Urinary Chp 49 Questions

13. The nurse performs a catheterization immediately after a patient voids and obtains 30 mL of residual urine. What action by the nurse should be taken next? 1. Document the procedure with outcome data. 2. Continue the catheterization routine after each voiding. 3. Restrict fluid intake after dinner. 4. Immediately notify the health care provider of the results.

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14. Which goal would have priority in planning care of the aging patient with urinary incontinence? 1. Recognizes the urge to void 2. Mobility necessary for toileting independently 3. Episodes of incontinence decrease 4. Drinks a minimum of 2000 mL of fluid per day

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15. What is the goal for peritoneal dialysis? 1. Removal of toxins and metabolic waste 2. Production of rapid fluid shifts 3. Increased clearance of dialysate flow 4. Restoration of normal kidney function

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19. The nurse making rounds discovers that there is no urine drainage from a postoperative patient's Foley catheter. What action by the nurse should be performed first? 1. Ensure patency. 2. Irrigate until clear. 3. Call the health care provider. 4. Insert larger lumen catheter.

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20. Which problem constitutes a medical emergency? 1. Anuria 2. Polyuria 3. Dysuria 4. Dyspnea

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22. What clinical findings in the oliguric phase of acute renal failure will be noted? 1. BUN and creatinine levels rise. 2. Urinary output increases. 3. Signs of impending shock are present. 4. Blood flow to the kidneys increases.

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27. A patient diagnosed with ESRD is treated with conservative management, including erythropoietin injections. After teaching the patient about management of ESRD, the nurse determines teaching has been effective when the patient makes which statement? 1. "I will measure my urinary output each day to help calculate the amount I can drink." 2. "I need to take the erythropoietin to boost my immune system and help prevent infection." 3. "I need to try to get more protein from dairy products." 4. "I will try to increase my intake of fruits and vegetables."

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5. Which activity would be most harmful for the incontinent patient? 1. Restricting fluid intake 2. Drinking only water 3. Fluid intake of 2000 mL/day 4. Restricting acidic fruit juice intake

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8. When scheduling the administration of furosemide (Lasix), it would be in a patient's best interest to schedule the medication to be given what time? 1. 09:00 2. 12:00 3. 21:00 4. 24:00

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24. The nurse is reviewing the health history of a patient suspected of having renal calculi. What factors in the patient's history increase the patient's risk for developing the condition? (Select all that apply.) 1. Stasis of urine caused by obstruction 2. Infections of urinary tract 3. Hypoparathyroidism 4. Diabetes mellitus 5. Immobility

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1. The nurse is reviewing the urinalysis report on an assigned patient. The nurse recognizes which findings to be normal? (Select all that apply.) 1. Turbidity clear 2. pH 6.0 3. Glucose negative 4. Red blood cells, 15 to 20 5. White blood cells, 1-3

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25. The collection of subjective and objective data for a patient with acute glomerulonephritis could include which symptoms? (Select all that apply.) 1. Periorbital edema 2. Anorexia 3. Hypotension 4. Frankly sanguineous urine 5. Headaches

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26. Careful preparation of a patient for an IVP is necessary. What nursing interventions would be included in the preparation? (Select all that apply.) 1. NPO for about 8 hours before examination 2. Ascertaining whether patient has allergy to magnesium 3. Giving prescribed bowel prep 4. Instructing patient concerning IVP 5. Discussing the anesthesia needed for the procedure

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10. Which patient report indicates that phenazopyridine hydrochloride (Pyridium) is being effective? 1. Decreased bladder spasms 2. Decrease in burning sensation 3. Increased urinary output 4. Increased pain tolerance

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11. When calculating actual urinary output during continuous bladder irrigations, the nurse would: 1. measure and record all fluid output in the drainage bag. 2. measure the total output and deduct the amount of irrigation solution used. 3. add the total of all intravenous and irrigation solutions and deduct output. 4. measure total output and deduct the total intravenous solutions.

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17. What is the primary function of the kidney? 1. Regulation of enzymes 2. Filtration of water and blood products 3. Collection of urine from the body 4. Control of the adrenal glands

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21. The most common cause of renal failure is: 1. Trauma 2. Diabetes mellitus 3. Cancer 4. Heart failure

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3. The nursing care plan includes teaching a patient Kegel exercises. The nurse teaches the patient to alternately tighten and relax which group of muscles? 1. Perineal floor 2. Pubococcygeal 3. Abdominis rectus 4. Detrusor

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9. In discussing dietary needs with a patient with ESRD, the nurse indicates that potassium-rich foods should be limited in the diet; these include: 1. apples, applesauce, grapes, and raisins. 2. bananas, nuts, and chocolate. 3. grapefruit, tomatoes, oranges, and bananas. 4. milk, grapefruit, orange juice, and sugar.

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23. What are correct patient teachings for a patient with cystitis? (Select all that apply.) 1. Teach the patient to drink apple juice to treat and prevent UTIs. 2. Teach the female patient to cleanse the perineal area from anterior to posterior to prevent rectal E. coli contamination of the urethra. 3. Encourage the patient to drink 2000 mL of fluid per day, unless contraindicated. 4. Instruct the patient that it is acceptable to stop taking prescribed medications when symptoms subside. 5. Instruct the patient to void as soon after sexual intercourse as possible.

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2. The nurse is caring for a patient who has just had a renal angiography performed. What is the priority assessment? 1. Blood pressure 2. Respiratory effort 3. Puncture site 4. Urinary output

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29. The nurse has instructed a patient who is receiving hemodialysis about dietary management. Which diet choices by the patient indicate that the teaching has been successful? 1. Scrambled eggs, English muffin, and apple juice 2. Cheese sandwich, tomato soup, and cranberry juice 3. Split-pea soup, whole-wheat toast, and nonfat milk 4. Oatmeal with cream, half a banana, and herbal tea

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6. The nurse is reviewing the culture and sensitivity reports for a patient being treated for pyelonephritis. What pathogen will most likely be identified as the infecting agent? 1. Candida albicans 2. Klebsiella 3. Escherichia coli 4. Pseudomonas

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12. What statement by a patient indicates the need for further teaching before renal angiography? 1. "I will miss having breakfast." 2. "I know the nurse will be checking my pulse after the test." 3. "I'm glad I don't have to stay in bed after the test." 4. "I had a test similar to this 3 years ago."

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16. The nurse is caring for a patient during the postoperative period after an arteriovenous shunt has been placed. What is the most important action to be taken? 1. Secure the shunt with an elastic bandage. 2. Notify the health care provider if a bruit or thrill is present. 3. Change the shunt if clotting occurs. 4. Use strict surgical asepsis for dressing changes.

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18. The priority short-term goal for disorders of the urinary system is: 1. patient confidentiality. 2. privacy. 3. education for patient and family. 4. normal patterns of urinary elimination.

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28. As the nurse reviews a diet plan with a patient with diabetes mellitus and renal insufficiency, the patient states that with diabetes and renal failure there is nothing that is good to eat. The patient says, "I am going to eat what I want; I'm going to die anyway!" What is the best nursing diagnosis for this patient? 1. Imbalanced nutrition: more than body requirements, related to knowledge deficit about appropriate diet 2. Risk for noncompliance, related to feelings of anger 3. Grieving, related to actual and perceived losses 4. Risk for ineffective health maintenance, related to complexity of therapeutic regimen

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4. The health care provider has talked to a patient and his wife about the treatment plan for his bladder cancer. Later, the patient tells the nurse he does not understand what the health care provider is going to do. What is the most appropriate initial response by the nurse? 1. "Okay. I'll explain it to you again." 2. "Make a list of questions for the doctor." 3. "Try not to think about the treatment."

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7. Which factor will most likely promote patient compliance with the prescribed treatment plan? 1. A set time schedule to follow 2. Data on success rates 3. Written information about the plan 4. An active role in the planning

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40. _____________ is a term for severe generalized edema.

ANS: Anasarca The patient with nephritic syndrome has severe generalized edema (anasarca), anorexia, fatigue, and impaired renal function. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1707 OBJ: 8 TOP: Key term KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

45. Put the sequence of blood flow in order of flow through the nephron. (Separate letters by a comma and space as follows: A, B, C, D) a. Reabsorption in loop of Henle b. Efferent arteriole c. Filtration in the glomerulus d. Reabsorption in proximal convoluted tubule e. Afferent arteriole f. Secretion in the distal convoluted tubule

ANS: E, C, D, A, F, B The blood enters the nephron via the afferent arteriole, is filtered through the glomerulus, reabsorption occurs in the proximal convoluted tubule, then the loop of Henle, then the distal convoluted tubule, and then out the efferent arteriole. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1673, Figure 49-3 OBJ: 2 TOP: Nephron action KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

43. _________ is a prostatic pain without evidence of infection or inflammation.

ANS: Prostatodynia Prostatodynia is a prostatic pain without evidence of infection of inflammation. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1692 OBJ: 8 TOP: Prostatodynia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

41. Acute glomerulonephritis is commonly a result of a preexisting infection of _____________.

ANS: beta-hemolytic streptococci The health history commonly reveals that the onset of acute glomerulonephritis is preceded by beta-hemolytic streptococcal infection. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1708 OBJ: 8 TOP: Acute glomerulonephritis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

44. In the nephrotic syndrome, the glomeruli are damaged by inflammation and allow small _______ to pass through into the urine.

ANS: proteins In nephrotic syndrome, the glomeruli are damaged by inflammation and allow small proteins such as albumin to enter the urine. This creates a deficit of protein in the circulation volume (hypoalbuminemia), which leads to massive edema. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1707 OBJ: 8 TOP: Nephrotic syndrome KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

42. The prostatectomy technique, which involves an incision through the abdomen and the bladder, is a ____________prostatectomy.

ANS: suprapubic A suprapubic prostatectomy involves an incision through the abdomen and the bladder with removal of the gland with the finger. PTS: 1 DIF: Cognitive Level: Knowledge REF: Pages 1702-1703, Table 49-3 OBJ: 3 TOP: Prostatectomy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

5. What portion of the nephron is involved with filtration? a. Glomerulus of the Bowman capsule b. Henle loop c. Proximal convoluted tubule d. Distal convoluted tubule

ANS: A Filtration of water and blood products occurs in the glomerulus of the Bowman capsule. PTS: 1 DIF: Cognitive Level: Application REF: Page 1673, Health Promotion OBJ: 8 TOP: Coping KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

11. What should the nurse encourage, barring any other contraindication, when teaching a patient how to decrease the chance of further problems with urolithiasis? a. Increase his fluid intake b. Increase intake of dairy products c. Restrict his protein intake d. Take one baby aspirin daily

ANS: A Fluid intake should be encouraged to at least 2000 mL of fluid in 24 hours, unless contraindicated. PTS: 1 DIF: Cognitive Level: Application REF: Page 1682 OBJ: 8 TOP: Urolithiasis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

34. What should the nurse counsel the young man with chronic prostatitis to avoid? a. Cessation of intercourse b. Warm baths c. Stool softeners d. Continuing antibiotics when symptoms abate

ANS: A Frequent intercourse may be beneficial to the treatment of chronic prostatitis. Warm baths, stool softeners, and antibiotic therapy are also part of the medical treatment. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1693 OBJ: 8 TOP: Urinalysis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

33. To help a patient control incontinence, what should the nurse recommend the patient avoid? a. Spicy foods b. Citrus fruits c. Organ meats d. Shellfish

ANS: A Incontinence may be improved by omitting spicy foods, alcohol, and caffeine from the diet. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1687 OBJ: 8 TOP: Incontinence KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

14. The patient with nephrosis complains about the need for bed rest. How would the nurse explain the benefit of bed rest? a. The recumbent position may initiate diuresis. b. It preserves the skin integrity. c. It lowers the level of albuminuria. d. It saves stress on joints.

ANS: A It is believed that the recumbent position helps initiate diuresis. PTS: 1 DIF: Cognitive Level: Application REF: Page 1707 OBJ: 8 TOP: Diagnostic procedures KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

21. A patient has nephrotic syndrome. Which statement made by the patient indicates understanding of the necessary diet modifications? a. "I will need to increase protein and decrease sodium intake." b. "I will need to drink more milk to get my calcium." c. "Carbohydrate restriction will be difficult." d. "Potassium restriction won't be hard since I don't like fruit."

ANS: A Medical management for nephrotic syndrome depends on the extent of tissue involvement and may include the use of corticosteroids and a low-sodium, high-protein diet. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1707 OBJ: 8 TOP: Nephrotic syndrome KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

24. An intravenous pyelogram confirms the presence of a 4-mm renal calculus in the proximal left ureter of a newly admitted patient. Physician orders include meperidine (Demerol) 100 mg IM q4h PRN, strain all urine, and encourage fluids to 4000 mL/day. What should be the nurse's highest priority when planning care for this patient? a. Pain related to irritation of a stone b. Anxiety related to unclear outcome of condition c. Ineffective health maintenance related to lack of knowledge about prevention of stones d. Risk for injury related to disorientation

ANS: A Nursing diagnoses directed at pain control are of primary importance at the early stages of care. Opioid medications manage the pain well. PTS: 1 DIF: Cognitive Level: Application REF: Page 1677 OBJ: 8 TOP: Renal calculi KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

7. The nurse is aware that as a person ages there is a loss of the __________mechanism of the kidney due to a decrease in blood supply to the kidneys and loss of nephrons. a. filtering b. reabsorption c. sterile water. d. concentrating

ANS: A The filtering mechanism is most affected with aging. By the age of 70, the filtering mechanism is only 50% as efficient as at 40 years of age. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1675 OBJ: 5 TOP: Effect of aging KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

3. Because the kidneys are located in proximity to the vertebrae and are protected by the ribs, their location in documentation is referred to as: a. retroperitoneal. b. diaphragm-vertebral. c. costovertebral. d. urachal-peritoneal.

ANS: A The kidneys lie behind the parietal peritoneum (retroperitoneal). PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1672 OBJ: 1 TOP: Location of kidneys KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

16. The patient is scheduled for a transurethral resection of the prostate. During preoperative teaching, what should the nurse emphasize about what the patient can expect after the procedure? a. Red drainage from the catheter b. Limited intake of fluids c. A sodium-restricted diet d. Incisional drainage

ANS: A The patient and family need to know that hematuria is expected after prostatic surgery. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1702 OBJ: 8 TOP: Transurethral resection of prostate (TURP) KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

32. Which foods should the home health nurse counsel hypokalemic patients to include in their diet? a. Bananas, oranges, cantaloupe b. Carrots, summer squash, green beans c. Apples, pineapple, watermelon d. Winter squash, cauliflower, lettuce

ANS: A The use of most diuretics, with the exception of the potassium-sparing diuretics, requires adding daily potassium sources (e.g., baked potatoes, raw bananas, apricots, or navel oranges, cantaloupe, winter squash). PTS: 1 DIF: Cognitive Level: Application REF: Page 1681 OBJ: 7 TOP: Hypokalemia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

37. Which of the following are signs of fluid overload in the patient with nephrosis? (Select all that apply.) a. Increase in pulse rate b. Increase in daily weight c. Clear lung sounds d. Edema e. Labored respirations

ANS: A, B, D, E Signs and symptoms of fluid overload: changes in pulse rate, respirations, cardiac sounds, and lung fields. Increase in daily morning weights. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1681 OBJ: 7 TOP: Fluid overload KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

36. Why are urinary tract infections (UTI) common in older adults? (Select all that apply.) a. Older adults have weakened musculature in the bladder and urethra. b. Older adults have urinary stasis. c. Older adults have increased bladder capacity. d. Older adults have diminished neurologic sensation. e. The effects of medications such as diuretics that many older adults take.

ANS: A, B, D, E Urinary frequency, urgency, nocturia, retention, and incontinence are common with aging. These occur because of weakened musculature in the bladder and urethra, diminished neurologic sensation combined with decreased bladder capacity, and the effects of medications such as diuretics. Older women are at risk for stress incontinence because of hormonal changes and weakened pelvic musculature. Inadequate fluid intake (less than 1000 to 2000 mL per 24 hours) can lead to urinary stasis. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1675, Lifespan OBJ: 8 TOP: Urinary frequency KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

35. The nurse reassures the patient recovering from acute glomerulonephritis that after all other signs and symptoms of the disease subside, it is normal to have some residual (select all that apply): a. proteinuria b. oliguria c. hematuria d. anasarca e. oliguria

ANS: A, C Proteinuria and hematuria may exist microscopically even when other symptoms subside. PTS: 1 DIF: Cognitive Level: Application REF: Page 1709 OBJ: 8 TOP: Acute glomerulonephritis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

38. The nurse is reviewing the urinalysis report on an assigned patient. The nurse recognizes which findings to be normal? (Select all that apply.) a. Turbidity clear b. pH 6.0 c. Glucose negative d. Red blood cells, 15 to 20 e. White blood cells

ANS: A, C The type and size of urinary catheter are determined by the location and cause of the urinary tract problem. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1676, Table 49-2 OBJ: 4 TOP: Urinalysis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

9. A 56-year-old patient with cancer of the bladder is recovering from a cystectomy with an ileal conduit. What is an important aspect in nursing interventions of the patient with an ileal conduit? a. Instructing the patient to void when the urge is felt. b. Maintaining skin integrity. c. Limiting oral intake to 1000 mL/day d. Limiting acid-ash foods.

ANS: B Care of the patient with an ileal conduit is a nursing challenge because of the continual drainage of urine through the stoma. Complications of this procedure are wound infection, dehiscence, and urinary leakage. The patient is urged to drink adequate fluids to flush the conduit. PTS: 1 DIF: Cognitive Level: Application REF: Page 1719 OBJ: 8 TOP: Cystectomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

23. The patient has end-stage renal disease (ESRD) and is admitted to the hospital with a blood urea nitrogen (BUN) level of 48 mg/dL. An excessive elevation of BUN could result from: a. dehydration. b. disorientation. c. edema. d. catabolism.

ANS: B If the BUN is elevated, preventive nursing measures should be instituted to protect the patient from possible disorientation or seizures. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1711 OBJ: 8 TOP: ESRD KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

4. A home health patient with end-stage renal disease (ESRD) has a nursing diagnosis of powerlessness related to life-altering disease. Which nursing intervention would be most helpful? a. Ensure restricted protein intake to prevent nitrogenous product accumulation. b. Include the patient in making the plan of care. c. Counsel patient about end-of-life provisions. d. Write out a detailed schedule of physician's appointments.

ANS: B Listen to the patient and allow time for discussion about concerns and the plan of care to return some sense of control. End-of-life discussions are premature. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1713, Nursing Care Plan OBJ: 12 TOP: ESRD KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

31. Why are pediatric patients, especially girls, susceptible to urinary tract infections? a. Genetically females have a weaker immune system b. Females have a short and proximal urethra in relation to the vagina c. Girls are more sexually active than males d. Girls have a weakened musculature and sphincter tone

ANS: B Pediatric patients, especially girls, are susceptible to urinary tract infections because of the short urethra. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1691 OBJ: 1 TOP: Urinary anatomy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

26. A patient with cystitis is receiving phenazopyridine (Pyridium) for pain and is voiding a bright red-orange urine. What should the nurse do? a. Report this immediately b. Explain to the patient that this is normal c. Increase fluid intake d. Collect a specimen

ANS: B Pyridium will turn the urine reddish-orange. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1680, Table 49-3 OBJ: 7 TOP: Cystitis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

18. A patient, age 69, is admitted to the hospital with gross hematuria and history of a 20-lb weight loss during the last 3 months. The physician suspects renal cancer. In obtaining a nursing history from this patient, the nurse recognizes which of the following as a significant risk factor for renal cancer? a. High caffeine intake b. Cigarette smoking c. Use of artificial sweeteners d. Chronic cystitis

ANS: B Risk factors include smoking; familial incidence; and preexisting renal disorders, such as adult polycystic kidney disease and renal cystic disease secondary to renal failure. PTS: 1 DIF: Cognitive Level: Application REF: Page 1698 OBJ: 8 TOP: Renal cancer KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

6. When the home health patient is started on dialysis, the home health nurse refers the patient to a community support group that assists with the adjustments necessary to living with dialysis. Which group offers this service? a. National Kidney Foundation b. American Association of Kidney Patients c. American Red Cross d. Veterans Administration

ANS: B The American Association of Kidney Patients offer support to the patient and family as they adapt to living with dialysis. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1518 OBJ: 11 TOP: Community resources KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity

27. The patient, age 43, has cancer of the urinary bladder. He has received a cystectomy with an ileal conduit. Which characteristics would be considered normal for his urine? a. Hematuria b. Clear amber with mucus shreds c. Dark bile-colored d. Dark amber

ANS: B There will be mucus present in the urine from the intestinal secretions. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1720 OBJ: 6 TOP: Ileal conduit KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

15. What should the nurse instruct the patient to do before obtaining the urine specimen for a urine culture? a. Collect the urine for a 24-hour period b. Obtain a clean-catch specimen c. Bring in an early morning specimen d. Limit fluid intake to concentrate the urine

ANS: B Urine cultures are dependent on a clean-catch or catheterized specimen. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1691 OBJ: 8 TOP: Diagnostic procedures KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

1. What is the hormone from the posterior pituitary gland that influences the amount of water that is eliminated with the urine? a. Pitocin b. Renin hormone c. Antidiuretic hormone (ADH) d. ACTH

ANS: C ADH causes the cells of the distal convoluted tubules to increase their rate of water reabsorption. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1674 OBJ: 3 TOP: Urine production KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

13. The nurse assessing a patient who is taking furosemide (Lasix) finds an irregular pulse. This is likely a sign of: a. hypomagnesemia. b. hypernatremia. c. hypokalemia. d. hypercalcemia.

ANS: C The loop diuretic prototype, furosemide (Lasix), affects electrolytes and causes hypokalemia; the deficiency of the electrolyte can cause arrhythmias and muscle weakness. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1680 OBJ: 7 TOP: Medications KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

17. A male patient, age 71, has benign prostatic hypertrophy. He is recovering from a trans-urethral prostatic resection. The physician orders removal of the indwelling catheter 2 days after the TURP procedure. What might the patient experience after the catheter is removed? a. Burning on urination b. Passing of blood clots in the urine c. Dribbling of urine d. Coffee-colored urine

ANS: C The patient is informed that initially he may experience frequency and voiding small amounts with some dribbling. There should be no hematuria or clots after 2 days. PTS: 1 DIF: Cognitive Level: Application REF: Page 1702 OBJ: 8 TOP: Transurethral resection of prostate (TURP) KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

22. What should the patient be encouraged to eat during the active phase of acute renal failure? a. A diet high in sodium b. A diet high in potassium c. A diet high in fats d. A diet high in fluid sources

ANS: C The patient with acute glomerulonephritis would need a high carbohydrate, high fat diet to maintain weight. Potassium and sodium are restricted as well as excess fluids. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1708 OBJ: 9 TOP: Diagnostic procedures KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

25. A patient is receiving chlorothiazide (Diuril), a thiazide diuretic for hypertension. What nursing action is most important for prevention of complications? a. Measure output b. Increase fluid intake c. Assess for hypokalemia d. Assess for hypernatremia

ANS: C The thiazide diuretic, chlorothiazide (Diuril), affects electrolytes to cause hypokalemia (extreme potassium depletion in blood). PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1680 OBJ: 7 TOP: Medications KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

12. The nurse notes the amount and color of the urine the patient with urolithiasis has voided. While using Standard Precautions, what should be the nurse's next action? a. Discard the urine b. Add the urine to a 24-hour collector c. Send the urine to the laboratory d. Strain the urine

ANS: D All urine should be strained. Because stones may be any size, even the smallest speck must be saved for assessment by the laboratory. PTS: 1 DIF: Cognitive Level: Application REF: Page 1697 OBJ: 8 TOP: Urolithiasis KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

2. As the body breaks down protein, nitrogen wastes are broken down into urea, ammonia, and: a. nitrogen. b. uric acid. c. nitrates. d. creatinine.

ANS: D As proteins break down, nitrogenous wastes—urea, ammonia, and creatinine—are produced. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1671 OBJ: 4 TOP: Physiology KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

29. The home health nurse suggests the use of complementary and alternative therapies to prevent and/or treat urinary tract infections (UTIs). Which of the following is an example of such therapies? a. Grape juice b. Caffeine c. Tea d. Cranberry juice

ANS: D Cranberry (Cranberry Plus, Ultra Cranberry) has been used to prevent urinary tract infections (UTIs), particularly in women prone to recurrent infection. It has also been used to treat acute UTI. Monitor patients for lack of therapeutic effect. Caffeine and tea will increase diuresis but not prevent UTI. PTS: 1 DIF: Cognitive Level: Application REF: Page 1689, Complementary and Alternative Therapy OBJ: 7 TOP: Complementary and alternative therapy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

30. Which action can reduce the risk of skin impairment secondary to urinary incontinence? a. Decreasing fluid intake b. Catheterization of the elderly patient c. Limiting the use of medication (diuretics, etc.) d. Frequent toileting and meticulous skin care

ANS: D Frequent toileting of the incontinent patient will prevent retained moisture in undergarments and bed linens and will preserve the integrity of the skin. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1676, Lifespan OBJ: 8 TOP: Urinary frequency KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

19. As the nurse and the dietitian review a female patient's diet plan with her, she shouts that with her diabetes and now the kidney failure, there is just nothing she can eat. She says she might as well eat what she wants, because there is nothing she can do to help herself. Based on the patient's response, which nursing diagnosis does the nurse identify? a. Noncompliance, risk for, related to feelings of anger b. Imbalanced nutrition less than body requirements, related to knowledge deficit c. Anticipatory grieving, related to actual and perceived losses d. Ineffective coping, related to sense of powerlessness

ANS: D Ineffective coping due to the feeling of powerlessness against the multiorgan failure may result in aggressive or infantile behavior. PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1712-1713, Nursing Care Plan OBJ: 12 TOP: Coping KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity

10. It is 2 days after a 42-year-old male patient's urinary diversion surgery. He continues to be critical of the hospital and the nursing care, even though the staff has spent time explaining the care to him. What is the most likely explanation for his behavior? a. He is angry about hospital policy. b. He is feeling neglected by the nursing staff. c. He is in denial of the effects of the surgery. d. He is reacting to the loss of self-esteem and altered body image.

ANS: D Persons with altered body image may react to the loss of self-esteem by behaving in a critical or derogatory manner. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1675 OBJ: 10 TOP: Coping KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

8. A patient who is receiving continuous bladder irrigation following a transurethral resection of the prostate (TURP) complains of "spasm-like" pain over his lower abdomen. What should the initial intervention be by the nurse? a. Inform the nurse in charge b. Decrease the continuous bladder irrigation flow c. Administer the prescribed analgesic d. Check the catheter and drainage system for obstruction

ANS: D The patient who has a TURP may have continuous closed bladder irrigation or intermittent irrigation to prevent occlusion of the catheter with blood clots, which would cause bladder spasms. PTS: 1 DIF: Cognitive Level: Application REF: Page 1702 OBJ: 8 TOP: Transurethral resection of prostate (TURP) KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

20. The patient is on postoperative day 1 after having undergone a TURP procedure. He has continuous bladder irrigation (CBI). Actual urine output during continuous bladder irrigation is calculated by: a. measuring and recording all fluid output in the drainage bag. b. measuring the total output and deducting the total of the irrigating and intravenous solutions. c. adding the total of the intravenous and irrigating solutions and then deducting the amount of output. d. measuring total output and deducting the amount of irrigating solution used.

ANS: D To determine urine output, the nurse will subtract the amount of irrigation fluid used with the Foley catheter output to calculate urine output. PTS: 1 DIF: Cognitive Level: Application REF: Page 1702 OBJ: 8 TOP: Transurethral resection of prostate (TURP) KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

28. A patient, age 78, has been admitted to the hospital with dehydration and electrolyte imbalance. She is confused and incontinent of urine on admission. Which nursing intervention does the nurse include in developing a plan of care? a. Restrict fluids after the evening meal b. Insert an indwelling catheter c. Assist the patient to the bathroom every 2 hours d. Apply absorbent incontinence pads

ANS: D Use of protective undergarments may help to keep the patient and the patient's clothing dry. Confused patients are high risk for falls. Restricting fluids will only decrease incontinence during the night and will exacerbate the dehydration and electrolyte imbalance. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1689 OBJ: 8 TOP: Incontinence KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

39. Exercises to increase muscle tone of the pelvic floor are known as ____________ exercises.

ANS: Kegel Women with weakened structures of the pelvic floor are prone to stress incontinence. For the female patient, Kegel exercises are helpful; 10 repetitions, 5 to 10 times a day, are suggested to improve muscle tone. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1685 OBJ: 8 TOP: Kegel exercises KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

21) A Pt prostate specific antigen (PSA) result is 9.5 ng/mL. Which condition(s) could be associated with this result? (Select all that apply.) (1678) 1. Had a recent prostate biopsy 2. Could be related to prostate cancer 3. Suggests urinary tract infection 4. Indicative of prostatitis 5. Within normal limits

Answer 1, 2, 3, 4: The normal range is less than 4 ng/mL. Elevated levels may result from prostate cancer, inflammation or infection, urinary tract infection, or recent cystoscopy or prostatic biopsy.

32. For patients with nephrotic syndrome, which signs/symptoms is the nurse most likely to ob- serve? (1708) 1. Periorbital edema, pitting edema in legs, and crackles in lungs 2. Sore throat or skin infection with fever and malaise 3. Burning with urination, low back pain, he- maturia, and fatigue 4. Dysuria, weak stream, and increasing pain with bladder distention

Answer 1: In nephrotic syndrome, excess fluid in the body is the most common sign. Patients who develop acute glomerulonephritis may report a preceding episode of sore throat or skin infection with fever and malaise. Burning with urination, low-back pain, hematuria, and fever are more associated with cystitis. Dysuria, weak stream, and increasing pain with bladder distention are seen in patients with urethral strictures

what is the patient most likely to benfit from learning about Kegel exercises? (1686) 1. Experiences loss of urine during sneezing and lifting 2. Has urinary retention secondary to chronic infection 3. Has urge incontinence due to advanced Parkinson's disease 4. Has a spastic bladder due to upper motor neuron lesion

Answer 1: Kegel exercises are recommended in prevention and treatment of stress incontinence, which is loss of urine during coughing, laughing, sneezing, or straining. Kegel exercises are recommended for all patients who are able to practice conscious motor control over the pelvic musculature to reduce present or future episodes of incontinence. Some patients who have Parkinson's or Alzheimer's may be able to learn Kegel exercises, depending on cognition and motor control.

17. For patients with diabetes mellitus or starva tion states, urinalysis will show the abnormal presences of ketones. What is the underlying physiology for this abnormality? (1675) 1. Fatty acids are rapidly catabolized. 2. Glucose is converted to ketones. 3. Insulin levels are excessive. 4. Glucose is transformed into fat.

Answer 1: Ketones appear in the urine as the body converts fats into energy, because glucose is not available to use as an energy source.

20. Identify the renal disorders associated with an abnormal elevation in serum creatinine. (Select all that apply.) (1678) 1. Prostatitis 2. Glomerulonephritis 3. Pyelonephritis 4. Acute tubular necrosis 5. Acute renal failure

Answer 2, 3, 4, 5: The serum creatinine test is used to diagnose impaired kidney function. With normal renal excretory function, the serum creatinine level should remain constant and normal. Prostatitis could cause an obstruction to flow, but the kidneys continue to produce urine normally

34. What is an early indicator of kidney failure that should be routinely checked for patients who are at high risk? (1710) 1. Residual urine 2. Albumin in the urine 3. Ketones in the urine 4. Prostate Specific Antigen

Answer 2: Albumin and blood in the urine are early indicators of renal failure. Residual urine is a bladder outflow problem that is not related to actual kidney function. Retained urine in the bladder is suspected to contribute to bladder cancer. Ketones in the urine are usually associated with diabetes mellitus, although diet and medication could be factors. Prostate-specific antigen is a screening test for prostate cancer

16. A patient diagnosed with a urinary tract infection was directed to take sulfamethoxazole-trimethoprim (Bactrim) for 3 days and phenazopyridine (Pyridium) for 2 days. What abnormal finding would you expecy in the urine during treatment? (1691) 1. An increase in pH 2. Bright orange color 3. Increase in leukocytes 4. Presence of ketones

Answer 2: Phenazopyridine (Pyridium) causes the urine to turn a bright-orange color. The goal is to increase the acidity of the urine, so if the patient is following the recommended diet, the pH should actually decrease. The leukocytes should decrease because of the Bactrim. Ketones should not be present.

29. A patient with benign prostatic hyperplasia (BPH) tells the nurse that he uses over-the- counter medications. Which medication is likely to create additional problems related to the BPH? (1686) 1. Acetaminophen (Ibuprofen) 2. Diphenhydramine (Benadryl) 3. Vitamin K supplement 4. Iron supplement

Answer 2: The nurse would advise the patient that diphenhydramine (Benadryl) can cause urinary retention. This could add problems with passing urine, because BPH can cause an obstruction of urine flow. In addition, the nurse would remind the patient that all OTC medications should be reviewed with the health care provider and on file with the local pharmacist.

35. What does the nurse do to assess the function of an ateriovenous fistula after a dialysis treatment? (1715) 1. Flush with saline using strict aseptic technique 2. Palpate a thrill and auscultate for a bruit. 3. Assess the distal pulses and check for sen- sation. 4. Ask the patient about pain or discomfort at the site

Answer 2: The nurse would auscultate the arteriovenous fistula for bruit (adventitious sound of venous or arterial origin heard on auscultation) and palpate arteriovenous fistula for thrill (abnormal tremor). A nurse should never access the fistula to draw blood, to give fluids or to check patency, unless he/she has had special training in dialysis procedures. Checking the distal pulses and sensation and asking about pain are routinely done for all patients, but circulation problems to distal tissues and pain are not anticipated.

26. The nurse is caring for several elderly men who have problems with urinary disorders. Which patient is the best candidate for an ex- ternal condom? (1684) 1. Has Alzheimer's disease and recently pulled out an indwelling catheter 2. Has urge incontinence and functional in- continence related to a hip fracture 3. Has a urinary tract infection and is currently taking antibiotics 4. Has an enlarged prostate and occasionally has trouble starting the stream

Answer 2: The patient with urge and functional incontinence will benefit the most from having an external condom, because he is unable to get to the bathroom in time. The patient with Alzheimer's is likely to pull the external catheter off. If the patient with a urinary tract infection has problems with incontinence, antibiotic therapy should resolve the problem. An enlarged prostate prevents flow, so the external catheter does not address the underlying problem.

23. During a urodynamic study, a patient is given bethanechol (Urecholine), a cholinergic drug. What is the expected effect of the medication? (1680) 1. Relaxes the patient 2. Reduces urine production 3. Stimulates the atonic bladder 4. Increases the uptake of dye

Answer 3: Cholinergic and anticholinergic medications may be administered during urodynamic studies to determine their effects on bladder function

22. The nurse is planning care for several patients who will have diagnostic testing for urinary disorders. Which procedure is going to require the most time for postprocedural care? (1679) 1. Kidney-ureter-bladder radiography 2. Intravenous pyelogram 3. Renal angiography 4. Renal ultrasonography

Answer 3: For renal angiography, the nurse must assess circulatory status of the involved extremity every 15 minutes for 1 hour, then every 2 hours for 24 hours. A kidney-ureterbladder radiography and ultrasonography do not require any special postprocedural care. For the intravenous pyelogram, the patient needs to be encouraged to drink water to flush the dye from the system, and the venipuncture site should be routinely observed.

31. The nurse and UAP are aware that no tension should be placed on urinary catheters; how- ever the nurse should reinforce this principle for which patient? (1707) 1. Has a suprapubic catheter for long-term management 2. Has a three-way catheter for continuous bladder irrigation 3. Has a Foley catheter after reconstruction of urethra 4. Has a catheter and urometer for hourly measurements

Answer 3: The Foley catheter is inserted to splint and support the suture line after reconstruction of the urethra; thus, tension on the catheter could result in disruption of the surgical site. The other patients have catheters primarily for drainage purposes.

The nurse sees that the urine specfic gravity results are 1.00o g/mL. Which patient condition is most likely to result in this abnormal finding(1678) 1. Diabetic ketoacidosis 2. Hyperemesis gravidarum 3. Water intoxication 4. Febrile with poor skin turgor

Answer 3: The normal range of specific gravity is 1.003-1.030; thus, excessive body water decreases specific gravity. Water intoxication occurs when the patient drinks an excessive amount of water. The other three conditions will cause dehydration and the specific gravity will increase.

18. Which patient condition is most likely to result in casts in the urine specimen? (1677) 1. Type 1 diabetes mellitus 2. Corticosteroid use 3. Renal disease 4. Urinary structure trauma

Answer 3: WBC casts in the urine indicate involvement of the renal parenchyma in renal disorders, such as acute pyelonephritis or acute glomerulonephritis.

33. The patient with acute glomerulonephritis is placed on bedrest. Which vital sign is of pri- mary interest as an indicator of the success of the therapy? (1709) 1. Temperature 2. Pulse rate 3. Respiratory rate 4. Blood pressure

Answer 4: Excess fluid causes edema and hypertension, so the patient is placed on bedrest until those symptoms resolve. The patient is also likely to have orthopnea, so the head of the bed should be elevated.

25. The nurse is reviewing medication orders for a patient with advanced end-stage renal disease. The nurse would question the use of which type of medication? (1682) 1. Antiemetic 2. Antipruritic 3. Vitamin supplement 4. Osmotic diuretic

Answer 4: Osmotic diuretics are used for acute renal failure to prevent irreversible failure, but they are contraindicated in advanced end-stage renal failure. (Note to student: Knowledge of correct nursing action and principles of delegation are combined to decide which action can be assigned or delegated to a UAP. Remember that UAP need specific instructions.)

27. The UAP tells the nurse that the patient with a urinary catheter has urine output of less than 50ml/hr. What should the nurse do first? (1703) 1. Notify the RN and health care provider. 2. Ask the UAP to recheck the amount. 3. Assess the patient for renal failure. 4. Check the function of the drainage system.

Answer 4: The nurse would first check to make sure that the tube and catheter are not kinked or obstructed and that the collection bag is below the level of the bladder. Once function of drainage system is checked and low urinary output is verified, the nurse would assess for signs and symptoms of decreased cardiac output, which will eventually contribute to renal failure. The RN and health care provider would then be notified of findings.

13. Identify three life span considerations for older adults related to the urinary system. (1676)

Urinary frequency, urgency, nocturia, retention, and incontinence are common with aging. These occur because of weakened musculature in the bladder and urethra, diminished neurologic sensation combined with decreased bladder capacity, and the effects of medications such as diuretics. • Urinary incontinence can lead to a loss of self-esteem and result in decreased participation in social activities. • Older women are at risk for stress incontinence because of hormonal changes and weakened pelvic musculature. • Older men are at risk for urinary retention because of prostatic hypertrophy. • Urinary tract infections in older adults are often associated with invasive procedures such as catheterization, diabetes mellitus, and neurologic disorders. • Inadequate fluid intake, immobility, and conditions that lead to urinary stasis increase the risk of infection in the older adult. • Frequent toileting and meticulous skin care can reduce the risk of skin impairment secondary to urinary incontinence.

11. What are the three major functions of the nephron? (1673)

a. Controlling body fluid levels by selectively removing or retaining water b. Assisting with the regulation of pH c. Removing toxic waste from the blood

12. Summarize the three phases of urine formation. (1674)

a. Filtration of water and blood products occurs in the glomerulus of Bowman's capsule. b. Reabsorption of water, glucose, and necessary ions back into the blood occurs primarily in the proximal convoluted tubules, Henle's loop, and the distal convoluted tubules. This process reclaims important substances needed by the body. c. Secretion of certain ions, nitrogenous waste products, and drugs occurs primarily in the distal convoluted tubule. This process is the reverse of reabsorption; the substances move from the blood to the filtrate.

36.A 42-year-old patient is admitted to the unit with a diagnosis of pyelonephritis. As the nurse collects data, she reveals a history of diabetes mellitus, and frequent urinary tract infections. (1694, 1695) a. What signs and symptoms would the nurse anticipate the patient to demonstrate? b. Discuss the diagnostic tests that may be used in the treatment of the patient and their probable results.

a. Signs and symptoms include pain in the costovertebral angle, elevated temperature, chills, and pus in the urine. b. Urinalysis: pus, bacteria, and leukocytosis present IVP: presence of an obstruction or degenerative changes

A 53-year-old man was in a motor vehicle accident 4 days ago. He sustained serious trauma with hypo- volemia that was treated in the emergency department. He has been diagnosed with acute renal failure and is currently in the oliguric phase. (1711, 1712) a. What potential clinical manifestations should the nurse be aware of when completing the nursing assessment? b. Discuss the three phases of acute renal failure. c. The patient's wife asks if she can bring him a hamburger and fries from a local fast-food restaurant. How will the nurse respond?

a. The patient may experience anorexia, nausea, vomiting, and edema. Special attention should be paid to signs of hydration, including mucous membranes, skin turgor, and urine output. There may also be signs of drowsiness, muscle twitching, and seizures. b. In the oliguric phase, BUN and serum creatinine levels rise while urinary output decreases to less than 20 mL/hr (less than 400 mL/24 hr). The oliguric phase may last from several days to weeks to months. Some patients may experience the nonoliguric form, usually caused by nephrotoxic antibiotics, in which urinary output may exceed 2 L/24 hr. In the diuretic phase, blood chemistry levels begin to return to normal and urinary output increases to 1-2 L/24 hr. The diuretic phase usually lasts 1-3 weeks. Return to normal or near-normal function occurs in the recovery phase. Recovery begins as the glomerular filtration rate rises. Recovery can take up to 1 year. c. The wife should be advised this would not be the best option. The diet should be low in protein, potassium, and sodium. Carbohydrates should be high. The items she is proposing to bring in are high in protein and sodium.

A patient reports to the ED complaining of severe flank pain, nausea, and vomiting. The Pt reports that the pain starts in the flank area radiates to the groin and inner thigh. A urinalysis reveals the presence of hematuria. A) what medical Dx can the nurse anticipate? B) Discuss both the conservative and invasive techniques that may be used in the management of this condition. C)After successful treatment, the nurse is preparing the patient for discharge. Discuss long-term preventive management options. Include diet and medications.

a. Urolithiasis b. Ideally, the stone will be passed without intervention. Fluid intake should be increased and monitored. The urine will be strained to check for the stone or "graveling." Cystoscopy, surgical incision, or chemolytic medications to dissolve the stone may be ordered. Extracorporeal shock wave lithotripsy is an alternative to surgery. c. Dietary modifications to reduce the level of calcium phosphorus and purinecontaining foods may be indicated. These foods include cheese, greens, whole grains, carbonated drinks, nuts, chocolate, shellfish, and organ meat. Fluid intake of at least 2000 mL/day is also recommended. Drugs may be ordered to prevent absorption of minerals associated with stone formation.

A 22yr-old woman seeks care at the doctor's office complaining of burning with urination, perineal pain, and blood-tinged urine. She is diagnosed with a urinary tract infection. (1690, 1691) a. Why are women more prone to urinary tract infections compared to men? b) What other signs and symptoms may be present? c)What medical treatments can be anticipated in the management of this patient? d) What self-care measures should the nurse suggest to the patient to prevent urinary tract infections?

a. Women are more susceptible to UTIs than men because the urethra is short and proximal to the vagina and rectum. b. Complaints may also include frequency, urgency, and nocturia. Abdominal palpation may also cause discomfort over the bladder. c. Antibiotics and urinary antiseptics d. Teach the woman to cleanse the perineal area from front to back to prevent contamination of pathogens (especially E. coli) from the rectum to the short urethra. • Encourage drinking 2000 mL of liquids per day unless contraindicated. • Instruct the patient to take all the prescribed medications, even though symptoms may subside quickly. • Empty bladder as soon after intercourse as possible. If UTIs are associated with intercourse, recommend cleansing of genitalia with soap and water prior to having sexual relations. • Shower instead of tub baths. • Limit use of bubble baths. • Instruct the patient about early detection and testing with Chemstrip LN.