the stoma daily.

38.  A client who has been diagnosed with calculi reports that the pain is intermittent and less colicky. Which of the following nursing actions is most important at this time?

1. Report hematuria to the physician
2. Strain the urine carefully
3. Administer meperidine (Demerol) every 3 hours
4. Apply warm compresses to the flank area

39.  A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter would be to:

1. Irrigate the catheter with 30 ml of normal saline every 8 hours
2. Ensure that the catheter is draining freely
3. Clamp the catheter every 2 hours for 30 minutes.
4. Ensure that the catheter drains at least 30 ml an hour

40.  Which of the following interventions would be most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery?

1. Encourage the client to ambulate every 2 to 4 hours
2. Offer 3 to 4 ounces of a carbonated beverage periodically.
3. Encourage use of a stool softener
4. Continue intravenous fluid therapy

41.  The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. Which of the following findings would be most important for the nurse to report to the physician?

1. Temperature, 99.8
2. Urine output, 20 ml/hour
3. Absence of bowel sounds
4. A 2×2 inch area of serous sanguineous drainage on the flank dressing.

42.  Because a client’s renal stone was found to be composed to uric acid, a low-purine, alkaline-ash diet was ordered. Incorporation of which of the following food items into the home diet would indicate that the client understands the necessary diet modifications?

1. Milk, apples, tomatoes, and corn
2. Eggs, spinach, dried peas, and gravy.
3. Salmon, chicken, caviar, and asparagus
4. Grapes, corn, cereals, and liver.

43.  Allopurinol (Zyloprim), 200 mg/day, is prescribed for the client with renal calculi to take home. The nurse should teach the client about which of the following side effects of this medication?

1. Retinopathy
2. Maculopapular rash
3. Nasal congestion
4. Dizziness

44.  The client has a clinic appointment scheduled 10 days after discharge. Which laboratory finding at that time would indicate that allopurinol (Zyloprim) has had a therapeutic effect?

1. Decreased urinary alkaline phosphatase level
2. Increased urinary calcium excretion
3. Increased serum calcium level
4. Decreased serum uric acid level

45.  When developing a plan of care for the client with stress incontinence, the nurse should take into consideration that stress incontinence is best defined as the involuntary loss of urine associated with:

1. A strong urge to urinate
2. Overdistention of the bladder
3. Activities that increase abdominal pressure
4. Obstruction of the urethra

46.  Which of the following assessment data would most likely be related to a client’s current complaint of stress incontinence?

1. The client’s intake of 2 to 3 L of fluid per day.
2. The client’s history of three full-term pregnancies
3. The client’s age of 45 years
4. The client’s history of competitive swimming

47.  The nurse is developing a teaching plan for a client with stress incontinence. Which of the following instructions should be included?

1. Avoid activities that are stressful and upsetting
2. Avoid caffeine and alcohol
3. Do not wear a girdle
4. Limit physical exertion

48.  A client has urge incontinence. Which of the following signs and symptoms would the nurse expect to find in this client?

1. Inability to empty the bladder
2. Loss of urine when coughing
3. Involuntary urination with minimal warning
4. Frequent dribbling of urine

49.  A 72-year old male client is brought to the emergency room by his son. The client is extremely uncomfortable and has been unable to void for the past 12 hours. He has known for some time that he has an enlarged prostate but has wanted to avoid surgery. The best method for the nurse to use when assessing for bladder distention in a male client is to check for:

1. A rounded swelling above the pubis.
2. Dullness in the lower left quadrant
3. Rebound tenderness below the symphysis
4. Urine discharge from the urethral meatus

50.  During a client’s urinary bladder catherization, the bladder is emptied gradually. The best rationale for the nurse’s action is that completely emptying an overdistended bladder at one time tends to cause:

1. Renal failure
2. Abdominal cramping
3. Possible shock
4. Atrophy of bladder musculature

51.  The primary reason for taping an indwelling catheter laterally to the thigh of a male client is to:

1. Eliminate pressure at the penoscrotal angle
2. Prevent the catheter from kinking in the urethra
3. Prevent accidental catheter removal
4. Allow the client to turn without kinking the catheter

52.  The primary function of the prostate gland is:

1. To store underdeveloped sperm before ejaculation
2. To regulate the acidity and alkalinity of the environment for proper sperm development.
3. To produce a secretion that aids in the nourishment and passage of sperm
4. To secrete a hormone that stimulates the production and maturation of sperm

53.  The nurse is reviewing a medication history of a client with BPH. Which medication should be recognized as likely to aggravate BPH?

1. Metformin (Glucophage)
2. Buspirone (BuSpar)
3. Inhaled ipratropium (Atrovent)
4. Ophthalmic timolol (Timoptic)

54.  A client is scheduled to undergo a transurethral resection of the prostate gland (TURP). The procedure is to be done under spinal anesthesia. Postoperatively, the nurse should be particularly alert for early signs of:

1. Convulsions
2. Cardiac arrest
3. Renal shutdown
4. Respiratory paralysis

55.  A client with BPH is being treated with terazosin (Hytrin) 2mg at bedtime. The nurse should monitor the client’s:

1. Urinary nitrites
2. White blood cell count
3. Blood pressure
4. Pulse

56.  A client underwent a TURP, and a large three way catheter was inserted in the bladder with continuous bladder irrigation. In which of the following circumstances would the nurse increase the flow rate of the continuous bladder irrigation?

1. When the drainage is continuous but slow
2. When the drainage appears cloudy and dark yellow
3. When the drainage becomes bright red
4. When there is no drainage of urine and irrigating solution

57.  A priority nursing diagnosis for the client who is being discharged t home 3 days after a TURP would be:

1. Deficient fluid volume
2. Imbalanced Nutrition: Less than Body Requirements
3. Impaired Tissue Integrity
4. Ineffective Airway Clearance

58.  If a client’s prostate enlargement is caused by a malignancy, which of the following blood examinations should the nurse anticipate to assess whether metastasis has occurred?

1. Serum creatinine level
2. Serum acid phosphatase level
3. Total nonprotein nitrogen level
4. Endogenous creatinine clearance time

59. Steroids, if used following kidney transplantation would cause which of the following side effects?

1. Alopecia
2. Increase Cholesterol Level
3. Orthostatic Hypotension
4. Increase Blood Glucose Level

60. Mr. Roberto was readmitted to the hospital with acute graft rejection. Which of the following assessment finding would be expected?

1. Hypotension
2. Normal Body Temperature
3. Decreased WBC
4. Elevated BUN and Creatinine

Answers and Rationales

1. A. Urine should be strained for calculi and sent to the lab for analysis. Fluid intake of 3 to 4 L is encouraged to flush the urinary tract and prevent further calculi formation. A low-calcium diet is recommended to help prevent the formation of calcium calculi. Ambulation is encouraged to help pass the calculi through gravity.
2. D. Cystitis is the most common adverse reaction of clients undergoing radiation therapy; symptoms include dysuria, frequency, urgency, and nocturia. Clients with radiation implants require a private room. Urine of clients with radiation implants for bladder cancer should be sent to the radioisotopes lab for monitoring. It is recommended that fluid intake be increased.
3. C. Infections is the major complication to watch for in clients on cyclosporine therapy because it’s an immunosuppressive drug. Depression may occur posttransplantation but not because of cyclosporine. Hemorrhage is a complication associated with anticoagulant therapy. Peptic ulcer disease is a complication of steroid therapy.
4. D. In a client with acute renal graft rejection, evidence of deteriorating renal function is expected. The nurse would see elevated WBC counts and fever because the body is recognizing the graft as foreign and is attempting to fight it. The client would most likely have acute hypertension.
5. D. The client undergoing a renal transplantation will need vigilant follow-up care and must adhere to the medical regimen. The client is most likely anuric or oliguric preoperatively, but postoperatively will require close monitoring of urine output to make sure the transplanted kidney is functioning optimally. While the client will always need to be monitored for signs and symptoms of infection, it’s most important post-op will require close monitoring of urine output to make sure the transplanted kidney is functioning optimally. While the client will always need to be monitored for signs and symptoms of infection, it’s most important postoperatively due to the immunosuppressant therapy. Rejection can occur postoperatively.
6. D. Blood clots and blocked outflow if the urine can increase spasms. The irrigation shouldn’t be stopped as long as the catheter is draining because clots will form. A belladonna and opium suppository should be given to relieve spasms but only afterassessment of the drainage. Oral analgesics should be given if the spasms are unrelieved by the belladonna and opium suppository.
7. D. Postobstructive diuresis seen in hydronephrosis can cause electrolyte imbalances; lab values must be checked so electrolytes can be replaced as needed. VS should initially be taken every 30 minutes for the first 4 hours and then every 2 hours. Urine output needs to be assessed hourly. The client’s weight should be taken daily to assess fluid status more closely.
8. C. The calculus should be analyzed for composition to determine appropriate interventions such as dietary restrictions. Calculi don’t result in infections. The size and number of calculi aren’t relevant, and they don’t contain antibodies.
9. C. Pain at the graft site and weight gain indicates the transplanted kidney isn’t functioning and possibly is being rejected. Transplant clients usually have edema, anorexia, fever, and nausea before transplantation, so those symptoms may not indicate rejection.
10. D. Steroid use tends to increase blood glucose levels, particularly in clients with diabetes and borderline diabetes. Steroids also contribute to poor wound healing and may cause acne, mood swings, and sodium and water retention. Steroids don’t affect thermoregulation, bleeding tendencies, or constipation.
11. C. Water diuresis causes low urine specific gravity, low urine osmolarity, and a normal to elevated serum sodium level. High specific gravity indicates dehydration. Hypernatremia signals acidosis and shock. Elevated urine pH can result from potassium deficiency, a high-protein diet, or uncontrolled diabetes.
12.  C. The PSA test is used to monitor prostate cancer progression; higher PSA levels indicate a greater tumor burden. Serum creatinine levels may suggest blockage from an enlarged prostate. CBC is used to diagnose anemia and polycythemia. Serum potassium levels identify hypokalemia and hyperkalemia.
13. C. Autonomic dysreflexia is a potentially life-threatening complication of spinal cord injury, occurring from obstruction of the urinary system or bowel. Incontinence and diarrhea don’t result in obstruction of the urinary system or bowel, respectively. An URI could obstruct the respiratory system, but not the urinary or bowel system.
14. D. To control uric acid calculi, the client should follow a low-purine diet, which excludes high-purine foods such as organ meats. A low-calcium diet decreases the risk for oxalate renal calculi. Oxalate is an essential amino acid and must be included in the diet. A low-oxalate diet is used to control calcium or oxalate calculi.
15. C. Struvite stones commonly are referred to as infection stones because they form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Calcium oxalate stones result from increased calcium intake or conditions that raise serum calcium concentrations. Uric acid stones occur in clients with gout. Cystine stones are rare and occur in clients with a genetic defect that results in decreased renal absorption of the amino acid cystine.
16. C. A nephrostomy tube is put in place after a percutaneous ultrasonic lithotripsy to treat calculuses in the renal pelvis. The client may also have a foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect elimination of the calculus fragments.
17. A. Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders. Bladder injury pain does not radiate to the umbilicus, CV angle, or hip.
18. A. The client with prostatitis has a prostate gland that is swollen and tender but that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection (which often accompany the disorder).
19. C. Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur.
20. D. In the client with BPH, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about the use of these medications if the client has urinary retention. Retention can also be precipitated by other factors, such as alcoholic beverages, infection, bedrest, and becoming chilled.
21. D. No specific precautions are necessary following a renal scan. Urination into a commode is acceptable without risk from the small amount of radioactive material to be excreted. The nurse wears gloves to maintain body secretion precautions.
22. C. Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.
23. B. Frequent dressing changes around the Penrose drain is required to protect the skin against breakdown from urinary drainage. If urinary drainage is excessive, an ostomy pouch may be placed over the drain to protect the skin. A Penrose drain is not irrigated. Weighing the dressings is not necessary. Placing the client on the affected side will prevent a free flow of urine through the drain.
24. B. To increase urinary output, diuretics and osmotic agents are considered. The client should be monitored closely because fluid overload can cause hypertension, congestive heart failure, and pulmonary edema. Fluid intake would not be encouraged or restricted. Irrigation of the foley catheter will not assist in allievating this oliguria.
25. A. Acute rejection most often occurs in the first 2 weeks after transplant. Clinical manifestations include fever, malaise, elevated WBC count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Chronic rejection occurs gradually during a period of months to years. Although kidney infection or obstruction can occur, the symptoms presented in the question do not relate specifically to these disorders.
26. A. Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.
27. C. Frank bleeding (arterial or venous) may occur during the first few days after surgery. Some hematuria is usual for several days after surgery. A urinary output of 200 ml of greater than intake is adequate. Bladder spasms are expected to occur after surgery. A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The physician should be notified.
28. C. Painless hematuria is the most common clinical finding in bladder cancer. Other symptoms include frequency, dysuria, and urgency, but these are not as common as the hematuria. Suprapubic pain and urinary retention do not occur in bladder cancer.
29. C. An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected and one end of the segment is closed. The ureters are surgically attached to this segment of the ileum, and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma. The client must wear a pouch to collect the urine that continually flows through the conduit. The bladder is removed during the surgical procedure and the ileal conduit is not reversible. Diversion of the urine to the sigmoid colon is called a ureteroileosigmoidostomy. An opening in the bladder that allows urine to drain externally is called a cystostomy.
30. B. After pelvic surgery, there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. Peritonitis is a potential complication of any abdominal surgery, not just pelvic surgery. Ascites is most frequently an indication of liver disease. Inguinal hernia may be caused by an increase in abdominal pressure or a congenital weakness of the abdominal wall; ventral hernia occurs at the site of a previous abdominal surgery.
31. D. Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Because mucus in the urine is expected, it is not necessary to change the appliance bag or notify the physician. The mucus is not an indication of an infection, so a urine culture is not necessary.
32. D. If the appliance becomes too full, it is likely to pull away from the skin completely or to leak urine onto the skin. A full appliance will not rupture the ileal conduit or interrupt urine production. Odor formation has numerous causes.
33. B. A reusable appliance should be routinely cleaned with soap and water.
34. C, D. The client with an ileal conduit must learn self-care activities related to care of the stoma and ostomy appliances. The client should be taught to increase fluid intake to about 3,000 ml per day and should not limit intake. Adequate fluid intake helps to flush mucus from the ileal conduit. The ostomy appliance should be changed approximately every 3 to 7 days and whenever a leak develops. A skin barrier is essential to protecting the skin from the irritation of the urine. An aspirin should not be used as a method of odor control because it can be an irritant to the stoma and lead to ulceration. The ostomy pouch should be emptied when it is one-third to one-half full to prevent the weight from pulling the appliance away from the skin.
35. D. It is normal for clients to express fears and concerns about the body changes associated with a urinary diversion. Allowing the client time to verbalize concerns in a supportive environment and suggest that she discuss these concerns with people who have successfully adjusted to ostomy surgery can help her begin coping with these changes in a positive manner. Although the client may be anxious about this situation and self-esteem may be diminished, the underlying problem is disturbance in body image. There are no data to support a diagnosis of Deficient Knowledge.
36. A. The most important reason for attaching the appliance to a standard urine collection bag at night is to prevent reflux into the stoma and ureters, which can result in infection. Use of a standard collection bag also keeps the appliance from separating from the skin and helps prevent urine leakage from an overly full bag, but the primary purpose is to prevent reflux of urine. A client with a urinary diversion should drink 2000-3000 ml of fluid each day; it would be inappropriate to suggest decreasing fluid intake.
37. B. Maintaining a fluid intake of 2,000 to 3,000 ml/day is likely to be effective in preventing UTI. A high fluid intake results in high urine output, which prevents urinary stasis and bacterial growth. Avoiding people with respiratory tract infections will not prevent urinary tract infections. Clean, not sterile, technique is used to change the appliance. An ileal conduit stoma is not irrigated.
38. B. Intermittent pain that is less colicky indicates that the calculi may be moving along the urinary tract. Fluids should be encouraged to promote movement, and the urine should be strained to detect passage of the stone. Hematuria is to be expected from the irritation of the stone. Analgesics should be administered when the client needs them, not routinely. Moist heat to the flank area is helpful when renal colic occurs, but it is less necessary as pain is lessoned.
39. B. The ureteral catheter should drain freely without bleeding at the site. The catheter is rarely irrigated, and any irrigation would be done by the physician. The catheter is never clamped. The client’s total urine output (ureteral catheter plus voiding or foley catheter output) should be 30 ml/hour.
40. A. Ambulation stimulates peristalsis. A client with paralytic ileus is kept NPO until peristalsis returns. Intravenous fluid infusion is a routine postoperative order that does not have any effect on preventing paralytic ileus. A stool softener will not stimulate peristalsis.
41. B. The decrease in urinary output may indicate inadequate renal perfusion and should be reported immediately. Urine output of 30 ml/hour or greater is considered acceptable. A slight elevation in temperature is expected after surgery. Peristalsis returns gradually, usually the second or third day after surgery. Bowel sounds will be absent until then. A small amount of serous sanguineous drainage is to be expected.
42.  A. Because a high-purine diet contributes to the formation of uric acid, a low-purine diet is advocated. An alkaline-ash diet is also advocated, because uric acid crystals are more likely to develop in acid urine. Foods that may be eaten as desired in a low-purine diet include milk, all fruits, tomatoes, cereals, and corn. Food allowed on an alkaline-ash diet include milk, fruits (except cranberries, plums, and prunes), and vegetables (especially legumes and green vegetables). Gravy, chicken, and liver are high in purine.
43. B. Allopurinol is used to treat renal calculi composed of uric acid. Side effects of allopurinol include drowsiess, maculopapular rash, anemia, abdominal pain, nausea, vomiting, and bone marrow depression. Clients should be instructed to report skin rashes and any unusual bleeding or bruising. Retinopathy, nasal congestion, and dizziness are not side effects of allopurinol.
44. D. By inhibiting uric acid synthesis, allopurinol decreases its excretion. The drug’s effectiveness is assessed by evaluating for a decreased serum uric acid concentration. Allopurinol does not alter the level of alkaline phosphatase, not does it affect urinary calcium excretion or the serum calcium level.
45. C. Stress incontinence is the involuntary loss of urine during such activities as coughing, sneezing, laughing, or physical exertion. These activities increase abdominal and detruser pressure. A strong urge to urinate is associated with urge incontinence. Overdistention of the bladder can lead to overflow incontinence. Obstruction of the urethra can lead to urinary retention.
46. B. The history of three pregnancies is most likely the cause of the client’s current episodes of stress incontinence. The client’s fluid intake, age, or history of swimming would not create an increase in intra-abdominal pressure.
47. B. Client’s with stress incontinence are encouraged to avoid substances such as caffeine and alcohol which are bladder irritants. Emotional stressors do not cause stress incontinence. It is caused most commonly be relaxed pelvic musculature. Wearing girdles is not contraindicated. Although clients may be inclined to limit physical exertion to avoid incontinence episodes, they should be encouraged to seek treatment instead of limiting their activities.
48. C. A characteristic of urge incontinence is involuntary urination with little or no warning. The inability to empty the bladder is urinary retention. Loss of urine when coughing occurs with stress incontinence. Frequent dribbling of urine is common in male clients after some types of prostate surgery or may occur in women after the development of vesicovaginal or urethrovaginal fistula.
49. A. The best way to assess for a distended bladder in either a male or female client is to check for a rounded swelling above the pubis. The swelling represents the distended bladder rising above the pubis into the abdominal cavity. Dullness does not indicate a distended bladder. The client might experience tenderness or pressure above the symphysis. No urine discharge is expected; the urine flow is blocked by the enlarged prostate.
50. C. Rapid emptying of an overdistended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. Previously, removing no more than 1,000 ml at one time was the standard of practice, but this is no longer thought to be necessary as long as the overdistended bladder is emptied slowly.
51. A. The primary reason for taping an indwelling catheter to a male client soothe penis is held in a lateral position to prevent pressure at the penoscrotal angle. Prolonged pressure at the penoscrotal angle can cause a ureterocutaneous fistula.
52. C. The prostate gland is located below the bladder and surrounds the urethra. It serves one primary purpose: to produce a secretion that aids in the nourishment and passage of sperm.
53. C. Atrovent is a bronchodilator, and its anticholinergic effects can aggravate urinary retention. Glucophage and BuSpar do not affect the urinary system; timolol does not have a systemic effect.
54. D. If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal anesthesia is used, the client is likely to develop respiratory paralysis. Artificial ventilation is required until the effects of the anesthesia subside. Convulsions, cardiac arrest, and renal shutdown are not likely results of spinal anesthesia.
55. C. Terazosin (Hytrin) is an antihypertensive drug that is also used in the treatment of BPH. Blood pressure must be monitored to ensure that the client does not develop hypotension, syncope, or postural hypotension. The client should be instructed to change positions slowly. Urinary nitrites, white blood cell count, and pulse rate are not affected by terazosin.
56. C. The decision made by the surgeon to insert a catheter after a TURP or prostatectomy depends on the amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the drainage becomes brighter red. The color indicates the presence of blood. Increasing the flow of irrigating solution helps flush the catheter well so clots do not plug it. There would be no reason to increase the flow rate when the return is continuous or when the return appears cloudy and dark yellow. Increasing the flow would be contraindicated when there is no return of urine and irrigating solution.
57. A. Deficient Fluid Volume is a priority diagnosis, because the client needs to drink a large amount of fluid to keep the urine clear. The urine should be almost without color. About 2 weeks after a TURP, when desiccated tissue is sloughed out, a secondary hemorrhage could occur. The client should be instructed to call the surgeon or go to the ED if at any time the urine turns bright red. The client is not specifically at risk for nutritional problems after a TURP. The client is not specifically at risk for impaired tissue integrity because there is no external incision, and the client is not specifically at risk for airway problems because the procedure is done after spinal anesthesia.
58. B. The most specific examination to determine whether a malignancy extends outside of the prostatic capsule is a study of the serum acid phosphatase level. The level increases when a malignancy has metastasized. The prostate specific antigen (PSA) determination and a digital rectal examination are done when screening for prostate cancer. Serum creatinine level, total nonprotein nitrogen level, and endogenous creatinine clearance time give information about kidney function, not prostate malignancy.
59. D.
60. D.