Med success genitourinary comprehensive exam

1. The elderly client being seen in the clinic has complaints of urinary frequency, urgency, and "leaking." Which priority intervention should the nurse implement when interviewing the client? 1. Ensure communication is nonjudgmental and respectful. 2. Set the temperature for comfort in the examination room. 3. Speak loudly to ensure the client understands the nurse. 4. Ensure the examining room has adequate lighting.

1. 1. Clients who have urinary incontinence are often embarrassed, so it is the responsibility of the nurse to approach this subject with respect and consideration.

15. The nurse is providing discharge teaching to the client diagnosed with polycystic kidney disease. Which statement made by the client indicates the teaching has been effective? 1. "I need to avoid any activity causing a risk for injury to my kidney." 2. "I should avoid taking medications for high blood pressure." 3. "When I urinate there may be blood streaks in my urine." 4. "I may have occasional burning when I urinate with this disease."

15. 1. Polycystic kidney disease poses an increased risk for rupture of the kidney, and therefore sports activities or occupations with risks for trauma should be avoided.

16. Which intervention should the nurse include when assessing the client for urinary retention? Select all that apply. 1. Inquire if the client has the sensation of fullness. 2. Percuss the suprapubic region for a dull sound. 3. Scan the bladder with the ultrasound scanner. 4. Palpate from the umbilicus to the suprapubic area. 5. Auscultate the two (2) lower abdominal quadrants.

16. 1. The nurse needs to assess the client's sensation of needing to void or feeling of fullness. 2. A dull sound heard when percussing the bladder indicates it is filled with urine. 3. A portable bladder scan is used to assess for the presence of urine, rather than using a straight catheter. 4. A distended bladder can be palpated.

18. The nurse is caring for the client recovering from a percutaneous renal biopsy. Which data indicate the client is complying with client teaching? 1. The client is lying flat in the supine position. 2. The client continues oral fluids restriction while on bedrest. 3. The client uses the bedside commode to urinate. 4. The client refuses to ask for any pain medication.

18. 1. The client needs to lie flat on the back to apply pressure to prevent bleeding.

2. The client is experiencing urinary incontinence. Which intervention should the nurse implement? 1. Teach the client to drink prune juice weekly. 2. Encourage the client to eat a high-fiber diet. 3. Discuss the need to urinate every six (6) hours. 4. Explain the importance of wearing cotton underwear.

2. Clients experiencing incontinence should eat a high-fiber diet to avoid constipation, which increases pressure on the bladder, which may increase incontinence.

13. The nurse is teaching the female client diagnosed with tuberculosis of the urinary tract prior to discharge. Which information should the nurse include specific to this diagnosis? 1. Instruct the client to take the medication with food. 2. Explain condoms should be used during treatment. 3. Discuss the need for follow-up chest x-rays. 4. Encourage a well-balanced diet and fluid intake.

2. Clients who have been diagnosed with tuberculosis of the renal tract should use condoms to prevent transmission of the mycobacterium. If the infection is located in the penis or urethra, abstaining from sexual activity is recommended.

25. The nurse is preparing the discharge teaching plan for the male client with a left-sided nephrectomy. Which statement indicates the teaching is effective? 1. "I can't wait to start back to work next week, I really need the money." 2. "I will take my temperature and if it is above 101 I will call my doctor." 3. "I am glad I won't have to keep track of how much I urinate in the day." 4. "I am happy I will be able eat what I usually eat, I don't like this food."

2. The client or family needs to contact the surgeon if the client develops chills, flank pain, decreased urinary output, or fever.

17. The nurse is discussing how to prioritize care with the UAP. Which client should the nurse instruct the UAP to see first? 1. The immobile client who needs sequential compression devices removed. 2. The elderly woman who needs assistance ambulating to the bathroom. 3. The surgical client who needs help changing the gown after bathing. 4. The male client who needs the intravenous catheter discontinued.

2. The elderly woman may have age-related changes (decreased bladder capacity, weakened urinary sphincter, and shortened urethra) causing urinary urgency or incontinence. The elderly client is at risk for falling while attempting to get to the bathroom, so this client should be seen first.

6. The nurse is preparing the plan of care for the client diagnosed with a neurogenic flaccid bladder. Which expected outcome is appropriate for this client? 1. The client has conscious control over bladder activity. 2. The client's bladder does not become overdistended. 3. The client has bladder sensation and no discomfort. 4. The client demonstrates how to check for bladder distention.

2. The treatment goal of the flaccid bladder is to prevent overdistention.

23. The nurse is preparing a teaching care plan for the client diagnosed with nephrotic syndrome. Which intervention should the nurse include? 1. Stop steroids if a moon face develops. 2. Provide teaching for taking diuretics. 3. Increase the intake of dietary sodium. 4. Report a decrease in daily weight.

2. Treatment includes diuretics to eliminate dependent edema, usually in the ankles and sacrum. Medication teaching is an appropriate intervention.

9. The nurse is caring for an elderly client who has an indwelling catheter. Which data warrant further investigation? 1. The client's temperature is 98.0˚F. 2. The client has become confused and irritable. 3. The client's urine is clear and light yellow. 4. The client feels the need to urinate.

2. When an elderly client's mental status changes to confused and irritable, the nurse should seek the etiology, which may be a UTI secondary to an indwelling catheter. Elderly clients often do not present with classic signs and symptoms of infection.

20. The nurse is preparing the plan of care for a client with fluid volume deficit. Which interventions should the nurse include in the plan of care? Select all that apply. 1. Monitor vital signs every two (2) hours until stable. 2. Measure the client's oral intake and urinary output daily. 3. Administer mouth care when bathing the client. 4. Weigh the client weekly in the same clothing at the same time. 5. Assess skin turgor and mucous membranes every shift.

20. 1. Vital signs should be monitored every two (2) hours until stable and more frequently if the client is unstable. 5. Skin turgor and mucous membranes should be assessed every shift or more often depending on the client's condition.

24. Which intervention is most important for the nurse to implement for the client with a left nephrectomy? 1. Assess the intravenous fluids for rate and volume. 2. Change surgical dressing every day at the same time. 3. Monitor the client's PT/PTT/INR level daily. 4. Monitor the percentage of each meal eaten.

24. 1. Assessing the rate and volume of intravenous fluid is the most important intervention for the client who has one (1) kidney because an overload of fluids can result in pulmonary edema.

26. The client diagnosed with a fluid and electrolyte disturbance in the emergency department is exhibiting peaked T waves on the STAT electrocardiogram. Which interventions should the nurse implement? List in order of priority. 1. Assess the client for leg and muscle cramps. 2. Check the serum potassium level. 3. Notify the health-care provider. 4. Arrange for a transfer to the telemetry floor. 5. Administer Kayexalate, a cation resin.

26. In order of priority: 1, 2, 3, 5, 4. 1. The nurse should assess to determine if the client is symptomatic of hyperkalemia. 2. A peaked T wave is indicative of hyperkalemia; therefore, the nurse should obtain a potassium level. 3. Hyperkalemia is a life-threatening situation because of the risk of cardiac dysrhythmias; therefore, the nurse should notify the health-care provider. 5. Kayexalate is a medication that will help remove potassium through the gastrointestinal system and should be administered to decrease the potassium level. 4. The client should be monitored continuously for cardiac dysrhythmias, so a transfer to the telemetry unit is warranted.

3. Which information indicates to the nurse the client teaching about treatment of urinary incontinence has been effective? 1. The client prepares a scheduled voiding plan. 2. The client verbalizes the need to increase fluid intake. 3. The client explains how to perform pelvic floor exercises. 4. The client attempts to retain the vaginal cone in place the entire day.

3. 1. Scheduled voiding allows the client to void every two (2) to three (3) hours apart, and when the client has remained consistently dry, the interval is increased by about 15 minutes.

22. The nurse is caring for a client diagnosed with rule-out nephrotic syndrome. Which intervention should be included in the plan of care? 1. Monitor the urine for bright-red bleeding. 2. Evaluate the calorie count of the 500-mg protein diet. 3. Assess the client's sacrum for dependent edema. 4. Monitor for a high serum albumin level.

3. The classic sign/symptom of nephrotic syndrome is dependent edema located on the client's sacrum and ankles.

21. Which outcome should the nurse identify for the client diagnosed with fluid volume excess? 1. The client will void a minimum of 30 mL per hour. 2. The client will have elastic skin turgor. 3. The client will have no adventitious breath sounds. 4. The client will have a serum creatinine of 1.4 mg/dL.

3. The client with fluid volume excess has too much fluid. Excess fluid is reflected by adventitious breath sounds. Therefore, an expected outcome is to have no excess fluid, as evidenced by normal, clear breath sounds.

10. The nurse is observing the UAP providing direct care to a client with an indwelling catheter. Which data warrant immediate intervention by the nurse? 1. The UAP secures the tubing to the client's leg with tape. 2. The UAP provides catheter care with the client's bath. 3. The UAP puts the collection bag on the client's bed. 4. The UAP cares for the catheter after washing the hands.

3. The drainage bag should be kept below the level of the bladder to prevent reflux of urine into the renal system; it should not be placed on the bed.

7. Which nursing intervention is most important before attempting to catheterize a client? 1. Determine the client's history of catheter use. 2. Evaluate the level of anxiety of the client. 3. Verify the client is not allergic to latex. 4. Assess the client's sensation level and ability to void.

3. The nurse should always assess for allergies to latex prior to inserting a latex catheter or using a drainage system because, if the client is allergic to latex, use of it could cause a life-threatening reaction.

4. Which intervention should the nurse implement first for the client who has had an incontinent episode? 1. Palpate the client's bladder to assess for urinary retention. 2. Obtain a bedside commode for the client. 3. Assist the client with changing the wet clothes. 4. Request the UAP to change the client's linens.

3. The nurse should first assist the client in getting out of the wet clothes prior to any other action. Wet clothes are embarrassing to the client and can lead to skin breakdown.

19. Which intervention should the nurse implement for the client who has had an ileal conduit? 1. Pouch the stoma with a one (1)-inch margin around the stoma. 2. Refer the client to the United Ostomy Association for discharge teaching. 3. Report to the health-care provider any decrease in urinary output. 4. Monitor the stoma for signs and symptoms of infection every shift. 20.

3. The output should be monitored to detect a decreased amount indicating an obstruction from edema or ureteral stenosis. Any decrease should be reported to the health-care provider.

27. The clinic nurse is reviewing information submitted by the UAP which states the presence of pediculosis pubis. Which area of the client's body should the nurse assess?

3. The pubic lice are found in the pubic area and are commonly transmitted during sexual intercourse.

12. The client is 12 hours postoperative renal surgery. Which data warrant immediate intervention by the nurse? 1. The abdomen is soft, nontender, and rounded. 2. Pain is not felt with dorsal flexion of the foot. 3. The urine output is 60 mL for the past two (2) hours. 4. The client's trough vancomycin level is 24 mcg/mL.

4. The client who has restricted kidney function from surgery should be monitored for damage as a result of the use of aminoglycoside antibiotics, such as vancomycin, which are nephrotoxic. This level is high and warrants notifying the HCP. Content - Surgical: Category

14. The nurse is assessing a client diagnosed with urethral strictures. Which data support the diagnosis? 1. Complaints of frequency and urgency. 2. Clear yellow drainage from the urethra. 3. Complaints of burning during urination. 4. A diminished force and stream during voiding.

4. The client with urethral strictures will report a decrease in force and stream during voiding. The stricture is treated by dilation using small filiform bougies.

11. Which intervention should the nurse implement when caring for the client with a nephrostomy tube? 1. Change the dressing only if soiled by urine. 2. Clean the end of the connecting tubing with Betadine. 3. Clean the drainage system every day with bleach and water. 4. Assess the tube for kinks to prevent obstruction.

4. The nephrostomy tube should never be clamped or have kinks because an obstruction can cause pyelonephritis.

5. The elderly client recovering from a prostatectomy has been experiencing stress incontinence. Which independent nursing intervention should the nurse discuss with the client? 1. Establish a set voiding frequency of every two (2) hours while awake. 2. Encourage a family member to assist the client to the bathroom to void. 3. Apply a transurethral electrical stimulator to relieve symptoms of urinary urgency. 4. Discuss the use of a "bladder drill," including a timed voiding schedule.

4. Use of the bladder training drill is helpful in stress incontinence. The client is instructed to void at scheduled intervals. After consistently being dry, the interval is increased by 15 minutes until the client reaches an acceptable interval.

8. Which client should the nurse not assign to a UAP working on a surgical floor? 1. The client with a suprapubic catheter inserted yesterday. 2. The client who has had an indwelling catheter for the past week. 3. The client who is on a bladder-training regimen. 4. The client who had a catheter removed this morning and is being discharged.

8. 1. This client requires the most skill and knowledge because this client has the greatest potential for an infection; therefore, the client should not be assigned to a UAP.