MS4

The nurse is caring for a client with a cystectomy and ileal conduit (urostomy) for prior bladder cancer. Which statements by the client would indicate that teaching has been effective? Select all that apply.

"I understand that I will need to consume adequate amounts of fluids each day." "It is important to observe the color and odor of my urine." "Redness around the stoma should be reported to my physician." Explanation: Teaching regarding care of the ostomy is important to maintain a healthy environment. The increased intake of fluids will keep the urine dilute and will help flush out bacteria. Observing the color and amount of urine will help determine whether output is adequate. Reporting redness will identify early symptoms of an infection. "This ostomy pouch is temporary until my surgery can be reversed" and "I should eat a diet high in protein and carbohydrates" are incorrect because an ileal conduit is permanent--the bladder has been removed. Furthermore, a diet high in protein is not recommended for problems with the urinary system because it can damage the kidneys.

A charge nurse is making arrangements for an elderly client newly admitted from the emergency department for treatment of suspected pyelonephritis. The charge nurse notes that the client has been assigned to a semiprivate room with another client who has the same last name. What should the nurse do first?

Ask the admissions department to assign the elderly client to a new room. Explanation: To prevent errors, the charge nurse should ask the admissions department to assign the elderly client to another room. Making signs and verbally alerting staff members don't eliminate the risk of error. It isn't appropriate to ask the client if they'd be willing to answer to a different last name.

An older adult client had spinal anesthesia for a transurethral resection of the prostate and received 4000 mL of room-temperature isotonic bladder irrigation. The client now has continuous irrigation through a three-way indwelling urinary catheter. Which postoperative nursing intervention is most important to include in the plan of care?

Cover the client with warm blankets. Explanation: It is important for the nurse to cover this client with warm blankets because they are at high risk for hypothermia secondary to age, spinal anesthesia, placement in a lithotomy position in the cool operating room for 1½ hours, instillation of 4000 mL of room-temperature bladder irrigation, and ongoing bladder irrigation. Spinal anesthesia causes vasodilation, which results in heat loss from the core to the periphery. The nurse will empty the catheter drainage bag and hang new bags of irrigation as needed, but the client's potential for hypothermia should be addressed first. The client will not be turned at this time.

A client has undergone a cystectomy and an ileal conduit diversion. What should the nurse include in the discharge instructions? Select all that apply.

Drink at least 101 oz (3000 mL) of fluid each day. Avoid odor-producing foods, such as onions, fish, eggs, and cheese. Explanation: An adequate fluid intake aids in the prevention of urinary calculi and infection. Odor-producing foods can produce offensive odors that may impact the client's lifestyle and relationships. Lack of activity leads to urinary stasis, which promotes urinary calculi development and infection. Acidic urine helps prevent urinary tract infections. Tight clothing over the stoma obstructs blood circulation and urine flow.

A client with prostate cancer is treated with a luteinizing hormone-releasing hormone agonist and antagonist goserelin. What symptom should the nurse instruct the client to expect while receiving this treatment?

Flushing Explanation: Goserelin is used to decrease testosterone production in men to slow or stop the production of cancer cells. A common side effect is flushing or hot flashes. Changes in blood pressure, tenderness of the scrotum, and dramatic changes in secondary sexual characteristics should not occur.

The nurse teaches a client scheduled for an I.V. pyelogram what to expect when the dye is injected. The client has correctly understood what was taught when the client states that there may be which of the following sensations when the dye is injected?

Flushing of the face. Explanation: As the dye is injected, the client may experience a feeling of warmth, flushing of the face, and a salty taste in the mouth. The client should not experience chest pa

An older adult who is to be on bed rest has become incontinent of urine. To prevent pressure ulcers, the nurse should do which task(s)? Select all that apply.

Institute a turning schedule. Inspect the groin for wetness. Have the client wear incontinence briefs. Explanation: This client is at risk for pressure ulcers because of age, being on bed rest, and being incontinent. The nurse assesses all pressure points and the groin area, assures that the client changes positions every 2 hours, and has the client wear incontinence pads containing absorbent material (specially designed to absorb many times its weight in water) or disposable incontinence briefs. Sanitary napkins are not designed to contain or absorb urine. Anchoring a Foley catheter increases the risk for infection.

A client requires behavioral therapies to decrease or eliminate urinary incontinence. Which procedures would the nurse expect to include in the teaching plan for this client? Select all that apply.

Kegel exercises scheduled voiding biofeedback Explanation: Clients, particularly females, have conditions relating to alterations in urinary output. Kegel exercises, scheduled voiding, and biofeedback are behavioral therapies used to decrease or eliminate urinary incontinence. Both external catheters and self-catheterization devices are used to collect urine. Post void residual monitoring assesses the ability to empty the bladder but does not decrease or eliminate urinary incontinence.

Which post-procedure instruction will the nurse include for a client who had a vasectomy?

Sperm cells will be reabsorbed into the body. Explanation: Vasectomy interrupts the pathway of sperm from the urethra during ejaculation. Ejaculation will be normal but the ejaculate will no longer contain sperm. No noticeable decrease in the amount of ejaculate occurs.

The nurse is assessing the client's urinary stoma, which was created 4 days ago. Which sign indicates stomal edema?

urine output below 30 mL/hr Explanation: Urine output below 30 mL/hhr could indicate stomal edema, which obstructs urine output. An elevated temperature should be noted, but it is not related to stomal edema. Urine dribbling from the stoma is normal. Discomfort around the stoma is common postoperatively after construction of an ileal conduit.

After transurethral resection of the prostate, the nurse notices that the urine draining from the catheter is bright red, has numerous clots, and is viscous. Which nursing action is most appropriate?

Assess vital signs and notify the surgeon. Explanation: Blood clots are normal after transurethral resection of the prostate, but bright red urine can indicate a hemorrhage. The nurse should assess the client's vital signs and notify the surgeon. Irrigation of the catheter may help remove clots, but it does not decrease bleeding. Milking a urinary catheter or increasing fluid intake is not effective for controlling bleeding or decreasing clots.

Which action(s) related to the care of a client with a Foley catheter would be appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? Select all that apply.

Empty the drainage bag, and record output at specified times. Apply a catheter-securing device to the client's leg. Provide a Foley catheter and perineal care each shift. Ensure the urine drainage bag is below the level of the bladder at all times. Explanation: While the scope of practice for a UAP may vary by state, province, or territory, as well as by place of employment, general duties include recording input and output, including emptying and recording urine output from a Foley catheter. A UAP 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 UAP as these activities involve nursing assessment skills.

If a client who had a cystoscopy 2 hours ago has lower abdominal pain, what action should the nurse take?

Have the client sit in a tub of warm water. Explanation: Lower abdominal pain after a cystoscopy is frequently caused by bladder spasms. Warm water can help relax muscles. Ice is not effective in relieving spasms. Massage and ambulation may increase bladder irritability.

The nurse is teaching a client with an ileal conduit how to prevent a urinary tract infection. Which measure would be most effective?

Maintain a daily fluid intake of 68 to 101 oz (2000 to 3000 mL.). Explanation: Maintaining a fluid intake of 68 to 101 oz (2000 to 3000 mL) a day is likely to be most effective in preventing urinary tract iinfections. A high fluid intake results in high urine output, which prevents urinary stasis and bacterial growth. Avoiding people with respiratory tract infections will not prevent urinary tract infections. Clean, not sterile, technique is used to change the appliance. An ileal conduit stoma is not irrigated.

Trimethoprim has been prescribed for a client with a urinary tract infection. What should the nurse instruct the client to do?

Report any unusual bleeding or bruising. Explanation: Trimethoprim can cause thrombocytopenia, so clients should be instructed to report any unusual bleeding or bruising. Periodic blood counts should be conducted while the client is using this medication. The medication should be taken until the full course of therapy has been completed. A urine culture should be obtained before therapy is implemented. Trimethoprim does not need to be taken with meals.

The nurse is assessing a client who just had a cystoscopy. Which symptom indicates that a client has developed a complication?

chills Explanation: Chills could indicate the onset of acute infection that can progress to septic shock. Dizziness would not be an anticipated symptom after a cystoscopy. Pink-tinged urine and bladder spasms are common after cystoscopy.

Which finding in the client's history would be the least likely to have predisposed the client to renal calculi?

drinking less than the recommended amount of milk Explanation: A high, rather than low, milk intake predisposes to renal calculi formation, owing to the calcium in milk.Recurrent urinary tract infections are implicated in stone formation as certain bacteria promote stone formation.High daily doses of vitamins C are a risk factor because they can increase the citric acid level.Prolonged immobility is a risk factor for renal calculi because it causes calcium to be released into the bloodstream.

A client reports having difficulty voiding to the nurse. What question(s) will the nurse ask the client? Select all that apply.

"Are you waking up in the middle of the night to void?" "How much fluids are you drinking in the late evenings?" "What are your usual voiding patterns?" Explanation: The nurse will focus on the genitourinary system with voiding during the night, drinking fluids in the evening, and patterns of voiding. The history of hemorrhoids and the colonoscopy are related to the gastrointestinal system.

A client is scheduled to undergo weekly intravesical chemotherapy for bladder cancer for 8 weeks. Which statement indicates that the client understands how to manage the urine as a biohazard? You Selected:

"I can disinfect the urine and toilet with bleach for 6 hours following a treatment." Explanation: After intravesical chemotherapy, the client must treat the urine as a biohazard; this involves disinfecting the urine and the toilet with household bleach for 6 hours following treatment. It is not necessary to use a bedpan and then empty the urine in the toilet; the client can use the toilet but must disinfect the urine with bleach. The bathroom does not need to be cleaned daily with disinfectant wipes. The client does not need to use a separate bathroom as long as the client's urine is disinfected with bleach.

A nurse is teaching a client about prevention of genital herpes. What statement indicates the teaching was successful?

"I'll ask any future partners if they have ever been diagnosed with genital herpes." Explanation: Clients with genital herpes should inform their partners of the disease to help prevent transmission, and the client should be advised to ask future partners about their health history. Spermicides are a form of birth control and do not prevent genital herpes. The notion that genital herpes is only transmittable when visible lesions are present is false. According to the Centers for Disease Control and Prevention, long-term monogamous relationships help prevent the spread of herpes, but the client is protected only if the partner is infection-free at the beginning of the relationship. Anyone not already in a long-term, monogamous relationship, regardless of current health status, should follow safer-sex practices.

After undergoing a total cystectomy and urinary diversion, a client has a Kock pouch (continent internal reservoir) in place. Which statement by the client indicates a need for further teaching?

"I'll have to wear an external collection pouch for the rest of my life." Explanation: Additional teaching is required if the client states that an external collection pouch must be worn for the rest of the client's life. An internal collection pouch, such as the Kock pouch, allows the client to perform self-catheterization for ileal drainage. This pouch is an internal reservoir, eliminating the need for an external collection pouch. A well-balanced diet is essential for healing; the client need not include or exclude particular foods. The client should drink at least eight glasses of fluid daily to prevent calculi formation and urinary tract infection. Intervals between pouch drainings should be increased gradually until the pouch is emptied two to four times daily.

A nurse is instructing a client with an ileal conduit about skin care around the stoma. What should the nurse tell the client about stoma care? Select all that apply.

"The stoma will shrink to a normal size in 4 to 6 weeks." "You can take a shower or a bath with the appliance on or off." "You can use an electric razor to remove the hair around the stoma." Explanation: The nurse should instruct the client with an ileal conduit that the stoma will shrink in about 4 to 6 weeks. The client can take a shower or a bath with the collection pouch on or off. The client can shave the hair around the stoma using an electric razor to make it easier for the collection bag to adhere to the skin. The client should wash the skin around the stoma with water; it is not necessary to use an antibacterial soap, and soap may cause the skin to become dry and irritated. The collection bag can remain in place for up to 7 days.

A client has renal colic due to renal lithiasis. What is the nurse's priority in managing care for this client?

Administer an opioid analgesic as prescribed. Explanation: If infection or blockage caused by calculi is present, a client can experience sudden severe pain in the flank area, known as renal colic. Pain from a kidney stone is considered an emergency situation and requires analgesic intervention. Withholding fluids will make urine more concentrated and stones more difficult to pass naturally. Forcing large quantities of fluid may cause hydronephrosis if urine is prevented from flowing past calculi. Straining urine for small stones is important but does not take priority over pain management.

The client has a strong urge to void 6 hours following a transurethral resection for benign prostatic hyperplasia. What are the priority nursing interventions? Select all that apply.

Assess patency of indwelling catheter. Open the irrigation system to flush the catheter. Explanation: The priority nursing interventions are to assess the catheter for kinks because this will impede the flow of urine out of the catheter. Flushing the catheter will help to the patency by clearing the tubing and catheter of clots. Pain medication, deep breathing, and ice will not help urination.

A client had a percutaneous nephrolithotomy to remove a kidney stone. The client is being discharged with drainage tubes from the kidney. What should the nurse instruct the client to do after the procedure? Select all that apply.

Avoid heavy lifting for 2 to 4 weeks. Report fever or chills to the health care provider (HCP). Go to the emergency department for bleeding from the drainage tubes. Explanation: Following percutaneous nephrolithotomy, the nurse should instruct the client to avoid lifting heavy objects for 2 to 4 weeks. The client should contact the HCP if they are having chills or fever. The client should go to the emergency department if there is bleeding from the drainage tubes. Usually, the client can return to work in a week. It is not necessary to strain the urine. The client will likely have x-rays or an ultrasound several weeks after the surgery to determine if there are other stones in the kidney.

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?

Call the hospital pharmacist and question the medication supplied. Explanation: 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.

An older adult admitted with new-onset confusion, headache, poor skin turgor, bounding pulse, and urinary incontinence has been drinking copious amounts of water. Upon reviewing the lab results, the nurse discovers a sodium level of 122 mEq/L (122 mmol/L). What action(s) should the nurse take? Select all that apply.

Keep partial side rails up. Restrict fluids to 800 mL in 24 hours. Prepare to insert a Foley catheter. Notify the health care provider (HCP). Explanation: The client is hyponatremic; the nurse should notify the HCP, restrict fluids, and prepare to insert a Foley catheter to ensure accurate intake and output. Side rails should be up to maintain client safety; it is not safe for the client to be ambulating in the hallway with family at this time. Encouraging fluids would not be beneficial and could be harmful.

The nurse is planning care for an obese client. The client experiences dribbling urine when they cough, sneeze, or change positions. The nurse should instruct the client to promote urinary health by encouraging which action(s)? Select all that apply.

Participate in a weight-loss program. Perform muscle-strengthening exercises (Kegel exercises). Use adult diapers as needed. Explanation: The goal is to promote health in this client who has stress incontinence. Participating in a weight-loss program or support group may decrease the intra-abdominal pressure that is contributing to the incontinence. Participating in swimming, bicycling, or low-impact exercise is beneficial to weight loss. Kegel exercises are helpful in developing muscle control. Wearing adult diapers will absorb leaked urine and prevent excoriation. Clients with urinary stress incontinence are encouraged to avoid drinks with caffeine and alcohol. Perineal care is essential to prevent skin breakdown, but the client does not require a Foley or straight catheter at this time.

The nurse is planning care for a client with a catheter. What action(s) should the nurse take to prevent a catheter-associated urinary tract infection? Select all that apply.

Provide perineal care at least once a day. Maintain a closed drainage system. Encourage the client to drink 101 oz (3000 mL) fluids daily. Explanation: Catheter-associated urinary tract infection is the most frequent type of health care-acquired infection (HAI) and represents as much as 80% of HAIs in hospitals. The nurse should provide meticulous perineal care at least once a day, maintain a closed drainage system, and encourage the client to obtain an adequate fluid intake. 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 a prescription for antibiotics as the client does not currently have an infection.

The nurse is planning care for a client with a history of benign prostatic hypertrophy (BPH). What action(s) should the nurse plan to take? Select all that apply.

Provide privacy and time for the client to void. Monitor intake and output. Ask the client if they have urinary retention. Test the urine for hematuria. Explanation: Because of the history of BPH, the nurse should provide privacy and time for the client to void. The nurse should also monitor intake and output, assess the client for urinary retention, and test the urine for hematuria. It is not necessary to catheterize the client.

A client has experienced excessive losses of bicarbonate and has subsequently developed an acid-base imbalance. How will this lost bicarbonate be replaced?

Renal tubular cells will generate new bicarbonate. Explanation: To replace any lost bicarbonate, the renal tubular cells generate new bicarbonate through a variety of chemical reactions. This newly generated bicarbonate is then reabsorbed by the tubules and returned to the body. The lungs and adrenal glands do not synthesize bicarbonate. Excretion of acid compensates for a lack of bicarbonate, but it does not actively replace it.

The nurse teaches a female client who has cystitis methods to relieve discomfort until the antibiotic takes effect. Which response by the client would indicate that they understand the nurse's instructions? "I will:

Strain the urine carefully. Explanation: Intermittent pain that is less colicky indicates that the calculi may be moving along the urinary tract. Fluids should be encouraged to promote movement, and the urine should be strained to detect the passage of the stone. Hematuria is to be expected from the 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.

The nurse is caring for a client with urinary calculi of unknown origin. Which interventions would be appropriate for this client? Select all that apply.

Strain urine. Medicate for pain. Explanation: Strain the urine to obtain the stone and send it for analysis, which will assist the healthcare provider in determining the correct course of treatment to prevent a recurrence. Urinary calculi are very painful and require pain medication. Client needs to increase fluid to flush out the stone. It is not appropriate to decrease calcium until it is determined that the stone consists of calcium. Allopurinol would only be ordered if the stone consisted of uric acid.

The nurse is observing an unlicensed assistive personnel (UAP) give care to a client after gynecologic surgery. When should the nurse discuss the care with the UAP?

The UAP massages the client's legs. Explanation: Massaging the legs postoperatively is contraindicated because it may dislodge small clots of blood, if present, and cause even more serious problems. Ambulation, elasticized stockings, and moving the legs in bed all help reduce the risk for thrombophlebitis.

A client had a cystoscopy to remove a renal stone. Which laboratory data warrants immediate intervention by the nurse?

a white blood cell count of 14,000 mm/dL (14.00 x 109/L) Explanation: The high white blood cell count signals infection and needs to be treated immediately. Microscopic hematuria may be related to trauma from the procedure and is not cause for alarm. The creatinine and calcium levels are normal.

The nurse is teaching a client with erectile dysfunction (ED) to alter their lifestyle. Which change should the nurse recommend?

avoiding alcohol Explanation: Avoidance of alcohol can improve the outcome of therapy. Alcohol and smoking can affect a man's ability to have and maintain an erection. The client should be encouraged to follow a healthy diet, but no specific diet is associated with improvement of sexual function. The client should cease smoking, not just decrease smoking. Increasing attempts at intercourse without treatment will not facilitate improvement. The client should be reassured that ED is a common problem and that help is available.

A nurse is triaging clients in the emergency department. Which client is the highest priority to receive treatment?

middle-aged adult with hematuria and ecchymosis of the penis 1 hour after a bicycling accident Explanation: Prioritization is based on evidence that a client's condition is unstable or deteriorating over time. The client with perineal injury following a bicycle accident is exhibiting immediate signs of a straddle injury that could result in a urethral rupture. This is an emergency that could require surgery. The client with a hip injury may also require surgery but is of lower priority because of the duration. The other two clients are both stable; therefore, they are less urgent.

A client with a history of chronic cystitis comes to an outpatient clinic with signs and symptoms of this disorder. To prevent cystitis from recurring, the nurse recommends maintaining an acid-ash diet to acidify the urine, thereby decreasing the rate of bacterial multiplication. On an acid-ash diet, the client must restrict which beverage?

milk Explanation: A client on an acid-ash diet must avoid milk and milk products because these make the urine more alkaline, encouraging bacterial growth. Other foods to avoid on this diet include all vegetables except corn and lentils; all fruits except cranberries, plums, and prunes; and any food containing large amounts of potassium, sodium, calcium, or magnesium. Cranberry and prune juice are encouraged because they acidify the urine. Coffee and tea are considered neutral because they don't alter the urine pH.

A client is admitted with fever and flank pain and is diagnosed with pyelonephritis. What is a priority nursing intervention in a client with this disorder?

monitoring laboratory values, especially WBCs Explanation: Pyelonephritis generally causes fever, chills, flank pain, nausea, vomiting, increased white blood cells, pyuria, bacteriuria, and hematuria. As such, the nurse should be monitoring laboratory values, especially white blood cell count for trends, and to observe if antibiotic therapy is effective. Urine is strained if renal calculi are suspected. Specific gravity values and a 24-hour urine collection are not consistent with the treatment of pyelonephritis.

The health care provider (HCP) has prescribed allopurinol for a client who has renal calculi. Which symptom(s) would indicate the client is experiencing adverse effects of this drug? Select all that apply.

nausea rash bone marrow depression Explanation: Common adverse effects of allopurinol include gastrointestinal distress, such as anorexia, nausea, vomiting, and diarrhea. A rash is another potential adverse effect. A potentially life-threatening adverse effect is bone marrow depression. Constipation and flushed skin are not associated with this drug.

A client with a testicular malignancy undergoes a radical orchiectomy. What should the nurse assess the client for during the immediate postoperative period?

pain Explanation: Because of the location of the incision in the high inguinal area, pain is a major problem during the immediate postoperative period. The incisional area and discomfort caused by movement contribute to increased pain. Bladder spasms and elimination problems are more commonly associated with prostate surgery. Nausea is not a priority problem.

The nurse is inserting a catheter for a client with a distended bladder following surgery for benign prostatic hypertrophy. The nurse should allow the urine to drain from the bladder slowly to prevent which complication?

possible shock Explanation: Rapid emptying of an overdistended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. The nurse should empty the bladder slowly. Removal of urine from the bladder does not cause renal failure. The client may experience cramping, but the primary concern is the potential for shock. Bladder muscles will not atrophy because of catheterization.

A nurse is caring for an elderly male client who complains that he can't pass urine. A bladder scan reveals 600 ml of urine present in the bladder. The nurse attempts to place the indwelling catheter the physician ordered, but resistance prevents the nurse from placing it. A serum prostate-specific antigen (PSA) test indicates a level of 29 g/L. The physician places an indwelling catheter and the urine specimen returns positive for nitrites, leukocytes, and bacteriuria. Which conditions should the nurse suspect? Select all that apply.

prostate problems urinary tract infection (UTI) Explanation: An elevated PSA level and lower urinary tract symptoms may indicate a prostate problem. A urine specimen positive for leukocytes, nitrites, and bacteriuria indicates UTI. The client's signs and symptoms don't indicate acute renal failure, liver failure, or a vitamin K deficiency.

The nurse is reviewing a client's urine culture and sensitivity test results. Which findings would the nurse expect to see in small amounts in normal urine? Select all that apply.

protein white blood cells Explanation: A urine culture is a test to detect and identify organisms, such as bacteria and components, within the urine. Information obtained can identify a urinary tract infection, kidney disease, or high blood glucose. Small amounts of protein and white blood cells are normal. Ketones, crystals, nitrates, and bilirubin are all abnormal findings.

In addition to nausea and severe flank pain, a female client with renal calculi has pain in the groin and bladder. What additional sign should the nurse assess?

referred pain Explanation: The pain associated with renal colic due to calculi is commonly referred to the groin and bladder in female clients and 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 stone formation.

To assess the client's renal status, the nurse should monitor which laboratory test(s)? Select all that apply.

serum blood urea nitrogen (BUN) creatinine levels Explanation: Serum BUN and creatinine are the tests most commonly used to assess renal function, with creatinine being the most reliable indicator. Nonrenal factors may affect BUN levels as well as serum sodium and potassium levels. Arterial blood gases and hemoglobin are not used to assess renal status. Urinalysis is a general screening test.

The nurse teaches a female client who has cystitis methods to relieve discomfort until the antibiotic takes effect. Which response by the client would indicate that they understand the nurse's instructions? "I will:

take warm tub baths." Explanation: Warm tub baths promote relaxation and help relieve urgency, discomfort, and spasm. Applying heat to the perineum is more helpful than cold because heat reduces inflammation. Although liberal fluid intake should be encouraged, caffeinated beverages, such as tea, coffee, and cola, can be irritating to the bladder and should be avoided. Voiding at least every 2 to 3 hours should be encouraged because it reduces urinary stasis.

The nurse is working the night shift and needs to collect urine from four clients for routine urinalysis in a skilled nursing home. When are the most accurate urine samples obtained? Select all that apply.

the first void of the morning anytime as long as the sample is refrigerated Explanation: The nurse will collect the first void of the morning and anytime as long as the sample is refrigerated. The first void of the day, or when the client voids needs to be refrigerated or transported to the laboratory.

After a client has surgery for an ileal conduit, the nurse should assess the client for the occurrence of which complication?

thrombophlebitis Explanation: After pelvic surgery, there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. Peritonitis is a potential complication of any abdominal surgery, not just pelvic surgery. Ascites is most frequently an indication of liver disease. Inguinal hernia may be caused by an increase in intra-abdominal pressure or a congenital weakness of the abdominal wall; ventral hernia occurs at the site of a previous abdominal incision.

The nurse is assessing laboratory values to identify if medical treatment and nursing interventions have improved kidney function in a client with renal disease. Which laboratory tests will the nurse monitor to determine the functioning status of the kidneys? Select all that apply.

urine albumin glomerular filtration rate (GFR) creatinine clearance basic metabolic panel (BMP) Explanation: The nurse assesses laboratory values that identify kidney function. Urine albumin is used to detect early kidney disease. Measuring the filtration rate of the glomerulus of the kidney is helpful in identifying the status of the kidney. The creatinine clearance measures blood levels being filtered by the kidney. Within the basic metabolic panel are tests identifying kidney function such as the BUN and creatinine. A urine culture determines if bacteria is present in the urine but is not a good indicator of kidney functioning. Hemoglobin AIC measures glucose in the blood over a 3-month period.