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ch 48 Urinary elimination NCLEX questions with correct answers.
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ch 48 Urinary elimination NCLEX questions with correct answers.
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ch 48 Urinary elimination NCLEX questions withcorrect answers
The nurse recognizes that urinary elimination changes may occur even
in healthy older adults because of which of the following?
The bladder distends and its capacity increases.
Older adults ignore the need to void.
Urine becomes more concentrated.
The amount of urine retained after voiding increases. Correct Answer-
The amount of urine retained after voiding increases.
Rationale: The capacity of the bladder may decrease with age but the
muscle is weaker and can cause urine to be retained (option 4). Older
adults do not ignore the urge to void and may have difficulty in getting
to the toilet in time (option 2). The kidney becomes less able to
concentrate urine with age (option 3).
Cognitive Level: Remembering.
Client Need: Physiological Integrity.
Nursing Process: Assessment.
During assessment of the client with urinary incontinence, the nurse is
most likely to assess for which of the following? Select all that apply.
Perineal skin irritation
Fluid intake of less than 1,500 mL/day
,History of antihistamine intake
History of frequent urinary tract infections
A fecal impaction Correct Answer-Perineal skin irritation
Fluid intake of less than 1,500 mL/day
History of frequent urinary tract infections
A fecal impaction
Rationale: The perineum may become irritated by the frequent contact
with urine (option 1). Normal fluid intake is at least 1,500 mL/day and
clients often decrease their intake to try to minimize urine leakage
(option 2). UTIs can contribute to incontinence (option 4). A fecal
impaction can compress the urethra, which can result in small amounts
of urine leakage (option 5). Antihistamines can cause urinary retention
rather than incontinence (option 3).
Cognitive Level: Analyzing.
Client Need: Physiological Integrity.
Nursing Process: Assessment.
Which action represents the appropriate nursing management of a client
wearing a condom catheter?
, Ensure that the tip of the penis fits snugly against the end of the
condom.
Check the penis for adequate circulation 30 minutes after applying.
Change the condom every 8 hours.
Tape the collecting tubing to the lower abdomen. Correct Answer-
Check the penis for adequate circulation 30 minutes after applying.
Rationale: The penis and condom should be checked one-half hour after
application to ensure that it is not too tight. A 1-in. space should be left
between the penis and the end of the condom (option 1). The condom is
changed every 24 hours (option 3), and the tubing is taped to the leg or
attached to a leg bag (option 4). An indwelling catheter is taped to the
lower abdomen or upper thigh.
Cognitive Level: Applying.
Client Need: Safe, Effective Care Environment.
Nursing Process: Implementation.
The catheter slips into the vagina during a straight catheterization of a
female client. The nurse does which action?
Leaves the catheter in place and gets a new sterile catheter.
Leaves the catheter in place and asks another nurse to attempt the
procedure.
Removes the catheter and redirects it to the urinary meatus.
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