Gender Specific Problems

A client is admitted to the emergency department following a fall from a horse and the health care provider (HCP) prescribes insertion of a Foley catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? 1. Notify the HCP. 2. Use a small-sized catheter. 3. Administer pain medication before inserting the catheter. 4. Use extra povidone-iodine solution in cleansing the meatu

1. Notify the HCP. Rationale: The presence of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse notifies the HCP, knowing that the client should not be catheterized until the cause of the bleeding is determined by diagnostic testing. Therefore options 2, 3, and 4 are incorrect.

In addition to nausea and severe flank pain, a female client w/ renal calculi has pain in the groin and bladder. the nurse should assess the client further for signs of: 1. nephritis 2. referered pain 3. urine retention 4. additinal stone formation

1. referrered pain Rationale: the pain associated with renal colic due to calculi is commonly referred to the groin and bladder in female clients & to the testicles in male clients. nausea, vomiting, abdominal cramping, and diarrhea may also be present. nephritis or urine retention is an unlikely cause of the referred pain. the type of pain described in this situation is unlikely to be caused by additional stont formation

The nursing student is caring for a client with a diagnosis of benign prostatic hyperplasia (BPH). The nursing instructor asks the student to identify the clinical manifestations associated with this condition. The student needs to research the condition further if the student states that which finding is an early symptom of BPH? 1. Nocturia 2. Hematuria 3. Decreased force of urine stream 4. Difficulty initiating urine stream

2. Hematuria Rationale: Hematuria is not an early sign of BPH. Nocturia, decreased force of urinary stream, and difficulty initiating urinary stream are all early signs of BPH

The nurse provides discharge instructions to a client after a prostatectomy. What is the priority discharge instruction for this client? 1. Avoid driving a car for at least 1 week. 2. Increase fluid intake to at least 2.5 L/day. 3. Avoid lifting any objects greater than 30 pounds. 4. Contact the health care provider (HCP) if small clots are noticed in the urine.

2. Increase fluid intake to at least 2.5 L/day. Rationale: A daily intake of 2.5 L of fluid should be maintained to limit clot formation and prevent infection. Driving a car and sitting for long periods are restricted for at least 3 weeks. The client should be instructed to avoid lifting objects heavier than 20 pounds for at least 6 weeks. Passing small pieces of tissue or blood clots in the urine for up to 2 weeks after surgery is expected and does not necessitate contacting the HCP.

The nurse is caring for a client just after ureterolithotomy and is monitoring the drainage from the ureteral catheter hourly. Suddenly, the catheter stops draining. The nurse assesses the client and determines that which is the least likely cause of the problem? 1. Blood clots 2. Ureteral edema 3. Chemical sediment 4. Catheter displacement

2. Ureteral edema Rationale: After ureterolithotomy, a ureteral catheter is put in place. Urine flows freely through it for the first 2 to 3 days. As ureteral edema diminishes, urine leaks around the ureteral catheter and drains directly into the bladder. At this point drainage through the ureteral catheter diminishes. Immediately after surgery, absence of drainage usually is caused by blockage from blood clots, mucous shreds, chemical sediment, or catheter displacement.

Which of the following nursing interventions is likely to provide the most relief from the pain associated with renal colic? 1. applying most heat to the flank area 2. administering meperidine (dermerol) 3. encouraging high fluid intake 4. maintaining complete bed rest

2. administering meperidine (Dermerol) Rationale: During episodes of renal colic, the pain is excruciating. it is necessary to administer opioid analgesics to control the pain. application of heat, encouraging high fluid intake, and limitation of activity are important interventions, but they will not relieve the renal colic pain.

a 24-year-old female client comes to an ambulatory care clinic in moderate distress with a probable diagnosis of acute cystitis. when obtaining the client's history, the nurse should ask the client if she has had: 1. fever and chills 2. frequency and burning on urination 3. flank pain & nausea 4. hematuria

2. frequency and burning on urination

a client w/ UTI is to take nitrofurantoin four times a day. the client asks the nurse, "What should I do if I forget a dose?" what should the nurse tell the client? 1. "you can wait and take the next dose when it is due." 2. "double the amount prescribed with your next dose." 3. "take the prescribed dose as soon as you remember it, it if it is very close to the time for the next dose, delay that net dose." 4. "take a lot of water with a double amount of your prescribed dose"

3. "take the prescribed dose as soon as you remember it, it if it is very close to the time for the next dose, delay that net dose."

The nurse is preparing a plan of care for the client diagnosed with acute glomerulonephritis. Which statement is an appropriate long-term goal? 1. The client will have a blood pressure within normal limits. 2. The client will show no protein in the urine. 3. The client will maintain normal renal function. 4. The client will have clear lung sounds.

3. The client will maintain normal renal function Rationale: 1. Blood pressure within normal limits is a short-term goal. 2. Lack of protein in the urine is a short-term goal. 3. A long-term complication of glomerulonephritis is it can become chronic if unresponsive to treatment, and this can lead to end-stage renal disease. Maintaining renal function is an appropriate long-term goal. 4. Clear lung sounds indicate the client has been able to process fluids and excrete them from the body. Preventing pulmonary edema is a short-term goal. TEST-TAKING HINT: Answer options "1," "2," and "4" all refer to body processes controlled or treated immediately after assessment of the problem. The stem is requesting a long-term goal.

The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client? 1. Fluid volume loss. 2. Knowledge deficit. 3. Impaired urinary elimination. 4. Alteration in comfort.

4. Alteration in comfort. Rationale: 1. The client's fluid volume is increased and there is usually not a fluid volume loss. 2. Knowledge deficit is important to help prevent future renal calculi, but this is not priority when the client is in pain, which will occur with an acute episode. 3. Impaired urinary elimination may occur, but it is not priority for the client with an acute episode of calculi. 4. Pain is priority. The pain can be so severe a sympathetic response may occur, causing nausea; vomiting; pallor; and cool, clammy skin. TEST-TAKING HINT: Remember Maslow's hierarchy of needs: airway and pain are priority. No option mentions possible airway problems, so pain is priority.

The client asks, "What does an elevated PSA test mean?" On which scientific rationale should the nurse base the response? 1. An elevated PSA can result from several different causes. 2. An elevated PSA can be only from prostate cancer. 3. An elevated PSA can be diagnostic for testicular cancer. 4. An elevated PSA is the only test used to diagnose BPH.

1. An elevated PSA can result from several different causes. Rationale: 1. An elevated PSA can be from urinary retention, BPH, prostate cancer, or prostate infarct. 2. An elevated PSA does not indicate only prostate cancer. 3. PSA does not diagnose testicular cancer. 4. An elevated PSA and digital examination are used in combination to diagnose BPH or prostate cancer. TEST-TAKING HINT: Answer options "2" and "4" have the word "only"; an absolute word should cause the test taker to eliminate them as possible answers. Options with words such as "always," "never," and "only" are usually incorrect.

A nurse has provided dietary instructions to a client with renal calculi who must learn about the foods that yield an alkaline residue in the urine. The nurse determines that the client has properly understood the information presented when the client chooses which selections from a diet menu? 1. Spinach salad, milk, and a banana 2. Chicken, potatoes, and cranberries 3. Peanut butter sandwich, milk, and prunes 4. Linguini with shrimp, tossed salad, and a plum

1. Spinach salad, milk, and a banana Rationale: In some client situations, the health care provider may prescribe a diet that consists of foods that yield either an alkaline or an acid residue in the urine. In an alkaline residue diet, all fruits are allowed except cranberries, blueberries, prunes, and plums. Options, 2, 3 and 4 represent an acid residue diet.

The client diagnosed with benign prostatic hyperplasia (BPH) is scheduled for a transrectal ultrasound examination and a test to measure the level of prostate-specific antigen (PSA). The client says to the nurse, "I can't remember...can you tell me again why I need these tests to be done?" The nurse responds knowing that these tests are done for which purpose? 1. Specifically predict the course of BPH 2. Help to rule out the possibility of cancer 3. Pinpoint the likelihood of developing urinary obstruction 4. Give an indication of whether intermittent self-catheterization is needed

2. Help to rule out the possibility of cancer Rationale: A transrectal ultrasound examination and PSA level determination help to rule out the possibility of prostate cancer. They do not specifically predict the course of BPH or the development of complications such as urinary obstruction. These tests have nothing to do with determining need for self-catheterization.

The nurse caring for a client immediately after transurethral resection of the prostate (TURP) notices that the client has suddenly become confused and disoriented. Which is the priority nursing action for this client? 1. Reorient the client. 2. Notify the health care provider (HCP). 3. Ensure that a clock and calendar are in the room. 4. Increase the flow rate of the intravenous infusion.

2. Notify the health care provider (HCP). Rationale: The client who suddenly becomes disoriented and confused after TURP could be experiencing early signs of hyponatremia. This may occur because the flushing solution used during the operative procedure is hypotonic. If the solution is absorbed through the prostate veins during surgery, the client experiences increased circulating volume and dilutional hyponatremia. The nurse should notify the HCP of these symptoms. Reorienting the client and ensuring that a clock and calendar are visible may be helpful but do not correct the problem. The nurse does not increase the flow rate of an intravenous infusion without a prescription. In addition, speeding up the flow rate could potentially worsen the problem, depending on the solution that is infusin

The nurse has provided instructions to a client with a urinary tract infection regarding foods and fluids to consume that will acidify the urine. Which fluids should the nurse include in the client's teaching plan that will aid in acidifying the urine? Select all that apply. 1. Milk 2. Prune juice 3. Apricot juice 4. Cranberry juice 5. Carbonated drinks

2. Prune juice 3. Apricot juice 4. Cranberry juice Rationale: Acidification of the urine inhibits multiplication of bacteria. Fluids that acidify the urine include prune, apricot, cranberry, and plum juice. Carbonated drinks should be avoided because they increase urine alkalinity. Two glasses of milk a day can make the urine more alkaline, which could aid in the development of kidney stones.

The nurse has performed a nutritional assessment on a client with cystitis. The nurse should tell the client to consume which beverage to minimize recurrence of cystitis? 1. Tea 2. Water 3. Coffee 4. White wine

2. Water

A client with nephrolithiasis arrives at the clinic for a follow-up visit. Laboratory analysis of the stone that the client passed 1 week earlier indicates that the stone is composed of calcium oxalate. On the basis of this analysis, what food item does the nurse instruct the client to avoid? 1. Pasta 2. Lentils 3. Lettuce 4. Spinach

4. Spinach Rationale: Many kidney stones are composed of calcium oxalate. Foods that raise urinary oxalate excretion include spinach, rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. Pasta, lentils, and lettuce are acceptable to consume.

A client has been diagnosed with a bladder infection. The nurse plans care, knowing that the client will be at increased risk for extension of the infection to the kidneys if there is improper function of which area of the urinary system? 1. Urethra 2. Nephron 3. Glomerulus 4. Ureterovesical junction

4. Ureterovesical junction Rationale: The ureterovesical junction is the point at which the ureters enter the bladder. At this juncture, the ureter runs obliquely for 1.5 to 2 cm through the bladder wall before opening into the bladder. This anatomical pathway prevents reflux of urine back into the ureter and, in essence, acts as a valve to prevent urine from traveling back into the ureter and up to the kidney.

A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder? 1. Hematuria and pyuria (white blood cell in urine) 2. Dysuria and proteinuria 3. Hematuria and urgency 4. Dysuria and penile discharge

4. dysuria penile discharge Rationale: Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays.

Which client is most at risk for developing a Candida urinary tract infection (UTI)? 1. An obese woman 2. A man with diabetes insipidus 3. A young woman on antibiotic therapy 4. A male paraplegic on intermittent catheterization .

3. A young woman on antibiotic therapy Rationale: Candida infections, which are fungal infections, develop in persons who are on long-term antibiotic therapy because an alteration of normal flora occurs. These infections also are commonly seen in clients with blood dyscrasias, diabetes mellitus, cancer, or immunosuppression and in those with a drug addiction

A client passes a urinary stone, and laboratory analysis of the stone indicates that it is composed of calcium oxalate. On the basis of this analysis, which option should the nurse specifically include in the dietary instructions? 1. Increase intake of dairy products. 2. Avoid citrus fruits and citrus juices. 3. Avoid green, leafy vegetables such as spinach. 4. Increase intake of meat, fish, plums, and cranberries.

3. Avoid green, leafy vegetables such as spinach Rationale: 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. The food items in options 1, 2, and 4 are acceptable to consume.

the client askes the nurse, "how did I get this urinary tract infection?" the nurse should explain that in most instances, cystitis is caused by: 1. congenital strictures in the urethra 2. an infection elsewhere in teh body 3. urinary stasis in the urinary bladder 4. an escending infection from the urethra

4. an escending infection from the urethra

After an (IVP), the nurse should anticipate incorporating which of the following measures into the client's plan of care? 1. maintaining bed rest 2. encouraging adequate fluid intake 3. assessing for hematuria 4. administering a laxative

encouraging adequate fluid intake Rationale: after an IVP, the nurse should encourage fluids to decrease the risk of renal complications caused by the contrast agent. there is no need to place the client on bed rest / administer a laxative. an IVP would not cause hematuria

A client with uric acid calculi is placed on a low-purine diet. The nurse instructs the client to restrict the intake of which food? 1. Fish 2. Plum juice 3. Fruit juice 4. Cranberries

1. Fish Rationale: Clients who form uric acid calculi should be placed on a low-purine diet. Their intake of fish and meats (especially organ meats) should be restricted. Dietary modifications also may help adjust urinary pH so that stone formation is inhibited. Depending on health care provider prescription, the urine may be alkalinized by increasing the intake of bicarbonates or acidified by drinking cranberry, plum, or prune juice.

A client has urinary calculi composed of uric acid. The nurse is teaching the client dietary measures to prevent further development of uric acid calculi. The nurse should inform the client that it is acceptable to consume which item? 1. Steak 2. Shrimp 3. Chicken liver 4. Cottage cheese

4. Cottage cheese Rationale: With a uric acid stone, the client should limit intake of foods high in purines. Organ meats, sardines, herring, and other high-purine foods are eliminated from the diet. Intake of foods with moderate levels of purines, such as red and white meats and some seafood, also is limited. Avoiding the consumption of milk and dairy products is recommended dietary changes for calculi composed of calcium stones but is acceptable for the client with a uric acid stone.

A nurse is caring for an older client. When evaluating the client's renal function, the nurse recalls that which change takes place as part of the normal aging process? 1. Tubular reabsorption increases 2. Urine-concentrating ability increases 3. Medications are metabolized in larger amounts 4. The glomerular filtration rate (GFR) diminishes

. 4. The glomerular filtration rate (GFR) diminishes Rationale: As part of the normal aging process, the GFR decreases, along with each of the other functional abilities of the kidney. Tubular reabsorption and urine-concentrating ability also decrease. The kidneys have decreased ability to metabolize medications.

The client returned from surgery after having a TURP and has a P 110, R 24, BP 90/40, and cool and clammy skin. Which interventions should the nurse implement? Select all that apply. 1. Assess the urine in the continuous irrigation drainage bag. 2. Decrease the irrigation fluid in the continuous irrigation catheter. 3. Lower the head of the bed while raising the foot of the bed. 4. Contact the surgeon to give an update on the client's condition. 5. Check the client's postoperative creatinine and BUN.

1. Assess the urine in the continuous irrigation drainage bag. 3. Lower the head of the bed while raising the foot of the bed. 4. Contact the surgeon to give an update on the client's condition. Rationale: 1. The nurse should assess the drain postoperatively. 2. The client is hemorrhaging, so the nurse should increase the irrigation fluid to clear the red urine, not decrease the rate. 3. The head of the bed should be lowered and the foot should be elevated to shunt blood to the central circulating system. 4. The surgeon needs to be notified of the change in condition. 5. These laboratory values assess kidney function, not the circulatory system, so this is not an appropriate intervention TEST-TAKING HINT: When the test taker reads vital signs with the blood pressure decreased and the pulse and respiratory rate elevated, the test taker should recognize the signs and symptoms of shock.

The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply. 1. Check for the ordered diet and medication modifications. 2. Instruct the client to urinate, and discard this urine when starting collection. 3. Collect all urine during 24 hours and place in appropriate specimen container. 4. Insert an indwelling catheter in client after having the client empty the bladder. 5. Instruct the UAP to notify the nurse when the client urinates.

1. Check for the ordered diet and medication modifications. 2. Instruct the client to urinate, and discard this urine when starting collection. 3. Collect all urine during 24 hours and place in appropriate specimen container. Rationale: 1. The health-care provider may order certain foods and medications when obtaining a 24-hour urine collection to evaluate for calcium oxalate or uric acid. 2. When the collection begins, the client should completely empty the bladder and discard this urine. The test is started after the bladder is empty. 3. All urine for 24 hours should be saved and put in a container with preservative, refrigerated, or placed on ice as indicated. Not following specific instructions will result in an inaccurate test result. 4. The urine is obtained in some type of urine collection device such as a bedpan, bedside commode, or commode hat. The client is not catheterized. 5. The nurse can delegate placing the urine output in the proper container to the UAP; therefore, the UAP does not need to notify the nurse when the client urinates. TEST-TAKING HINT: This is an alternate-type question which will have more than one correct answer. The test taker must be knowledgeable of specific laboratory tests.

The nurse is reviewing a client's record and notes that the health care provider has documented that the client has a renal function disorder. On review of the laboratory results, the nurse most likely would expect to note which finding? 1. Elevated creatinine level 2. Decreased hemoglobin level 3. Decreased red blood cell count 4. Decreased white blood cell count

1. Elevated creatinine level Rationale: Measuring the creatinine level is a frequently used laboratory test to determine renal function. The creatinine level increases when at least 50% of renal function is lost. A decreased hemoglobin level and red blood cell count may be noted if bleeding from the urinary tract occurs or if erythropoietic function by the kidney is impaired. An increased white blood cell count is most likely to be noted in renal disease.

The nurse has a prescription to obtain a urinalysis specimen from a client with an indwelling urinary catheter. Which actions should the nurse include in performing this procedure? Select all that apply. 1. Explaining the procedure to the client 2. Clamping the tubing of the drainage bag 3. Aspirating a sample from the port on the drainage bag 4. Obtaining the specimen from the urinary drainage bag 5. Wiping the port with an alcohol swab before inserting the syringe

1. Explaining the procedure to the client 2. Clamping the tubing of the drainage bag 3. Aspirating a sample from the port on the drainage bag 5. Wiping the port with an alcohol swab before inserting the syringe Rationale: A urine specimen is not taken from the urinary drainage bag. Urine undergoes chemical changes while sitting in the bag, so its properties do not necessarily reflect current client status. In addition, it may become contaminated with bacteria from opening the system. The remaining options are correct interventions for obtaining the specimen.

A nurse is monitoring a client who has just returned from surgery after a transurethral resection of the prostate (TURP). The client has a three-way Foley catheter in place for ongoing bladder irrigation. The nurse is observing the color of the client's urine and should expect which urine color during the immediate postoperative period? 1. Pale pink urine 2. Dark pink urine 3. Tea-colored urine 4. Bright red blood with small clots in the urine

1. Pale pink urine Rationale: If the bladder irrigation is infusing at a sufficient rate, the urinary drainage through the Foley tubing should be pale pink. Dark pink urine indicates that the rate of the irrigation solution should be increased. Tea-colored urine is not seen after a TURP but may be noted in a client with other renal disorders such as renal failure. Bright red bleeding and clots could indicate a complication, and if this is noted, it should be reported to the health care provider.

a client has nephropathy. the physician prescribes a 24-hour urine collection for creatinine clearance. which of the following actions is necessary to ensure proper collection of the specimen? 1. collect the urine in a preservative-free container & keep it on ice 2. inform the client to discard the last voided specimens at the conclusion of urine collection 3. obtain a self-report of the client's weight before beginning the collection of urine. 4. request a prescription for insertion of an indwellling urinary catheter

1. collect the urine in a preservative-free container & keep it on ice

A client with benign prostatic hyperplasia undergoes a transurethral resection of the prostate. Postoperatively the client is receiving continuous bladder irrigations. The nurse assesses the client for manifestations of transurethral resection syndrome. Which assessment data would indicate the onset of this syndrome? 1. Tachycardia and diarrhea 2. Bradycardia and confusion 3. Increased urinary output and anemia 4. Decreased urinary output and bladder spasms

2. Bradycardia and confusion Rationale: 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.

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, would the nurse identify as a risk factor for this disorder? 1. Hypoglycemia 2. Diabetes mellitus 3. Coronary artery disease 4. Orthostatic hypotension

2. Diabetes mellitus Rationale: Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and presence of an indwelling urinary catheter or frequent catheterization. The conditions noted in options 1, 3, and 4 are not associated risk factors.

the nurse teaches a female client who has cystitis methods to relieve her discomfort until the antibiotic takes effect. which of the following responses by the client would indicate that she understands the nurse's instructions? 1. "I will place ice packs on my perineum." 2. "I will take hot tub baths." 3. "I will drink a cup of warm tea every hour." 4. "I will void every 5 to 6 hours"

2. "I will take hot tub baths." Rationale: hot tub baths promote relaxation & help relieve urgency, discomfort, adn spasm

The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement first? 1. Monitor the client's urinary output. 2. Assess the client's pain and rule out complications. 3. Increase the client's oral fluid intake. 4. Use a safety gait belt when ambulating the client.

2. Assess the client's pain and rule out complications. Rationale: 62 1. The client's urinary output should be monitored, but it is not the first nursing intervention. 2. Assessment is the first part of the nursing process and is priority. The renal colic pain can be so intense it can cause a vasovagal response, with resulting hypotension and syncope. 3. Increased fluid increases urinary output, which will facilitate movement of the renal stone through the ureter and help decrease pain, but it is not the first intervention. 4. Ambulation will help facilitate movement of the renal stone through the ureter and safety is important, but it is not the first intervention. TEST-TAKING HINT: Remember, if the question asks which intervention is first, all four (4) options may be appropriate for the client's diagnosis but only one has priority. Assessment is the first part of the nursing process and it is the first intervention a nurse should implement if the client is not in distress.

The clinic nurse is caring for a client diagnosed with chronic pyelonephritis who is prescribed trimethoprim-sulfamethoxazole (Bactrim), a sulfa antibiotic, twice a day for 90 days. Which statement is the scientific rationale for prescribing this medication? 1. The antibiotic will treat the bladder spasms that accompany a urinary tract infection. 2. If the urine cannot be made bacteria free, the Bactrim will suppress bacterial growth. 3. In three (3) months, the client should be rid of all bacteria in the urinary tract. 4. The HCP is providing the client with enough medication to treat future infections.

2. If the urine cannot be made bacteria free, the Bactrim will suppress bacterial growth. Rationale: 1. Antibiotics may indirectly treat bladder spasms if the spasms are caused by an infection, but this is not the reason for prescribing the antibiotic in this manner. 2. Some clients develop a chronic infection and must receive antibiotic therapy as a routine daily medication to suppress the bacterial growth. The prescription will be refilled after the 90 days and continued. 3. Clients who develop chronic infections may never be free of the bacteria. 4. HCPs do not usually prescribe PRN prescriptions for antibiotics. TEST-TAKING HINT: The question is asking why an HCP prescribes long-term use of antibiotics for a client with a chronic infection. Antibiotics treat bacterial infections. Based on this, option "1" can be eliminated. Option "3" promises "all," which is false reassurance and can be eliminated. Option "4" describes future infections, but the client currently has an infection, so this option can be eliminated.

Which clinical manifestations should the nurse expect to assess for the client diagnosed with a ureteral renal stone? 1. Dull, aching flank pain and microscopic hematuria. 2. Nausea; vomiting; pallor; and cool, clammy skin. 3. Gross hematuria and dull suprapubic pain with voiding. 4. The client will be asymptomatic.

2. Nausea; vomiting; pallor; and cool, clammy skin Rationale: 1. Dull flank pain and microscopic hematuria are manifestations of a renal stone in the kidney. 2. The severe flank pain associated with a stone in the ureter often causes a sympathetic response with associated nausea; vomiting; pallor; and cool, clammy skin. 3. Gross hematuria and suprapubic pain when voiding are manifestations of a stone in the bladder. 4. Kidney stones and bladder stones may produce no signs/symptoms, but a ureteral stone always causes pain on the affected side because a ureteral spasm occurs when the stone obstructs the ureter. TEST-TAKING HINT: Options "1" and "3" both have assessment data indicating bleeding. The test taker can usually eliminate these as possible answers or eliminate the other two options not addressing blood. Renal stones are painful; therefore, option "4" could be eliminated as a possible answer.

A client is admitted to the emergency department following a motor vehicle accident. The client was wearing a lap seat belt when the accident occurred and now the client has hematuria and lower abdominal pain. To assess further whether the pain is caused by bladder trauma, the nurse should ask the client if the pain is referred to which area? 1. Hip 2. Shoulder 3. Umbilicus 4. Costovertebral angle

2. Shoulder Rationale: Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders due to phrenic nerve irritation. Bladder injury pain does not radiate to the umbilicus, costovertebral angle, or hip.

Which intervention is most important for the nurse to implement for the client diagnosed with rule-out renal calculi? 1. Assess the client's neurological status every two (2) hours. 2. Strain all urine and send any sediment to the laboratory. 3. Monitor the client's creatinine and BUN levels. 4. Take a 24-hour dietary recall during the client interview.

2. Strain all urine and send any sediment to the laboratory. Rationale: 1. Assessment is important, but the neurological system is not priority for a client with a urinary problem. 2. Passing a renal stone may negate the need for the client to have lithotripsy or a surgical procedure. Therefore, all urine must be strained, and a stone, if found, should be sent to the laboratory to determine what caused the stone. 3. These are laboratory studies evaluating kidney function, but they are not pertinent when passing a renal stone. These values do not elevate until at least half the kidney function is lost. 4. A dietary recall can be done to determine what types of foods the client is eating which may contribute to the stone formation, but it is not the most important intervention. TEST-TAKING HINT: Remember, if the question asks for "most important," more than one of the options could be appropriate but only one is most important. Assessment is priority if the client is not in distress, but the test taker should make sure it is appropriate for the situation.

The nurse is caring for a client with chronic pyelonephritis. Which assessment data support the diagnosis of chronic pyelonephritis? 1. The client has fever, chills, flank pain, and dysuria. 2. The client complains of fatigue, headaches, and increased urination. 3. The client had a group B beta-hemolytic strep infection last week. 4. The client has an acute viral pneumonia infection.

2. The client complains of fatigue, headaches, and increased urination. Rationale: 1. Fever, chills, flank pain, and dysuria are symptoms of acute pyelonephritis, not chronic pyelonephritis. 2. Fatigue, headache, and polyuria as well as loss of weight, anorexia, and excessive thirst are symptoms of chronic pyelonephritis. 3. Group B beta-hemolytic streptococcus infections cause acute glomerulonephritis. 4. Acute viral pneumonia is a cause of acute glomerulonephritis. TEST-TAKING HINT: The key to this question is the adjective "chronic." The test taker must be aware disease processes may change over time to produce different effects.

The nurse observes red urine and several large clots in the tubing of the normal saline continuous irrigation catheter for the client who is one (1) day postoperative TURP. Which intervention should the nurse implement? 1. Remove the indwelling catheter. 2. Titrate the NS irrigation to run faster. 3. Administer protamine sulfate IVP. 4. Administer vitamin K slowly.

2. Titrate the NS irrigation to run faster. Rationale: 1. The indwelling catheter should not be removed because doing so may result in edema, which, in turn, may obstruct the urethra and not allow the client to urinate. 2. Increasing the irrigation fluid will flush out the clots and blood. 3. Protamine is the reversal agent for heparin, an anticoagulant. 4. Vitamin K is the reversal agent for the anticoagulant warfarin (Coumadin). TEST-TAKING HINT: The test taker should eliminate options "3" and "4" because both are medications and the problem is with continuous irrigation, which does not require medications.

A client who has been diagnosed with renal calculi reports that the pain is intermittent adn 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) Q3 hr 4. apply warm compresses to the flank area

2. strain the urine carefully Rationale: Intermittent pain that is less colicky indicates that the calculi may be moving. fluid should be encouraged to promote movement, and the urine should be strained to detect passage of the stone. hematuria is to be expected from teh 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 lessened

A nurse is providing dietary instructions to a client with an oxalate kidney stone. The nurse should instruct the client to avoid which food high in oxalate? 1. Breads 2. Poultry 3. Chocolate 4. Prune juice

3. Chocolate

A client has been diagnosed with polycystic kidney disease. On assessment of the client, the nurse will observe for which as the most common manifestation of this disorder? 1. Headache 2. Hypotension 3. Flank pain and hematuria 4. Complaints of low pelvic pain

3. Flank pain and hematuria Rationale: The most common findings with polycystic kidney disease are hematuria and flank or lumbar pain that is either colicky in nature or dull and aching. Other common findings include proteinuria, calculi, uremia, and palpable kidney masses. Hypertension is another common finding and may be associated with cardiomegaly and heart failure. The client may complain of a headache, but this is not a specific assessment finding in polycystic kidney disease.

A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which condition? 1. Pyelonephritis 2. Glomerulonephritis 3. Trauma to the bladder or abdomen 4. Renal cancer in the client's family

3. Trauma to the bladder or abdomen Rationale: Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever and are thus not applicable to the client described in this question. Renal cancer would not cause pain that is felt in the low abdomen; rather, the pain would be in the flank area.

client with urolithiasis (struvite stones) has a history of chronic urinary tract infections. What should the nurse plan to teach the client to avoid? Antibiotics 2. Foods that make the urine more acidic 3. Wearing synthetic underwear and pantyhose 4. Foods that make the urine more acidic, such as cranberries

3. Wearing synthetic underwear and pantyhose Rationale: Urolithiasis (struvite stones) can result from chronic infections. They form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Teaching should focus on preventing infections and ingesting foods to make the urine more acidic. The client should wear cotton, not synthetic underclothing to prevent the accumulation of moisture and to prevent irritation of the perineal area, which can lead to infection. Antibiotics are not associated with chronic urinary infections.

The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client? 1. Increase water intake for the next 24 hours. 2. Take two (2) Tylenol to help decrease the temperature. 3. Come to the clinic and provide a urinalysis specimen. 4. Use a sterile 4 × 4 gauze to strain the client's urine.

3. Come to the clinic and provide a urinalysis specimen. Rationale: 1. The client needs to be evaluated for a possible urinary tract infection, which may accompany renal calculi. Therefore, the clinic nurse should not give advice without knowing what is wrong with the client. 2. The nurse should not recommend any medication (even Tylenol) unless the nurse is absolutely sure what is wrong with the client. 3. A urinalysis can assess for hematuria, the presence of white blood cells, crystal fragments, or all three, which can determine if the client has a urinary tract infection or possibly a renal stone, with accompanying signs/symptoms of UTI. 4. The client needs to strain the urine if there is a possibility of renal calculi, which these signs/symptoms do not support. Further diagnostic testing is needed to determine the presence of renal calculi. TEST-TAKING HINT: Fever, chills, and burning on urination require some type of assessment. Therefore, the test taker should select an option which helps determine what is wrong with the client and "3" is the only such option.

The elderly client is diagnosed with chronic glomerulonephritis. Which laboratory value indicates to the nurse the condition has become worse? 1. The blood urea nitrogen is 15 mg/dL. 2. The creatinine level is 1.2 mg/dL. 3. The glomerular filtration rate is 40 mL/min. 4. The 24-hour creatinine clearance is 100 mL/min.

3. The glomerular filtration rate is 40 mL/min. Rationale: 1. Normal blood urea nitrogen levels are 7 to 18 mg/dL or 8 to 20 mg/dL for clients older than age 60 years. 2. Normal creatinine levels are 0.6 to 1.2 mg/dL. 3. Glomerular filtration rate (GFR) is approximately 120 mL/min. If the GFR is decreased to 40 mL/min, the kidneys are functioning at about one-third filtration capacity. 4. Normal creatinine clearance is 85 to 125 mL/min for males and 75 to 115 mL/min for females. TEST-TAKING HINT: The nurse must memorize common laboratory values. BUN and creatinine levels are common laboratory values used to determine status in a number of diseases. Options "1" and "2" are normal values and could be eliminated. Then, the test taker could choose from only two (2) options.

the client is schedule for an intravenous pyelogram (IVP) to determine the location of the renal calculi. which of the following measures would be most important for the nurse to include in pretest preparation? 1. ensuring adequate fluid intake on the day of the test 2. preparing the client for the possibility of bladder spasms during the test 3. checking the client's history for allergy to iodine 4. determining when the client last had a bowel movement

3. checking the client's history for allergy to iodine

A client has just had a Foley catheter removed and is to be started on a bladder retraining program. Which intervention will provide the most useful information about the client's ability to empty the bladder? 1. Calculating total fluid intake for the shift 2. Recording the amount of the client's voidings 3. Assisting the client to the bathroom every 2 hours 4. Measuring post-void residual using a bladder scan

4. Measuring post-void residual using a bladder scan Rationale: Measuring post-void residual gives specific information about the ability of the bladder to empty completely. Recording intake and output and assisting the client to the bathroom are general interventions but do not provide information about the client's ability to empty the bladder.

A client being discharged home after renal transplantation has a risk for infection related to immunosuppressive medication therapy. The nurse determines that the client needs further instruction on measures to prevent and control infection if the client states that it is necessary to take which action? 1. Take an oral temperature daily. 2. Use good hand washing technique. 3. Take all scheduled medications exactly as prescribed. 4. Monitor urine character and output at least 1 day each week.

4. Monitor urine character and output at least 1 day each week. Rationale: The client receiving immunosuppressive medication therapy must learn and use infection-control methods for use at home. The client self-monitors urine output and its characteristics on a daily basis. The client must learn proper hand washing technique and should take the temperature daily to detect early infection. This is especially important because the client also takes corticosteroids, which mask signs and symptoms of infection. All medications should be taken exactly as prescribed.

A 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 reviews the results of the prostate examination for which characteristic of this disorder? 1. Soft and swollen prostate gland 2. Reddened, swollen, and boggy prostate gland 3. Tender and edematous prostate gland with ecchymosis 4. Tender, indurated prostate gland that is warm to the touch

4. Tender, indurated (harden) prostate gland that is warm to the touch Rationale: The client with bacterial prostatitis has a swollen and tender prostate gland 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.

The female client in an outpatient clinic is being sent home with a diagnosis of urinary tract infection (UTI). Which instruction should the nurse teach to prevent a recurrence of a UTI? 1. Clean the perineum from back to front after a bowel movement. 2. Take warm tub baths instead of hot showers daily. 3. Void immediately preceding sexual intercourse. 4. Avoid coffee, tea, colas, and alcoholic beverages.

4. Avoid coffee, tea, colas, and alcoholic beverages. Rationale: 1. The perineum should be cleaned from front to back after a bowel movement to prevent fecal contamination of the urethral meatus. 2. The temperature of the water does not matter, but the client should take showers instead of baths to prevent bacteria in the bathwater from entering the urethra. 3. Voiding immediately after, not before, sexual intercourse uses the action of the urine passing through the urethra to the outside of the body to flush bacteria from the urethra that might have been introduced during intercourse. 4. Coffee, tea, cola, and alcoholic beverages are urinary tract irritants. TEST-TAKING HINT: The test taker might jump to option "3" as the correct answer if the test taker did not read the word "preceding."

The client from a long-term care facility is admitted to the medical unit with a fever, hot flushed skin, and clumps of white sediment in the indwelling catheter. Which intervention should the nurse implement first? 1. Start an IV with a 20-gauge catheter. 2. Initiate antibiotic therapy IVPB. 3. Collect a urine specimen for culture. 4. Change the indwelling catheter.

4. Change the indwelling catheter. Rationale: 1. The first action is to get a viable urine culture so the causative pathogen can be identified. An IV should be started, but this is not the first action. 2. Initiating an IV antibiotic is priority, but obtaining a culture is done first to make sure the HCP can treat the causative organism. 3. This is not the first intervention since the culture will be obtained when the new catheter has been inserted. 4. Unless the nurse can determine the catheter has been inserted within a few days, the nurse should replace the catheter and then get a specimen. This will provide the most accurate specimen for analysis. TEST-TAKING HINT: In a question requiring the test taker to choose a "first" action, the test taker usually can order the choices 1, 2, 3, 4. In this question, options "4," "3," "1," and "2" should be the order of interventions.

The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement? 1. Encourage the client to eat a low-purine diet and limit foods such as organ meats. 2. Explain the importance of not drinking water two (2) hours before bedtime. 3. Discuss the importance of limiting vitamin D-enriched foods. 4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).

Rationale/61: 1. This is appropriate for the client who has uric acid stones. 2. The nurse should recommend drinking one (1) to two (2) glasses of water at night to prevent concentration of urine during sleep. 3. Dietary changes for preventing renal stones include reducing the intake of the primary substance forming the calculi. In this case, limiting vitamin D will inhibit the absorption of calcium from the gastrointestinal tract. 4. This is a treatment for an existing renal stone, not a discharge teaching intervention for a client who has successfully passed a renal calculus. TEST-TAKING HINT: The test taker should remember to read the question carefully. The question asks for a "discharge teaching" intervention. This rules out option "4," which is a treatment, as a potential answer.

The nurse is participating in a prostate screening clinic for men. Which complaints by a client are associated with prostatism? Select all that apply. 1. Inability to stop urinating 2. Postvoid dribbling of urine 3. Increased episodes of nocturia 4. Unusual force in urinary stream 5. Hesitancy on initiating the urinary stream

The nurse is participating in a prostate screening clinic for men. Which complaints by a client are associated with prostatism? Select all that apply. 1. Inability to stop urinating 2. Postvoid dribbling of urine 3. Increased episodes of nocturia 5. Hesitancy on initiating the urinary stream Rationale: Signs and symptoms of prostatism include reduced force and size of urinary stream, intermittent stream, hesitancy in beginning the flow of urine, inability to stop urinating, a sensation of incomplete bladder emptying after voiding, postvoid dribbling of urine, and an increase in episodes of nocturia. These signs and symptoms are the result of pressure of the enlarging prostate on the client's urethra.