Genitourinary

A middle-aged male client comes to the clinic for an evaluation of difficulty urinating and nocturia. His father died from prostate cancer. He asks the nurse what he can do to ensure early detection of this disease. Which of the following questions should the nurse ask next? a) "Do you perform monthly testicular self-examinations?" b) "Do you have a digital rectal examination and prostate-specific antigen (PSA) tests yearly?" c) "What were the results of your last complete blood count (CBC), blood urea nitrogen (BUN), and creatinine levels." d) "Have you had a transrectal ultrasound within the last 10 years?"

B. "Do you have a digital rectal examination and prostate-specific antigen (PSA) tests yearly?" PSA and digital rectal examinations, although not specific for prostate cancer, will indicate possible changes in the prostate gland. The transrectal ultrasound would be performed as a follow-up for an increased PSA and/or an enlarged prostate gland. Testicular exams will not reveal changes in the prostate. The CBC, BUN, and creatinine, although valuable, will not identify changes in the prostate gland.

A client with a urinary tract infection is ordered co-trimoxazole. The nurse should provide which medication instruction? a) "Take the medication with food." b) "Drink at least eight 8-oz (240 mL) glasses of fluid daily." c) "Avoid taking antacids during co-trimoxazole therapy." d) "Don't be afraid to go out in the sun."

B. "Drink at least eight 8-oz (240 mL) glasses of fluid daily." The nurse should instruct a client receiving a sulfonamide such as co-trimoxazole to drink at least eight 8-oz (240 mL) glasses of fluid daily to maintain a urine output of at least 1,500 ml/day. Otherwise, inadequate urine output may lead to crystalluria or tubular deposits. For maximum absorption, the client should take this drug at least 1 hour before or 2 hours after meals. No evidence indicates that antacids interfere with the effects of sulfonamides. To prevent a photosensitivity reaction, the client should avoid direct sunlight during co-trimoxazole therapy.

After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which of the following client statements indicates a need for further teaching? a) "If I get pregnant, I will have to be refitted for another diaphragm after the birth." b) "If I gain or lose 20 lb (9.1 kg), I can still use the same diaphragm." c) "Before inserting the diaphragm I should coat the rim with contraceptive jelly." d) "I can continue to use the diaphragm for about 2 to 3 years if I keep it protected in the case."

B. "If I gain or lose 20 lb (9.1 kg), I can still use the same diaphragm." The client would need additional instructions when she says that she can still use the same diaphragm if she gains or loses 20 lb (9.1 kg). Gaining or losing more than 15 lb (6.8 kg) can change the pelvic and vaginal contours to such a degree that the diaphragm will no longer protect the client against pregnancy. The diaphragm can be used for 2 to 3 years if it is cared for and well protected in its case. The client should be refitted for another diaphragm after pregnancy and childbirth because weight changes and physiologic changes of pregnancy can alter the pelvic and vaginal contours, thus affecting the effectiveness of the diaphragm. The client should use a spermicidal jelly or cream before inserting the diaphragm.

The client asks the nurse, "How did I get this urinary tract infection?" The nurse should explain that in most instances, cystitis is caused by: a) An infection elsewhere in the body. b) An ascending infection from the urethra. c) Urinary stasis in the urinary bladder. d) Congenital strictures in the urethra.

B. An ascending infection from the urethra. Although various conditions may result in cystitis, the most common cause is an ascending infection from the urethra. Strictures and urine retention can lead to infections, but these are not the most common cause. Systemic infections are rarely causes of cystitis.

A client undergoes a nephrectomy. In the immediate postoperative period, which nursing intervention has the highest priority? a) Encouraging the use of the incentive spirometer. b) Assessing urine output hourly. c) Checking the flank dressing for urine drainage. d) Monitoring blood pressure.

B. Assessing urine output hourly. After a nephrectomy, a specific aspect of immediate postoperative management includes monitoring urine output at least hourly. Monitoring blood pressure and encouraging the use of incentive spirometry are other important considerations, but because of the surgical disruption of the urinary system, urine output is a priority. Measurement of urine output should also include an estimation of the amount of urine drainage on the flank dressing.

A client is receiving continuous ambulatory peritoneal dialysis (CAPD). The nurse should assess the client for which of the following signs of peritoneal infection? a) Poor drainage of the dialysate fluid. b) Cloudy dialysate fluid. c) Redness at the catheter insertion site. d) Swelling in the legs.

B. Cloudy dialysate fluid. Cloudy drainage indicates bacterial activity in the peritoneum. Other signs and symptoms of infection are fever, hyperactive bowel sounds, and abdominal pain. Swollen legs may indicate heart failure. Poor drainage of dialysate fluid is probably the result of a kinked catheter. Redness at the insertion site indicates local infection, not peritonitis. However, a local infection that is left untreated can progress to the peritoneum.

Which of the following has the highest priority in the care of a client with chronic renal failure? a) Apply corticosteroid creams to relieve itching. b) Maintain a low-sodium diet. c) Measure abdominal girth daily. d) Achieve pain control with analgesics.

B. Maintain a low-sodium diet It is appropriate for the client to be on a low-sodium diet to help decrease fluid retention. Dry skin and pruritus are common in renal failure. Lotions are used to relieve the dry skin, and antihistamines may be used to control itching; corticosteroids are not used. Pain is not a major problem in chronic renal failure, but analgesics that are excreted by the kidneys must be avoided. It is not necessary to measure abdominal girth daily because ascites is not a clinical problem in renal failure.

To prevent catheter-associated urinary tract infection, the nurse should do which of the following? Select all that apply. a) Change the catheter daily. b) Recommend the health care provider order antibiotics. c) Provide perineal care several times a day. d) Assess the client for signs of infection. e) Encourage the client to drink 3,000 ml of fluids a day.

C. Provide perineal care several times a day. D. Assess the client for signs of infection. E. Encourage the client to drink 3,000 ml of fluids a day. Catheter acquired urinary tract infection is the most frequent type of health care-acquired infection (HAI) and represents as many as 80% of HAIs in the hospital setting. The nurse should provide meticulous perineal care, encourage the client to obtain an adequate fluid intake, and assess the client for signs of infection such as elevated temperature. It is not necessary to change the catheter daily. It is recommended that long-term use of an indwelling urinary catheter be evaluated carefully and other methods considered, if the catheter will be in place longer than 2 weeks. It is not necessary to request an order for antibiotics, because the client does not currently have an infection.

A client is experiencing premenstrual syndrome (PMS). The nurse should next ask the client about which of the following? a) Mood swings immediately after menses. b) Menstrual cycle irregularity with increased menstrual flow. c) Tension and fatigue before menses and through the second day of the menstrual cycle. d) Midcycle spotting and abdominal pain at the time of ovulation.

C. Tension and fatigue before menses and through the second day of the menstrual cycle. The timing of symptoms is important to the diagnosis of PMS. The client should keep a 3-month log of symptoms and menses. With PMS, the symptoms begin 3 to 7 days before menses and resolve 1 to 2 days after the menstrual cycle has started. Menstrual cycle irregularity and mood swings after menses are not related to PMS, and other causes should be investigated. Midcycle spotting and pain are related to ovulation.

The nurse is observing a nursing assistant give care to a client after gynecologic surgery. The nurse should intervene if the nursing assistant does which of the following? a) Assists the client perform range-of-motion exercises in bed. b) Has client wear elasticized stockings. c) Ambulates the client. d) Massages the client's legs.

D. Massages the client's legs Massaging the legs postoperatively is contraindicated because it may dislodge small clots of blood, if present, and cause even more serious problems. Ambulation helps reduce the risk of thrombophlebitis. Elasticized stockings help reduce the risk of thrombophlebitis. Having the client move her legs in bed has been found to help reduce the incidence of postoperative thrombophlebitis.

The nurse is observing a nursing assistant give care to a client after gynecologic surgery. The nurse should intervene if the nursing assistant does which of the following? a) Assists the client perform range-of-motion exercises in bed. b) Has client wear elasticized stockings. c) Ambulates the client. d) Massages the client's legs.

D. Massages the client's legs. Massaging the legs postoperatively is contraindicated because it may dislodge small clots of blood, if present, and cause even more serious problems. Ambulation helps reduce the risk of thrombophlebitis. Elasticized stockings help reduce the risk of thrombophlebitis. Having the client move her legs in bed has been found to help reduce the incidence of postoperative thrombophlebitis.

Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with benign prostatic hyperplasia (BPH)? a) Serum testosterone level b) Creatinine clearance c) Size of the prostate d) Voiding pattern

D. Voiding pattern The client's voiding pattern should be checked to evaluate the effectiveness of alpha-adrenergic blockers. These drugs relax the smooth muscle of the bladder neck and prostate, so the urinary symptoms of BPH are reduced in many clients. These drugs don't affect the size of the prostate, production or metabolism of testosterone, or renal function.

A client is scheduled to undergo transurethral resection of the prostate. The procedure is to be done under spinal anesthesia. Postoperatively, the nurse should assess the client for: a) Respiratory paralysis. b) Seizures. c) Cardiac arrest. d) Renal shutdown.

A. Respiratory paralysis If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal anesthesia is used, the client is likely to develop respiratory paralysis. Artificial ventilation is required until the effects of the anesthesia subside. Seizures, cardiac arrest, and renal shutdown are not likely results of spinal anesthesia.

The nurse is caring for a client with acute renal failure. Rank in chronological order the phases of acute renal failure. Use all the options. Initial insult Recovery phase Diuretic phase Oliguric phase

1. Initial insult 2. Oliguric phase 3. Diuretic phase 4. Recovery phase

Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point. A client who weighs 207 lb (94.1 kg) is to receive 1.5 mg/kg of gentamicin sulfate I.V. three times each day. How many milligrams of medication should the nurse administer for each dose? Round to the nearest whole number. ________ mg

141 1.5 mg X 94.1 = 141.15 = 141 mg.

The client asks the nurse, "How did I get this urinary tract infection?" The nurse should explain that in most instances, cystitis is caused by: a) An ascending infection from the urethra. b) Congenital strictures in the urethra. c) Urinary stasis in the urinary bladder. d) An infection elsewhere in the body.

A. An ascending infection from the urethra. Although various conditions may result in cystitis, the most common cause is an ascending infection from the urethra. Strictures and urine retention can lead to infections, but these are not the most common cause. Systemic infections are rarely causes of cystitis.

A client is to receive peritoneal dialysis. To prepare for the procedure, the nurse should? a) Warm the solution in the warmer. b) Ask the client to turn toward the left side. c) Insert an indwelling urinary catheter and drain all urine from the bladder. d) Assess the dialysis access for a bruit and thrill.

A. Warm the solution in the warmer. Solution for peritoneal dialysis should be warmed to body temperature in a warmer or with a heating pad; do not use the microwave. Cold dialysate increases discomfort. Assessment for a bruit and thrill is necessary with hemodialysis when the client has a fistula, graft, or shunt. An indwelling urinary catheter is not required for this procedure. The nurse should position the client in a supine or low Fowler's position.

A 28-year-old female client is prescribed danazol for endometriosis. The nurse should instruct the client to report: a) Hair loss. b) Headaches. c) Increased libido. d) Weight loss.

B. Headaches. Adverse effects of danazol include headaches, dizziness, irritability, and decreased libido. Masculinization effects, such as deepened voice, facial hair, and weight gain, also may occur.

A client with chronic renal failure (CRF) has a hemoglobin of 10.2 g/dl and hematocrit of 40%. Which of the following would be a primary assessment? a) Presence of edema and fluid volume overload b) Presence of fatigue and weakness c) Presence of dyspnea and cyanosis d) Presence of thrush and circumoral pallor

B. Presence of fatigue and weakness A hemoglobin of 10.2 is low; however the hematocrit is normal. RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Although chronic renal failure can cause fluid volume overload, the normal hematocrit level does not indicate fluid volume overload. Dyspnea and cyanosis is associated with fluid excess, not anemia. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, are not signs of anemia.

A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence? a) Consulting with a dietitian b) Giving the client a glass of soda before bedtime c) Encouraging intake of at least 2 L of fluid daily d) Taking the client to the bathroom twice per day

C. Encouraging intake of at least 2 L of fluid daily Encouraging a daily fluid intake of at least 2 L helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn't give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won't address the problem of urinary incontinence.

The client with acute renal failure asks the nurse for a snack. Because the client's potassium level is elevated, which of the following snacks is most appropriate? a) Peanuts. b) Yogurt. c) An orange. d) A gelatin dessert.

D. A gelatin dessert. Gelatin desserts contain little or no potassium and can be served to a client on a potassium-restricted diet. Foods high in potassium include bran and whole grains; most dried, raw, and frozen fruits and vegetables; most milk and milk products; chocolate, nuts, raisins, coconut, and strong brewed coffee.

Which of the following nursing interventions is likely to provide the most relief from the pain associated with renal colic in an adult? a) Encouraging high fluid intake. b) Maintaining complete bed rest. c) Applying moist heat to the flank area. d) Administering meperidine.

D. Administering meperidine 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 client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl (70mmol/L). The most therapeutic pharmacologic intervention would be to administer: a) enoxaparin. b) filgrastim. c) ferrous sulfate. d) epoetin alfa.

D. epoetin alfa. Chronic renal failure diminishes the production of erythropoietin by the kidneys and leads to a subnormal Hb level. (Normal Hb level is 13 to 18 g/dl in men and 12 to 16 g/dl in women.) An effective pharmacologic treatment for this is epoetin alfa, a recombinant erythropoietin. Because the client's anemia is caused by a deficiency of erythropoietin and not a deficiency of iron, administering ferrous sulfate would be ineffective. Neither filgrastim, a drug used to stimulate neutrophils, nor enoxaparin (low-molecular-weight heparin) will raise the client's Hb level.

A client with renal insufficiency is admitted to the hospital with pneumonia. He's being treated with gentamicin. Which laboratory value should be closely monitored? a) Blood urea nitrogen (BUN) b) Alkaline phosphatase c) White blood cell (WBC) count d) Sodium level

A. Blood urea nitrogen (BUN) BUN and creatinine levels should be closely monitored to detect elevations caused by nephrotoxicity. Sodium level should be routinely monitored in all hospitalized clients. Alkaline phosphatase helps evaluate liver function. The WBC count should be monitored to evaluate the effectiveness of the antibiotic; it doesn't help evaluate kidney function.

A physician orders a single dose of trimethoprim/sulfamethoxazole by mouth for a client diagnosed with an uncomplicated urinary tract infection. The pharmacy sends three unit-dose tablets. The nurse verifies the physician's order. What should the nurse do next? a) Call the hospital pharmacist and question the medication supplied. b) Call the physician to verify the order. c) Give one tablet, three times per day. d) Administer the three tablets as the single dose.

A. Call the hospital pharmacist and question the medication supplied. The nurse should call the hospital pharmacy and question the medication supplied. The hospital pharmacist should be able to tell the nurse whether three tablets are necessary for the single dose or whether a dispensing error occurred. It isn't clear whether the three tablets are the single dose because they were packaged as a unit-dose. The physician's order was clearly written, so clarifying the order with the physician isn't necessary. Administering the tablets without clarification might cause a medication error.

A client is voiding small amounts of urine every 30 to 60 minutes. Which of the following actions is the nurse's first priority? a) Palpate for a distended bladder. b) Request a urine specimen for culture. c) Catheterize the client for residual urine. d) Encourage an increased fluid intake.

A. Palpate for a distended bladder. When a client voids frequent, small amounts, the nurse should suspect that the client is retaining urine. Palpating for a distended bladder is the first assessment that the nurse should perform to verify this suspicion. Obtaining an order to catheterize for residual urine may be appropriate as a follow-up activity. Obtaining a urine specimen for culture is not a first priority. The nurse would not encourage an increased fluid intake until further assessment of the situation is completed.

A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. The intended outcome of this diet is to: a) Prevent the development of ketosis. b) Act as a diuretic. c) Reduce demands on the liver. d) Help maintain urine acidity.

A. Prevent the development of ketosis High-carbohydrate foods meet the body's caloric needs during acute renal failure. Protein is limited because its breakdown may result in accumulation of toxic waste products. The main goal of nutritional therapy in acute renal failure is to decrease protein catabolism. Protein catabolism causes increased levels of urea, phosphate, and potassium. Carbohydrates provide energy and decrease the need for protein breakdown. They do not have a diuretic effect. Some specific carbohydrates influence urine pH, but this is not the reason for encouraging a high-carbohydrate, low-protein diet. There is no need to reduce demands on the liver through dietary manipulation in acute renal failure.

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: a) weight loss. b) hematuria. c) increased urine output. d) increased blood pressure.

A. weight loss. Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

A client recovering from an abdominal hysterectomy has pain in her right calf. The nurse should: a) Have the client flex and extend her leg and note the presence of pain. b) Measure the circumference of both calves and note the difference. c) Palpate the calf to note pain. d) Raise the right leg and lower it to detect changes in skin color.

B. Measure the circumference of both calves and note the difference. After abdominal pelvic surgery, the client is especially prone to thrombophlebitis. Measuring calf circumference can help detect edema in the affected leg. The calf should not be rubbed or palpated because a clot could be loosened and travel to the lungs as a pulmonary embolism. Homans' sign, which is calf pain on dorsiflexion of the foot when the leg is raised, is sometimes associated with thrombophlebitis. Having the client flex and extend the leg does not provide useful assessment data; the leg will not change color when raised and lowered.

Which of the responsibilities related to the care of a client with a Foley catheter is appropriate for the nurse to delegate to the nursing assistant? Select all that apply. a) Flush the catheter as needed to ensure patency. b) Provide Foley catheter and perineal care each shift. c) Ensure the urine drainage bag is below the level of the bladder at all times. d) Apply catheter-securing device to the client's leg. e) Perform bladder irrigation as ordered. f) Empty drainage bag and record output at specified times.

B. Provide Foley catheter and perineal care each shift. C. Ensure the urine drainage bag is below the level of the bladder at all times. D. Apply catheter-securing device to the client's leg. F. Empty drainage bag and record output at specified times. While the scope of practice for nurse assistants may vary by state, province, or territory, as well as place of employment, general duties include recording input and output, including emptying and recording urine output from a Foley catheter. A nurse assistant with proper training may apply a securing device to maintain safety, provide regular Foley catheter and perineal care, and ambulate a client with a catheter, continually monitoring that the collection bag remains below the level of the bladder to help prevent infection. Activities such as irrigating or flushing a catheter should not be assigned to a CNA--these activities involve nursing assessment skills.

A nurse is planning to administer a sodium polystyrene sulfonate enema to a client with a potassium level of 6.2 mEq/L. Correct administration and the effects of this enema should include having the client: a) retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea. b) retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. c) retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn't necessary to reduce the potassium level. d) retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn't necessary to reduce the potassium level.

B. retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. 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, sodium polystyrene sulfonate must be in contact with the bowel for at least 30 minutes. Sorbitol in the sodium polystyrene sulfonate enema causes diarrhea, which increases potassium loss and decreases the potential for sodium polystyrene sulfonate retention.

A graduate nurse is asking for information about chronic renal failure. Which of the following statements by the nurse would be most accurate when providing teaching? a) "It results in an inability of the kidneys to convert waste products to creatinine and blood urea nitrogen." b) "The most common cause of chronic renal failure is recurrent pyelonephritis." c) "It is characterized by azotemia, fluid volume excess, and hyperkalemia." d) "It results in an increase in erythropoietin, leading to chronic anemia and fatigue."

C. "It is characterized by azotemia, fluid volume excess, and hyperkalemia." When chronic renal failure occurs, the body is unable to eliminate the wastes, resulting in azotemia. In addition, the kidneys are not able to eliminate the body fluids, resulting in fluid volume overload. There is also a rise in potassium levels resulting in hyperkalemia. The most common cause of chronic renal failure is diabetes. There is a depression of erythropoietin with chronic renal failure. The liver converts wastes to creatinine and blood urea nitrogen, not the kidneys.

The typical chancre of syphilis appears as: a) An itching, crusted area. b) A grouping of small, tender pimples. c) A painless, moist ulcer. d) An elevated wart.

C. A painless, moist ulcer The chancre of syphilis is characteristically a painless, moist ulcer. The serous discharge is very infectious. Because the chancre is usually painless and disappears, the client may not be aware of it or may not seek care. The chancre does not appear as pimples or warts, and does not itch, thus making diagnosis difficult.

A client with benign prostatic hypertrophy (BPH) is being treated with terazosin 2 mg at bedtime. The nurse should monitor the client's: a) White blood cell count. b) Pulse. c) Blood pressure. d) Urine nitrites.

C. Blood pressure Terazosin is an antihypertensive drug that is also used in the treatment of BPH. Blood pressure must be monitored to ensure that the client does not develop hypotension, syncope, or orthostatic hypotension. The client should be instructed to change positions slowly. Urine nitrates, white blood cell count, and pulse rate are not affected by terazosin.

The nurse receives a report of a serum potassium level on an infant of 6.0 mEq/L (6 mmol/l). The nurse should: a) Notify the physician of the abnormal level. b) Connect the infant to a cardiac monitor. c) Call the laboratory to see how the specimen was obtained. d) Check the infant's last 24-hour output.

C. Call the laboratory to see how the specimen was obtained. If the specimen was from a fingerstick and not a venous sample, the potassium level can be falsely elevated. Because the finger is squeezed to obtain the sample, cells may have been broken from the pressure of squeezing. When the cells break, they release potassium, which will falsely elevate the potassium level in the result. Calling the physician without first checking the source of the sample would not give the physician accurate and complete information. A cardiac monitor would not be necessary if the potassium level is falsely elevated. The last 24-hour output would only indicate that the infant is voiding in an adequate amount. This may or may not have an influence on the infant's potassium level.

A client has urge incontinence. When obtaining the health history, the nurse should ask if the client has: a) Loss of urine when coughing. b) Inability to empty the bladder. c) Involuntary urination with minimal warning. d) Frequent dribbling of urine.

C. Involuntary urination with minimal warning. A characteristic of urge incontinence is involuntary urination with little or no warning. The inability to empty the bladder is urine retention. Loss of urine when coughing occurs with stress incontinence. Frequent dribbling of urine is common in male clients after some types of prostate surgery or may occur in women after the development of a vesicovaginal or urethrovaginal fistula.

A client is experiencing premenstrual syndrome (PMS). The nurse should next ask the client about which of the following? a) Menstrual cycle irregularity with increased menstrual flow. b) Mood swings immediately after menses. c) Tension and fatigue before menses and through the second day of the menstrual cycle. d) Midcycle spotting and abdominal pain at the time of ovulation.

C. Tension and fatigue before menses and through the second day of the menstrual cycle. The timing of symptoms is important to the diagnosis of PMS. The client should keep a 3-month log of symptoms and menses. With PMS, the symptoms begin 3 to 7 days before menses and resolve 1 to 2 days after the menstrual cycle has started. Menstrual cycle irregularity and mood swings after menses are not related to PMS, and other causes should be investigated. Midcycle spotting and pain are related to ovulation.

A woman with cystitis is to take a 10 day prescription of an antibiotic. The client asks the nurse if she can continue to have sexual intercourse. The nurse should tell the client? a) "Avoid intercourse until you've completed the antibiotic therapy then limit intercourse to once a week." b) "You can have intercourse as often as you wish, but be sure your partner uses a condom." c) "Limit intercourse to once a day in the early morning after your bladder has rested." d) "As long as you're comfortable, you can have intercourse as often as you wish; but be sure to urinate within 15 minutes after intercourse."

D. "As long as you're comfortable, you can have intercourse as often as you wish; but be sure to urinate within 15 minutes after intercourse." Intercourse is not contraindicated in cystitis. Voiding immediately after intercourse flushes bacteria from the urethra, which should help prevent recurrence. There is no reason to wait until the antibiotic therapy is completed to have intercourse. There is no reason to limit the frequency of intercourse. A condom does not prevent cystitis because cystitis results from the introduction of the client's own organisms (usually Escherichia coli) into the urethra. A male partner cannot acquire cystitis from a woman with cystitis.

The nurse is developing a teaching plan for a client with stress incontinence. Which of the following instructions should be included? a) Avoid activities that are stressful and upsetting. b) Do not wear a girdle. c) Limit physical exertion. d) Avoid caffeine and alcohol.

D. Avoid caffeine and alcohol. Clients with stress incontinence are encouraged to avoid substances, such as caffeine and alcohol, that are bladder irritants. Emotional stressors do not cause stress incontinence. It is most commonly caused by relaxed pelvic musculature. Wearing girdles is not contraindicated. Although clients may want to limit physical exertion to avoid incontinence episodes, they should be encouraged to seek treatment instead of limiting their activities.

The nurse is developing a teaching plan for a client with stress incontinence. Which of the following instructions should be included? a) Limit physical exertion. b) Avoid activities that are stressful and upsetting. c) Do not wear a girdle. d) Avoid caffeine and alcohol.

D. Avoid caffeine and alcohol. Clients with stress incontinence are encouraged to avoid substances, such as caffeine and alcohol, that are bladder irritants. Emotional stressors do not cause stress incontinence. It is most commonly caused by relaxed pelvic musculature. Wearing girdles is not contraindicated. Although clients may want to limit physical exertion to avoid incontinence episodes, they should be encouraged to seek treatment instead of limiting their activities.