Genitourinary Disorders - ML5
A client reports pain during intercourse. Which statement by the client would be most important for the nurse to report to the health care provider? "When I was 19, I had a spontaneous abortion." "I had sex a couple of times when I was 17." "I had a human papillomavirus infection at age 32." "My second pregnancy was complicated with eclampsia."
"I had a human papillomavirus infection at age 32." Explanation: Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 16, multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia are not risk factors for cervical cancer.
Which statement made by a client with a chlamydial infection indicates understanding of the potential complications? "If I had known a diaphragm would put me at risk for this, I would have taken birth control pills." "I'm glad I'm not pregnant; I'd hate to have a malformed baby from this disease." "I need to treat this infection so it doesn't spread into my pelvis because I want to have children some day." "I hope this medicine works before this disease gets into my urine and destroys my kidneys."
"I need to treat this infection so it doesn't spread into my pelvis because I want to have children some day." Explanation: Chlamydia is a common cause of pelvic inflammatory disease and infertility. It does not affect the kidneys or cause birth defects. It can cause conjunctivitis and respiratory infection in neonates exposed to infected cervicovaginal secretions during birth. Use of a diaphragm is not a risk factor.
After a nurse reinforces discharge education to the parents of a child with hypospadias, which statement by the parent indicates that additional education is needed? "It's important to keep the catheter free of kinks and blockages." "Proper catheter care helps prevent infection." "I'll need to learn irrigation techniques." "I should bathe my child in the tub daily."
"I should bathe my child in the tub daily." Explanation: A tub bath should be avoided to prevent infection until the stent has been removed. Parents are taught to care for the indwelling catheter or stent and how to perform irrigation techniques if indicated. They need to know how to empty the urine bag and how to avoid kinking, twisting, or blockage of the catheter or stent.
When reinforcing education about fluid intake with the parents of a child with a urinary tract infection (UTI), which statement by a parent would indicate the need for further education? "Clear liquids should be the primary liquids that my child drinks." "I should offer my child carbonated beverages about every 2 hours." "My child should avoid drinking caffeinated beverages." "I should encourage my child to drink about 50 mL per pound of body weight daily."
"I should offer my child carbonated beverages about every 2 hours." Explanation: Carbonated or caffeinated beverages are avoided because of their potentially irritating effect on the bladder mucosa. Adequate fluid intake is always indicated during an acute UTI. It is recommended that a person drink approximately 50 mL/lb of body weight daily. The child should primarily drink clear liquids.
A nurse reinforces teaching comfort measures to a client with genital herpes. Which statement by the client indicates the teaching has been effective? "I will apply a water-based lubricant to my lesions." "I should rub rather than scratch in response to itching." "I can pour hydrogen peroxide and water over my lesions." "I will wear loose cotton underwear."
"I will wear loose cotton underwear." Explanation: Wearing loose cotton underwear promotes drying and helps avoid irritation of the lesions. The use of lubricants is contraindicated because they can prolong healing time and increase the risk of secondary infection. Lesions should not be rubbed or scratched because of the risk of tissue damage and additional infection. Cool, wet compresses can be used to soothe the itch. The use of hydrogen peroxide and water on lesions is not recommended.
A client with nephritis is taking the diuretic furosemide as prescribed. To avoid potassium depletion, the nurse reinforces education on prevention techniques. Which client statement indicates an accurate understanding of this education? "I'll avoid consuming magnesium-rich foods." "I'll eat such foods as apricots, dates, and citrus fruits." "I'll watch for, and report signs of, hypercalcemia." "I'll take furosemide with the usual dose of my antihypertensive drug."
"I'll eat such foods as apricots, dates, and citrus fruits." Explanation: Because furosemide is a potassium-wasting diuretic, the client should eat potassium-rich foods, such as apricots, dates, and citrus fruits, to prevent potassium depletion. The other client statements have no relationship to potassium balance. The client may consume magnesium-rich foods as desired. The client should watch for signs of adverse reactions to furosemide such as hypocalcemia—not hypercalcemia. The client should take furosemide with an antihypertensive drug only if prescribed; the combination may produce hypotension but doesn't cause potassium depletion.
The nurse is reinforcing education to parents of a child prescribed sulfamethoxazole-trimethoprim for a urinary tract infection. What education should the nurse include? "For the drug to be effective, keep your child's urine acidic by having him drink at least a quart of cranberry juice per day." "Give your child two pills each day, but keep the rest of the pills to give if the symptoms reappear within 2 weeks." "Return to the clinic in 3 days for another urine culture." "Make sure your child takes the medication for 10 days even if his symptoms improve in a few days."
"Make sure your child takes the medication for 10 days even if his symptoms improve in a few days." Explanation: Discharge instructions for parents of children receiving an anti-infective medication should include taking all of the prescribed medication for the prescribed time. The child will not need to have a culture repeated until the medication is completed. Drinking highly acidic juices, such as cranberry juice, may help maintain urinary health, but will not get rid of an infection already present.
After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded? The client reports bladder spasms and the urge to void. The normal saline irrigation is infusing at the rate of 50 gtt/minute. The urine in the drainage bag appears red to pink. About 1,000 mL of irrigant have been instilled, and 1,200 mL of drainage have been returned.
The client reports bladder spasms and the urge to void. Explanation: Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. After TURP, urine normally appears red to pink, and normal saline irrigant is usually infused at a rate of 40 to 60 gtt/minute or according to facility protocol. The amount of returned fluid (1,200 mL) should correspond to the amount of instilled fluid, plus the client's urine output (1,000 mL + 200 mL), which reflects catheter patency.
The parent of a female child asks the nurse why the child seems to have so many urinary tract infections (UTIs). Which response by the nurse would be the most accurate? Girls cannot be protected by circumcision like boys can. The urethra is in close proximity to the anus. Girls touch their genitalia more often than boys do. Vaginal secretions are too acidic.
The urethra is in close proximity to the anus. Explanation: Girls are especially at risk for bacterial invasion of the urinary tract because of basic anatomical differences; the urethra is shorter and closer to the anus. Vaginal secretions are normally acidic, which decreases the risk of infection. Circumcision doesn't protect boys from UTIs. There is no documented research that supports that girls touch their genitalia more often than boys do.
A client in the short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should: remove the dressing on the puncture site after vital signs stabilize. check the client's pedal pulses frequently. apply pressure to the puncture site for 30 minutes. keep the client's knee on the affected side bent for 6 hours.
check the client's pedal pulses frequently. Explanation: After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the client's knee bent is unnecessary. By the time the client returns to the short- procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse shouldn't remove this dressing for several hours — and only if instructed to do so.
The nurse should counsel parents to postpone which action until after their son's hypospadias has been repaired? getting hepatitis B vaccine circumcision checking blood for inborn errors of metabolism phototherapy
circumcision Explanation: Circumcision shouldn't be performed until after the hypospadias has been repaired. The foreskin might be needed to help in the repair of hypospadias. None of the other actions has any bearing on the repair of hypospadias.
In which group is it most important for the client to understand the importance of an annual Papanicolaou (Pap) test? clients with a history of recurrent candidiasis clients infected with the human papillomavirus (HPV) clients with a long history of oral contraceptive use clients with a pregnancy before age 20
clients infected with the human papillomavirus (HPV) Explanation: The human papillomavirus (HPV) causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of oral contraceptives do not increase the risk of cervical cancer.
The nurse is planning to administer a sodium polystyrene sulfonate enema to a client with a potassium level of 5.9 mEq/L. Correct administration and the effects of this enema would include having the client: retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn't necessary to reduce the potassium level. retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea. retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn't necessary to reduce the potassium level. retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.
retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. Explanation: Sodium polystyrene sulfonate is a sodium exchange resin. Thus the client will gain sodium as potassium is lost in the bowel. For the exchange to occur, it must be in contact with the bowel for at least 30 minutes. Sorbitol in the enema causes diarrhea, which increases potassium loss and decreases the potential for sodium polystyrene sulfonate retention.
A nurse is taking frequent blood pressure readings on a child diagnosed with acute glomerulonephritis. The parents ask the nurse why this is necessary. When implementing nursing care, which statement by the nurse is accurate? "Acute hypertension must be anticipated and identified." "Blood pressure fluctuations are a common adverse effect of antibiotic therapy." "Hypotension leading to sudden shock can develop at any time." "Blood pressure fluctuations are a sign that the condition has become chronic."
"Acute hypertension must be anticipated and identified." Explanation: Regular measurement of vital signs, including blood pressure, body weight, and intake and output, is essential to monitor the progress of acute glomerulonephritis and to detect complications that may appear at any time during the course of the disease. Hypertension is more likely to occur with glomerulonephritis than hypotension and should be anticipated. Blood pressure fluctuations do not indicate that the condition has become chronic and are not common adverse reactions to antibiotic therapy.
A nurse is reinforcing education to a client diagnosed with renal calculi. Which statement made by the client suggests further instruction is indicated? "I do not need to limit my intake of tea or cola." "I should avoid foods that are high in calcium." "I should contact my health care provider if I develop flank pain again." "I should contact my health care provider if I see blood in my urine."
"I do not need to limit my intake of tea or cola." Explanation: A client with a history of kidney stones should notify the health care provider if he develops flank pain or blood in the urine. Foods high in calcium can cause calcium stones. Cola and teas can cause oxalate stones and should be avoided.
Which statement made by a client with a chlamydial infection indicates understanding of the potential complications? "I need to treat this infection so it doesn't spread into my pelvis because I want to have children someday." "If I had known a diaphragm would put me at risk for this, I would have taken birth control pills." "I hope this medicine works before this disease gets into my urine and destroys my kidneys." "I'm glad I'm not pregnant; I'd hate to have a malformed baby from this disease."
"I need to treat this infection so it doesn't spread into my pelvis because I want to have children someday." Explanation: Chlamydia is a common cause of pelvic inflammatory disease and infertility. It does not affect the kidneys or cause birth defects. It can cause conjunctivitis and respiratory infection in neonates exposed to infected cervicovaginal secretions during birth. Use of a diaphragm is not a risk factor.
A client with nephritis is taking the diuretic furosemide as prescribed. To avoid potassium depletion, the nurse reinforces education on prevention techniques. Which client statement indicates an accurate understanding of this education? "I'll eat such foods as apricots, dates, and citrus fruits." "I'll watch for, and report signs of, hypercalcemia." "I'll avoid consuming magnesium-rich foods." "I'll take furosemide with the usual dose of my antihypertensive drug."
"I'll eat such foods as apricots, dates, and citrus fruits." Explanation: Because furosemide is a potassium-wasting diuretic, the client should eat potassium-rich foods, such as apricots, dates, and citrus fruits, to prevent potassium depletion. The other client statements have no relationship to potassium balance. The client may consume magnesium-rich foods as desired. The client should watch for signs of adverse reactions to furosemide such as hypocalcemia—not hypercalcemia. The client should take furosemide with an antihypertensive drug only if prescribed; the combination may produce hypotension but doesn't cause potassium depletion.
A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign highest priority to which nursing diagnosis? Risk for infection Acute pain Imbalanced nutrition: Less than body requirements Deficient knowledge related to medication regimen
Acute pain Explanation: Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of Acute pain takes highest priority. Diagnoses of Risk for infection and Deficient knowledge related to medication regimen are appropriate when the client's pain is controlled. A diagnosis of Imbalanced nutrition: Less than body requirements isn't pertinent at this time.
A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? Respirations Blood pressure Temperature Cardiac rhythm
Cardiac rhythm Explanation: The nurse should assess the client's cardiac rhythm using electrocardiography because an elevated serum potassium level may lead to a life- threatening cardiac arrhythmia. The client's blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also can delay assessing respirations and temperature because these aren't affected by the serum potassium level.
A client had a transurethral prostatectomy for benign prostatic hyperplasia (BPH). He is currently being treated with continuous bladder irrigation and is reporting an increase in severity of bladder spasms. What should the nurse do first for this client? Check for the presence of clots, and make sure the catheter is draining properly. Administer a belladonna and opium suppository as ordered by the health care provider. Stop the irrigation and call the health care provider. Administer an oral analgesic.
Check for the presence of clots, and make sure the catheter is draining properly. Explanation: Blood clots and blocked outflow of the urine can increase spasms. The irrigation should not 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 after assessment of the drainage. Oral analgesics should be given if the spasms are unrelieved by the belladonna and opium suppositories.
Which intervention should a nurse recommend to parents of young girls to help prevent urinary tract infections (UTIs)? Increase fluids and decrease salt intake. Educate the child about cleaning her perineum from back to front. Dress the child in cotton underpants. Limit bathing as much as possible.
Dress the child in cotton underpants. Explanation: Cotton is a more breathable fabric than nylon and allows for dampness to be absorbed from the perineum. Dressing the child in cotton underpants helps prevent UTIs. Increasing fluids would be helpful, but decreasing salt is not necessary. Bathing should not be limited; however, the use of bubble bath or whirlpool baths should be avoided. If the child has frequent UTIs, taking a bath should be discouraged and taking a shower encouraged. The perineum should always be cleaned from front to back.
A nurse is reinforcing education to a client with prostatitis who is receiving co-trimoxazole double strength. Which education is appropriate for this client? Do not expect improvement of symptoms for 7 to 10 days. Drink six to eight glasses of fluid daily while taking this medication. If a sore mouth or throat develops, take the medication with milk or an antacid. Use a sunscreen of at least SPF-15 with PABA to protect against drug-induced photosensitivity.
Drink six to eight glasses of fluid daily while taking this medication. Explanation: Six to eight glasses of fluid daily are needed to prevent renal problems, such as crystalluria and calculi formation. The prostatitis symptoms should improve in a few days if the drug is effective. Sore throat and sore mouth are adverse effects that should be reported right away. The drug causes photosensitivity, but a PABA-free sunscreen should be used because PABA can interfere with the drug's action.
Which intervention might safely prevent constipation in a client who has end-stage ovarian cancer and requires high doses of opioids to control pain? Explaining the importance of increasing the intake of fiber and fluids Instructing the client to avoid consuming alcohol Telling the client to avoid taking over-the-counter medications Informing the client that taking laxatives routinely might help
Explaining the importance of increasing the intake of fiber and fluids Explanation: The nurse should explain the importance of increasing the intake of fiber and fluids to prevent constipation. Avoiding alcohol won't prevent constipation; however, the client should be cautioned about its use with opioids. The client should be instructed to consult with her physician before taking over-the-counter medications. The client should also be cautioned against taking laxatives routinely because they can lead to dependency.
A client is admitted for treatment of glomerulonephritis. During the initial assessment, the nurse documents which finding (one of the classic signs of acute glomerulonephritis found in sudden onset)? Moderate to severe hypotension Polyuria Green-tinged urine Generalized edema, especially of the face and periorbital area
Generalized edema, especially of the face and periorbital area Explanation: Generalized edema, especially of the face and periorbital area, is a classic sign of acute glomerulonephritis of sudden onset. Other classic signs and symptoms of this disorder include hematuria (not green-tinged urine), proteinuria, fever, chills, weakness, pallor, anorexia, nausea, and vomiting. The client also may have moderate to severe hypertension (not hypotension), oliguria or anuria (not polyuria), headache, reduced visual acuity, and abdominal or flank pain.
When caring for a child with acute glomerulonephritis, which action is a priority nursing intervention? Select all that apply. Monitor the child for signs of hypokalemia. Assess for periorbital or dependent edema. Measure daily weight. Provide sodium supplements. Increase oral fluid intake.
Measure daily weight. Assess for periorbital or dependent edema. Explanation: The child with acute glomerulonephritis should be monitored for fluid imbalance, which is done through daily weights. Sodium and water retention leads to edema. Weight gain is an early sign of fluid retention. Increasing oral intake, providing sodium supplements, and monitoring for hypokalemia are not part of the therapeutic management of acute glomerulonephritis.
A client is admitted with severe nausea, vomiting, and diarrhea and is hypotensive. There is severe oliguria with elevated blood urea nitrogen (BUN) and creatinine levels. For which treatment option should the nurse prepare the client? Give furosemide 20 mg IV. Start hemodialysis after temporary access is obtained. Encourage oral fluids. Start IV fluid of normal saline solution bolus followed by a maintenance dose.
Start IV fluid of normal saline solution bolus followed by a maintenance dose. Explanation: The client is experiencing prerenal failure secondary to hypovolemia. IV fluids should be given to rehydrate the client; urine output should increase, and the BUN and creatinine levels will normalize. The client would not be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client is not fluid overloaded, and her urine output will not increase with furosemide. The client will not need dialysis because the oliguria and increased BUN and creatinine levels are due to dehydration.
A nurse enters the room of a client who had a left modified mastectomy 8 hours earlier. Which observation indicates that the unlicensed assistive personnel (UAP) assigned to the client needs further instruction and guidance? The client is squeezing a ball in her left hand. The client is wearing a robe with elastic cuffs. The client's affected arm is elevated on a pillow. The client's right arm is wearing a blood pressure cuff.
The client is wearing a robe with elastic cuffs. Explanation: Elastic cuffs can contribute to the development of lymphedema and should be avoided. Simple exercises such as squeezing a ball help promote circulation and should be started as soon as possible after surgery. Elevation of the affected arm promotes venous and lymphatic return from the extremity. Blood pressure measurements in the affected arm should be avoided.
A client with suspected renal insufficiency is scheduled for a comprehensive diagnostic workup. The nurse develops a teaching plan to explain the diagnostic tests. Which portion of the kidney does the nurse plan to include as the "working" or functional unit? Bowman's capsule The glomerulus The nephron The tubular system
The nephron Explanation: The nephron, the functioning unit of the kidney, includes the glomerulus, Bowman's capsule, and tubular system, which work together to form urine from the blood.
The nurse suspects that a client with a temperature of 103.6° F (39.8° C) and an elevated white blood cell count is in the initial stage of sepsis. The nurse reviews the client's chart and expects to find which disorder, which is the most common cause of sepsis in hospitalized clients? Vasculitis Osteomyelitis Respiratory infection Urinary tract infection (UTI)
Urinary tract infection (UTI) Explanation: Sepsis most commonly results from a UTI caused by gram-negative bacteria. Other causes of sepsis include infections of the biliary, GI, and gynecologic tracts. Respiratory infection, vasculitis, and osteomyelitis rarely cause sepsis in hospitalized clients.
The client underwent a transurethral resection of the prostate gland 24 hours ago and has a continuous bladder irrigation. Which of the following nursing interventions is appropriate? Tell the client to try to urinate around the catheter to remove blood clots. Restrict fluids to prevent the client's bladder from becoming distended. Use aseptic technique when irrigating the catheter. Prepare to remove the catheter.
Use aseptic technique when irrigating the catheter. Explanation: If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. The nurse should encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is only removed with a physician's order.
A client with dysuria is prescribed phenazopyridine. The nurse should advise the client that his urine will: be more concentrated. increase in volume. appear orange. smell pungent.
appear orange. Explanation: Phenazopyridine causes urine to appear orange. The drug doesn't increase urine volume or concentration and doesn't cause a pungent odor.
When a client returns from the operating room after undergoing a left nephrectomy, a nurse must make sure that urine is draining through the client's indwelling urinary catheter. This assessment is important for this client because it: monitors bladder control. assesses function of the remaining kidney. helps determine the volume of I.V. fluid the client requires. prevents the client from dehydrating.
assesses function of the remaining kidney. Explanation: Monitoring urine flow from the indwelling urinary catheter helps assess function of the remaining kidney. It can also help determine the client's I.V. fluid needs and thereby prevent dehydration. However, the physician is responsible for prescribing the amount of I.V. fluids appropriate to the client's needs. Bladder control can't be monitored with an indwelling urinary catheter.
A nurse is caring for a client newly diagnosed with end-stage renal disease (ESRD) who is refusing to go to dialysis. What is the nurse's best action? asking another dialysis client to speak with the client about refusing treatment. explaining the benefits and consequences of refusing treatment, then document arranging for transport and telling the client that dialysis is necessary asking family members to force the client to go
explaining the benefits and consequences of refusing treatment, then document Explanation: The nurse has an obligation to explain the consequences of the client's action as well as respecting the autonomy of the client. Documenting the refusal protects the agency in case of a lawsuit. Arranging transport does not acknowledge the client's right to self-determination. Asking family members violates the client's confidentiality as well as asking another dialysis client.
A client reports an intermittent milky vaginal discharge. The client is not sexually active and does not report itching or burning. Which factor is the most likely cause of the milky discharge? normal fluctuation in estrogen and progesterone levels inadequate cleaning of the perineal area reaction to heat and moisture from wearing tight clothing sensitivity to a feminine hygiene product
normal fluctuation in estrogen and progesterone levels Explanation: Vaginal fluid is clear, milky, or cloudy, depending on the fluctuating levels of estrogen and progesterone. A milky vaginal discharge is normal and is not associated with sensitivity, reaction to heat or moisture, or inadequate cleaning.
A child is diagnosed with recurrent urinary tract infections (UTIs). Which treatment does the nurse anticipate reinforcing education regarding? surgical intervention frequent catheterizations prophylactic antibiotics limited activities
prophylactic antibiotics Explanation: Children who experience recurrent UTIs may require antibiotic therapy for months or years. Recurrent UTIs would be investigated for anatomic abnormalities and surgical intervention may be indicated, but the child would also be placed on antibiotics before the tests. The child's activities are not limited. Frequent catheterization predisposes a child to infection.
The nurse is planning to administer a sodium polystyrene sulfonate enema to a client with a potassium level of 5.9 mEq/L. Correct administration and the effects of this enema would include having the client: retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn't necessary to reduce the potassium level. retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea. retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn't necessary to reduce the potassium level.
retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. Explanation: Sodium polystyrene sulfonate is a sodium exchange resin. Thus the client will gain sodium as potassium is lost in the bowel. For the exchange to occur, it must be in contact with the bowel for at least 30 minutes. Sorbitol in the enema causes diarrhea, which increases potassium loss and decreases the potential for sodium polystyrene sulfonate retention.
When explaining to the parents the optimal time for repair of hypospadias, the nurse should indicate which as the age of choice? 4 years 2 years 1 week 6 to 18 months
6 to 18 months Explanation: The preferred time for surgical repair is ages 6 to 18 months, before the child has developed body image and castration anxiety. Surgical repair of hypospadias as early as age 3 months has been successful, but with a high incidence of complications.
A nurse is completing an intake and output record for a client who is receiving continuous bladder irrigation after transurethral resection of the prostate (TURP). How many milliliters of urine should the nurse record as output for his or her shift if the client received 1,800 mL of normal saline irrigating solution and the output in the urine drainage bag is 2,400 mL? Record your answer as a whole number.
600 Explanation: To calculate urine output, subtract the amount of irrigation solution infused into the bladder from the total amount of fluid in the drainage bag. For this client:2,400 mL - 1,800 mL = 600 mL.
When caring for the child with Wilms tumor preoperatively, which nursing intervention would be most important? Closely monitor arterial blood gas (ABG) values. Prepare the child and family for long-term dialysis. Avoid abdominal palpation. Prepare the child and family for renal transplantation.
Avoid abdominal palpation. Explanation: After the diagnosis of Wilms tumor is made, the abdomen should not be palpated. Palpation of the tumor might lead to rupture, which would cause the cancerous cells to spread throughout the abdomen. ABG values should not be affected. If surgery is successful, there will not be a need for long-term dialysis or renal transplantation.
Which response is the most appropriate when a client asks what activity limitations are necessary after a dilation and curettage (D & C) procedure? Tampons may be used during exercise. Avoid strenuous work and sexual intercourse for at least 2 weeks. Engage in activity as tolerated, and take a soaking tub bath each day to promote relaxation. Stay on bed rest for 3 days, then gradually resume normal activity.
Avoid strenuous work and sexual intercourse for at least 2 weeks. Explanation: Strenuous work, which can result in increased bleeding, should be avoided for 2 weeks to allow time for healing. Sexual intercourse should also be avoided for 2 weeks to allow healing and decrease the risk of infection. Overall activity should be gradually resumed, reaching preoperative levels in the 2-week period, but bed rest is not necessary. Tampons and tub baths should be avoided for 1 week. No other restrictions are routinely necessary.
A nurse-manager on the urology unit tells the staff that supplies have been disappearing at an alarming rate. A staff nurse has been assigned to monitor supply use. Which method can best help the nurse monitor supply use? Provide each staff member with a daily allocation of supplies. Limit the supplies allocated each day. Inventory the supplies as they are brought to the unit. Compare charge slips for supplies used against the inventory left in the supply room every 24 hours.
Compare charge slips for supplies used against the inventory left in the supply room every 24 hours. Explanation: The nurse can best monitor supply use by comparing charges for those items that were used against the supplies that remain in the supply room. This reconciliation should be performed every 24 hours. If supplies aren't adequately charged, the nurse should follow-up immediately with staff members to see which supplies were used without being charged. Inventorying supplies as they arrive on the unit doesn't help account for their use. Supplies should be allocated based on the client's needs; they shouldn't be limited. Staff members shouldn't be allocated supplies individually; supplies should be allocated for the floor based on client needs.
A physician informs a client that her renal calculus is small enough that she should be able to pass it without surgical intervention. Which action should the nurse take to help the client pass the renal calculus? Provide the client with fruit juices only. Administer I.V. fluids. Maintain the client on bed rest. Encourage the client to consume 3 to 4 liters of fluid a day.
Encourage the client to consume 3 to 4 liters of fluid a day. Explanation: The nurse should encourage the client to drink 3 to 4 liters of fluid a day to flush the renal calculus from the kidney. The nurse shouldn't encourage the client to limit her intake to juices because some juices contribute to renal calculi formation. The nurse should encourage to the client to ambulate. Bed rest increases the risk of renal calculi formation. The nurse can't administer I.V. fluids without a physician's order.
A client receiving total parental nutrition is prescribed a 24-hour urine test. The nurse delegates the collection of the specimen to the unlicensed assistive personnel (UAP). The nurse is aware that the UAP is collecting the specimen correctly when he or she initiates the collection in which instance? Start with the client's first voiding of the day Start after the client eats breakfast Ends with the client's last evening's void as the last sample Start after a client's known voiding that empties the bladder
Start after a client's known voiding that empties the bladder Explanation: When initiating a 24-hour urine specimen, have the client void, and then start timing. The collection should start on an empty bladder. The exact time the test starts isn't important, but it's commonly started in the morning.
After having a transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which data collected by the nurse suggests that the client's catheter is occluded? The client reports bladder spasms and the urge to void. The urine in the drainage bag appears pink. The normal saline irrigant is infusing at a rate of 50 gtt/minute. About 1,000 mL of irrigant have been instilled, and 1,200 mL of drainage have been returned.
The client reports bladder spasms and the urge to void. Explanation: Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter of a client who had a transurethral resection of the prostate. After TURP, urine normally appears red to pink, and normal saline irrigant usually is infused at a rate of 40 to 60 gtt/minute, or according to facility protocol. The amount of returned fluid (1,200 mL) should correspond to the amount of instilled fluid plus the client's urine output (1,000 mL + 200 mL), which reflects catheter patency.
A client is admitted for treatment of chronic renal failure (CRF). The nurse reviews the client's chart to monitor which electrolyte imbalance? Water and sodium retention Metabolic alkalosis Decreased serum phosphate level Increased serum calcium level
Water and sodium retention Explanation: A client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to the inability of the kidneys to excrete hydrogen ions.
