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A nurse is caring for older adult clients at a long-term care facility. Which of the following assessments should the nurse consider when monitoring clients for urinary retention? (Select all that apply.)

Dribbling of urine

Color of the urine

Voiding patern

Proteinuria

Bladder distension

Answer and Explanation

Correct Answer : A,C,E

Choice A reason: Dribbling of urine can indicate urinary retention, as it may suggest that the bladder is not emptying

completely during voiding.

Choice B reason: While the color of the urine can provide information about hydration status and other health issues, it is not a direct indicator of urinary retention.

Choice C reason: The voiding patern is an important assessment for urinary retention. Infrequent voiding or small amounts despite a full bladder can be signs of this condition.

Choice D reason: Proteinuria is not typically used as an assessment for urinary retention. It can indicate kidney damage or disease but does not directly relate to the bladder's ability to empty.

Choice E reason: Bladder distension can be observed and palpated in cases of urinary retention, as the bladder may become enlarged due to the accumulation of urine.

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Correct Answer is C

Explanation

Choice A reason: The output solution is typically the same or slightly less than the input solution due to fluid removal during dialysis.

Choice B reason: The fluid from the abdomen should be clear or slightly yellow; any other color may indicate infection or bleeding.

Choice C reason: Using a microwave to warm the solution is not recommended as it can unevenly heat the solution and damage its composition.

Choice D reason: While sterile precautions are taken, there is still a risk of infection with any catheter.

A. "The kidney infection has caused narrowing of the ureters, and your abdomen has filled with fluid." B. "The kidneys continue to enlarge due to the cysts growing, which increases the girth of your abdomen." C. "The stones might descend into the ureters, blocking the flow of urine and causing an increase in the girth of your abdomen." D. "The in?ammation in your kidneys damages the filtration system, which causes fluid retention in your abdomen."

Correct Answer is B

Explanation

Choice A reason: While kidney infections can cause swelling, they typically do not lead to a significant increase in abdominal girth unless associated with severe obstruction or advanced kidney disease.

Choice B reason: In PKD, the kidneys can become significantly enlarged due to the growth of numerous cysts, which

can indeed lead to an increase in abdominal girth.

Choice C reason: While stones can cause blockage and swelling, they would not typically result in a generalized increase in abdominal girth unless there is an associated infection or severe obstruction.

Choice D reason: Inflammation can lead to fluid retention, but in the context of PKD, it is the cysts' growth that primarily contributes to increased kidney size and abdominal girth.

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A nurse is caring for older adult clients at a long-term care facility. Which of the following assessments should the nurse consider when monitoring clients for urinary retention? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a client about self-administered peritoneal dialysis. Which of the following statements by the client indicates a need for further teaching?

Correct Answer is C

Explanation

A nurse is caring for a client who has polycystic kidney disease (PKD). The client is admited to the hospital for renal calculi and reports that their abdomen has been getting bigger. Which of the following statements by the nurse is the best explanation for the increase in abdominal girth?

Correct Answer is B

Explanation

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