NCLEX-PN
NCLEX Genitourinary Questions Questions
Extract:
Question 1 of 5
Which intervention should the nurse include when assessing the client for urinary retention? Select all that apply.
Correct Answer: A,B,C,D
Rationale: Assessing urinary retention involves asking about fullness, percussing for dullness (indicating a full bladder), scanning with ultrasound for residual urine, and palpating for a distended bladder. Auscultation is not relevant.
Question 2 of 5
The nurse is preparing the plan of care for a client with fluid volume deficit. Which interventions should the nurse include in the plan of care? Select all that apply.
Correct Answer: A,B,E
Rationale: For fluid volume deficit, monitor vital signs frequently for stability, track intake/output daily to assess hydration, and assess skin turgor/mucous membranes for dehydration. Weekly weights are too infrequent, and mouth care during bathing is not specific.
Question 3 of 5
Which intervention is most important for the nurse to implement for the client with a left nephrectomy?
Correct Answer: A
Rationale: Post-nephrectomy, maintaining adequate hydration and perfusion to the remaining kidney is critical to prevent acute kidney injury. Assessing IV fluid rate and volume ensures proper fluid balance. Dressing changes, coagulation monitoring, and meal intake are less urgent.
Question 4 of 5
Which response by the nurse is most appropriate?
Correct Answer: C
Rationale:
To comply with HIPAA, the nurse must protect the client's privacy and not disclose health information without consent, making this the most appropriate response.
Question 5 of 5
After inserting an indwelling catheter into a male client, which technique is most appropriate for stabilizing the catheter to avoid damage to the penis?
Correct Answer: A
Rationale: Taping the catheter to the abdomen stabilizes it without causing traction or damage to the penis, promoting comfort and safety.