Adult Health I - Exam III NCLEX review Renal/Urinary
The ambulatory care nurse is working with a 22-year-old female client who has been diagnosed with pelvic inflammatory disease (PID). The nurse incorporates which item in a teaching plan for this client? 1.Avoid frequent douching. 2.Undergarments made of nylon are best. 3.Intrauterine devices are a good birth control method. 4.It is necessary to change sanitary pads only every 8 hours.
1.Avoid frequent douching. The client who has been diagnosed with PID should avoid frequent douching because it decreases the natural flora that controls the growth of infectious organisms. The client should wear cotton undergarments, and clothes should not fit tightly. Intrauterine devices increase the client's susceptibility to infection. Sanitary pads should be changed at least every 4 hours. Tampons should not be used during the acute infection, and some primary health care providers may recommend avoiding them indefinitely. The client also should avoid strong soaps, sprays, powders, and similar products that will irritate the perineum.
A client with acute glomerulonephritis has had a urinalysis sample sent to the laboratory. The report reveals the presence of hematuria and proteinuria. The nurse interprets these results as which condition? 1.Consistent with glomerulonephritis 2.Inconsistent with glomerulonephritis 3.Unclear; no conclusion can be drawn 4.Indicative of impending acute kidney injury
1.Consistent with glomerulonephritis Gross hematuria and proteinuria are the classic signs of glomerulonephritis. The urine may be small in volume, dark or smoky from the hematuria, and foamy from the proteinuria. Concurrent serum studies would reveal an elevated level of blood urea nitrogen, creatinine, C-reactive protein, and antistreptolysin O titer.
A client has been diagnosed with pyelonephritis. The nurse interprets that which health problem has placed the client at risk for this disorder? 1.Diabetes mellitus 2.Orthostatic hypotension 3.Coronary artery disease 4.Intravenous (IV) contrast medium
1.Diabetes mellitus Pyelonephritis is most commonly caused by entry of bacteria, obstruction, or reflux. Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, overuse of analgesics, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.
The nurse has a prescription to obtain a 24-hour urine collection in a client with a renal infection. Which actions should the nurse take when collecting this specimen? Select all that apply. 1.Explain the procedure to the client. 2.Save all subsequent voidings after the first void during the 24-hour period. 3.During the collection period, place the main container on ice or in a refrigerator. 4.Have the client void at the end time, and place this specimen in the main container. 5.Have the client void at the start time, and place this specimen in the main container.
1.Explain the procedure to the client. 2.Save all subsequent voidings after the first void during the 24-hour period. 3.During the collection period, place the main container on ice or in a refrigerator. 4.Have the client void at the end time, and place this specimen in the main container. The nurse should first explain the procedure to the client and ask the client to void at the beginning of the collection period and to discard this urine sample. All subsequent voided urine is saved in a container, which is placed on ice or refrigerated. The client is asked to void at the finish time, and this sample is added to the collection. The container is labeled, placed on fresh ice, and sent to the laboratory immediately.
The nurse is providing instructions regarding the complications of peritoneal dialysis. The nurse emphasizes that onset of peritonitis, a serious complication, is most likely to be associated with which clinical manifestation? 1.Fever 2.Fatigue 3.Clear dialysate output 4.Leaking around the catheter site
1.Fever The signs of peritonitis include fever, nausea, malaise, rebound abdominal tenderness, and cloudy dialysate output. Fatigue may be associated with peritonitis, but fever is the most likely sign. Leaking around the catheter site is not an indication of peritonitis.
The nurse is reviewing the urinalysis results for a client with glomerulonephritis. Which findings should the nurse expect to note? Select all that apply. 1.Proteinuria 2.Hematuria 3.Positive ketones 4.A low specific gravity 5.A dark and smoky appearance of the urine
1.Proteinuria 2.Hematuria 5.A dark and smoky appearance of the urine In the client with glomerulonephritis, characteristic findings in the urinalysis report are gross proteinuria and hematuria. The specific gravity is elevated, and the urine may appear dark and smoky. Positive ketones are not associated with this condition but may indicate a secondary problem.
A client is diagnosed with epididymitis. The nurse checks the primary health care provider's prescriptions and expects that which measures will be prescribed? Select all that apply. 1.Sitz bath 2.Antibiotics 3.Scrotal elevation 4.Use of a heating pad 5.Bed rest with bathroom privileges
1.Sitz bath 2.Antibiotics 3.Scrotal elevation 5.Bed rest with bathroom privileges Common interventions used in the treatment of epididymitis include bed rest with bathroom privileges, elevation of the scrotum, ice packs, sitz baths, analgesics, and antibiotics. A heating pad would not be used because direct application of heat would enhance blood flow to the area, thereby increasing the swelling.
A client has been admitted to the hospital for urinary tract infection and dehydration. The nurse determines that the client has received adequate volume replacement if the blood urea nitrogen (BUN) level drops to which value? 1.3 mg/dL (1.05 mmol/L) 2.15 mg/dL (5.25 mmol/L) 3.29 mg/dL (10.15 mmol/L) 4.35 mg/dL (12.25 mmol/L)
2.15 mg/dL (5.25 mmol/L) The normal BUN level is 6 to 20 mg/dL (2.1 to 7.1 mmol/L). Values of 29 mg/dL (10.15 mmol/L) and 35 mg/dL (12.25 mmol/L) reflect continued dehydration. A value of 3 mg/dL (1.05 mmol/L) reflects a lower than normal value, which may occur with fluid volume overload, among other conditions.
A client with urolithiasis is scheduled for extracorporeal shock wave lithotripsy. The nurse should tell the client that which will be necessary before the procedure is performed? 1.Insertion of a Foley catheter 2.A signed informed consent form 3.Clear liquids only on the day of the procedure 4.Administration of antihypertensive medication
2.A signed informed consent form Extracorporeal shock wave lithotripsy is done with the client under epidural or general anesthesia. The client must sign a consent form for the procedure and must have no oral intake beginning the night before the procedure. The client needs an intravenous line for the procedure as well. Insertion of a Foley catheter is not normally performed, and there is no reason to administer antihypertensive medication for this procedure.
A client with benign prostatic hyperplasia undergoes a transurethral resection of the prostate. Postoperatively the client is receiving continuous bladder irrigations. The nurse assesses the client for manifestations of transurethral resection syndrome. Which assessment data would indicate the onset of this syndrome? 1.Tachycardia and diarrhea 2.Bradycardia and confusion 3.Increased urinary output and anemia 4.Decreased urinary output and bladder spasms
2.Bradycardia and confusion Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure, such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.
A client with a urinary tract infection (UTI) has been prescribed ciprofloxacin. The nurse notes that the client also has a prescription for theophylline written by a pulmonologist. Based on this information, the nurse should take which action? 1.Encourage intake of antacids. 2.Clarify the medication prescriptions. 3.Schedule the doses to be given together. 4.Schedule the doses to be given at the same time.
2.Clarify the medication prescriptions. Quinolones, such as ciprofloxacin, prolong the half-life of caffeine and theophylline. This would make the theophylline stay in the client's system longer and could cause toxic effects. The nurse should clarify the medication prescriptions. The remaining options are incorrect actions.
The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, should the nurse identify as a risk factor for this disorder? 1.Hypoglycemia 2.Diabetes mellitus 3.Coronary artery disease 4.Orthostatic hypotension
2.Diabetes mellitus Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and presence of an indwelling urinary catheter or frequent catheterization. The conditions noted in the remaining options are not associated risk factors.
The nurse is planning teaching for a female client diagnosed with urethritis caused by chlamydial infection. Which information should the nurse plan to include in the teaching session? 1.Alter the perineal pH by using a spermicide with a condom. 2.Keep follow-up appointments for repeat cultures in 4 to 7 days. 3.Discontinue antibiotics after 3 weeks of uninterrupted administration. 4.Identify sexual partners for the past 12 months so they can be treated.
2.Keep follow-up appointments for repeat cultures in 4 to 7 days. Follow-up cultures are typically done in 4 to 7 days to evaluate the effectiveness of the medication. Using a spermicide does not change the perineal pH. The infection can be prevented by the use of latex condoms. Chlamydial infection is treated with antibiotics, which are not discontinued until the prescribed course is completed. All sexual partners during the 30 days before diagnosis should be notified, examined, and treated as necessary.
he nurse has provided instructions to a client with a urinary tract infection regarding foods and fluids to consume that will acidify the urine. Which fluids should the nurse include in the client's teaching plan that will aid in acidifying the urine? Select all that apply. 1.Milk 2.Prune juice 3.Apricot juice 4.Cranberry juice 5.Carbonated drinks
2.Prune juice 3.Apricot juice 4.Cranberry juice Acidification of the urine inhibits multiplication of bacteria. Fluids that acidify the urine include prune, apricot, cranberry, and plum juice. Carbonated drinks should be avoided because they increase urine alkalinity. Two glasses of milk a day can make the urine more alkaline, which could aid in the development of kidney stones.
The nurse has performed a nutritional assessment on a client with cystitis. The nurse should tell the client to consume which beverage to minimize recurrence of cystitis? 1.Tea 2.Water 3.Coffee 4.White wine
2.Water Water helps flush bacteria out of the bladder, and an intake of 6 to 8 glasses per day is encouraged. Caffeine and alcohol can irritate the bladder. Therefore, alcohol- and caffeine-containing beverages such as coffee, tea, and wine are avoided to minimize risk.
A client with prostatitis following kidney infection has received instructions on management of the condition at home and prevention of recurrence. The nurse determines that education was effective if the client makes which statement? 1."I will stop antibiotic therapy when pain subsides." 2."I will exercise as much as possible to stimulate circulation." 3."I should use warm tub baths and analgesics to increase comfort." 4."I will keep fluid intake to a minimum to decrease the need to void."
3."I should use warm tub baths and analgesics to increase comfort." Treatment of prostatitis includes medication with antibiotics, analgesics, and stool softeners. The nurse also teaches the client to rest, increase fluid intake, and use sitz baths or warm tub baths for comfort. Antimicrobial therapy is always continued until the prescription is finished.
Sulfisoxazole, 1 g orally twice daily, is prescribed for an adolescent with a urinary tract infection. The medication label reads "500-mg tablets." The nurse has determined that the dosage prescribed is safe. The nurse administers how many tablets per dose to the adolescent? 1.1, 2 tablet 2.1 tablet 3.2 tablets 4.3 tablets
3.2 tablets Change 1 g to milligrams, knowing that 1000 mg = 1 g. Also, when converting from grams to milligrams (larger to smaller), move the decimal point 3 places to the right: 1 g = 1000 mg. Next, use the formula to calculate the correct dose.
Which client is most at risk for developing a Candida urinary tract infection (UTI)? 1.An obese woman 2.A man with diabetes insipidus 3.A young woman on antibiotic therapy 4.A male paraplegic on intermittent catheterization
3.A young woman on antibiotic therapy Candida infections, which are fungal infections, develop in persons who are on long-term antibiotic therapy because an alteration of normal flora occurs. These infections also are commonly seen in clients with blood dyscrasias, diabetes mellitus, cancer, or immunosuppression and in those with a drug addiction.
A client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. A Penrose drain is in place. Which action should the nurse include in the client's postoperative plan of care? 1.Positioning the client on the affected side 2.Irrigating the Penrose drain using sterile procedure 3.Changing dressings frequently around the Penrose drain 4.Weighing dressings and adding the amount to the output
3.Changing dressings frequently around the Penrose drain Frequent dressing changes around the Penrose drain are required to protect the skin against breakdown from the urinary drainage. If urinary drainage is excessive, an ostomy pouch may be placed over the drain to protect the skin. Placing the client on the affected side will prevent a free flow of urine through the drain. A Penrose drain is not irrigated. Weighing the dressings is not necessary.
The evening shift nurse is reviewing the laboratory results of a client's urine culture showing 100,000 bacterial units/mL of urine. What should be the nurse's action? 1.Notify the primary health care provider during rounds in the morning. 2.No action is needed because this is a normal value. 3.Page the primary health care provider with the results. 4.Collect another urine specimen to confirm the results.
3.Page the primary health care provider with the results. The primary health care provider needs to be notified. A colony count of 100,000 is considered a positive culture and could be indicative of pyelonephritis if accompanied by fever and flank pain. A positive culture that is accompanied by dysuria, frequency, and urgency is indicative of cystitis. The other options are not correct and delay necessary intervention.
The nurse is caring for a client with acute glomerulonephritis. The nurse instructs the assistive personnel (AP) to implement which action when caring for the client? 1.Ambulate the client frequently. 2.Encourage a diet that is high in protein. 3.Remove the water pitcher from the bedside. 4.Monitor the client's temperature every 2 hours.
3.Remove the water pitcher from the bedside. The client with acute glomerulonephritis commonly experiences an excess of fluid volume and fatigue. Interventions include fluid restriction and monitoring weight, intake, and output. The diet is high in calories but low in protein. The client is placed on bed rest, or at least encouraged to rest, because there is a direct correlation between proteinuria and hematuria and increased activity levels. It is unnecessary to monitor the temperature as frequently as every 2 hours.
A man is admitted to the hospital with the diagnosis of urethritis secondary to chlamydial infection. What precaution should the nurse implement for this client? 1.Enteric 2.Contact 3.Standard 4.Reverse isolation
3.Standard Chlamydial infection is a sexually transmitted infection and frequently is called nongonococcal urethritis in the male client. It requires no special precautions other than standard precautions. Caregivers cannot acquire the disease during administration of care, and using standard precautions is the only necessary measure.
A client with urolithiasis (struvite stones) has a history of chronic urinary tract infections. What should the nurse plan to teach the client to avoid? 1.Antibiotics 2.Foods that make the urine more acidic 3.Wearing synthetic underwear and pantyhose 4.Fruits such as currants, blueberries, and cranberries
3.Wearing synthetic underwear and pantyhose Urolithiasis (struvite stones) can result from chronic infections. They form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Teaching should focus on preventing infections and ingesting foods to make the urine more acidic. Foods such as currants, blueberries, and cranberries are acidic. The client should wear cotton, not synthetic, underclothing to prevent the accumulation of moisture and to prevent irritation of the perineal area, which can lead to infection. Antibiotics are not associated with chronic urinary tract infections.
The nurse has provided instructions regarding home care measures for a client with acute pyelonephritis. Which statement by the client indicates a need for further teaching? 1."I should try to maintain an acid ash diet." 2."I should increase my fluid intake to 3 L per day." 3."I should take my daily dose of vitamin C to acidify the urine." 4."I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day."
4."I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day." Clients with acute pyelonephritis should be instructed to try to maintain an acid ash diet, which may be of some benefit. Also, they should increase fluid intake to 3 L per day; this helps relieve dysuria and flushes bacteria out of the bladder. However, for clients with chronic pyelonephritis and renal dysfunction, an increase in fluid intake may be contraindicated. Medications such as vitamin C help acidify the urine. Juices such as cranberry, plum, and prune juice will leave an acid ash in the urine. Caffeine, alcohol, chocolate, and highly spiced foods are avoided to prevent potential bladder irritation.
The nurse has given instructions about Kegel exercises to a female client with a cystocele (bulge of the bladder into the vagina) . The nurse determines that the client needs further instruction if she makes which statement? 1."I should stop and start my stream of urine during a voiding." 2."I should tighten my perineal muscles for up to 5 minutes, 3 or 4 times a day." 3."I should tighten my perineal muscles for up to 10 seconds several times a day." 4."I should begin voiding and then stop the stream, holding residual urine for an hour."
4."I should begin voiding and then stop the stream, holding residual urine for an hour." Kegel muscles strengthen the perineal floor and are useful in the prevention and management of cystocele, rectocele, and enterocele. Several ways to perform Kegel exercises are acceptable. One method entails starting and stopping the flow of urine during a single voiding for about 5 seconds. Also, these exercises may be done by holding perineal muscles taut for up to 10 seconds several times a day or for 5 minutes, 3 or 4 times a day. Residual urine should not be held in the bladder for long periods because this could promote urinary tract infection.
A client with epididymitis is upset about the extent of scrotal edema. Attempts to reassure the client that this condition is temporary have not been effective. The nurse should plan to address which client problem? 1.Pain related to fluid accumulation in the scrotum 2.Uneasiness related to inability to reduce scrotal swelling 3.Guilt related to the possibility of sterility secondary to scrotal swelling 4.Altered body appearance related to change in the appearance of the scrotum
4.Altered body appearance related to change in the appearance of the scrotum Altered body appearance is a problem when the client has either a verbal or a nonverbal response to a change in the structure or the function of a body part. Pain may apply but does not correlate with the information in the question. There are no data in the question that uneasiness, inability to reduce scrotal swelling, or sterility is a client concern.
The nurse is reviewing a client's medication reconciliation form in the medical record and notes that the client is taking Tamsulosin at home. Which medication, if started in the hospital, should the nurse question? 1.Lisinopril 2.Valsartan 3.Metoprolol 4.Cimetidine
4.Cimetidine Tamsulosin is used most commonly for the treatment of benign prostatic hyperplasia. This medication should not be used concurrently with cimetidine because of the risk of Tamsulosin toxicity. The other medications noted do not cause interactions with this medication.
The nurse is caring for a client with a urinary tract infection (UTI). The culture report reveals the presence of Pseudomonas aeruginosa. The nurse anticipates that which medication will be prescribed to treat the infection? 1.Isoniazid 2.Rifampin 3.Ethambutol 4.Ciprofloxacin
4.Ciprofloxacin Ciprofloxacin is an antimicrobial agent that is used to treat UTIs caused by P. aeruginosa. The medications identified in the other options are antituberculosis medications.
A client has urinary calculi composed of uric acid. The nurse is teaching the client dietary measures to prevent further development of uric acid calculi. The nurse should inform the client that it is acceptable to consume which item? 1.Steak 2.Shrimp 3.Chicken liver 4.Cottage cheese
4.Cottage cheese With a uric acid stone, the client should limit intake of foods high in purines. Organ meats, sardines, herring, and other high-purine foods are eliminated from the diet. Intake of foods with moderate levels of purines, such as red and white meats and some seafood, also is limited. Avoiding the consumption of milk and dairy products is a recommended dietary change for calculi composed of calcium stones but is acceptable for the client with a uric acid stone.
A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication? 1.Diuretics 2.Antibiotics 3.Antilipemics 4.Decongestants
4.Decongestants In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. These medications lessen the voluntary ability to contract the bladder. The client should be questioned about the use of these medications if he has urinary retention. Diuretics increase urine output. Antibiotics and antilipemics do not affect ability to urinate.
A client with nephrolithiasis arrives at the clinic for a follow-up visit. Laboratory analysis of the stone that the client passed 1 week earlier indicates that the stone is composed of calcium oxalate. Based on these data, what food item does the nurse instruct the client to avoid? 1.Pasta 2.Lentils 3.Lettuce 4.Spinach
4.Spinach Many kidney stones are composed of calcium oxalate. Foods that raise urinary oxalate excretion include spinach, rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. Pasta, lentils, and lettuce are acceptable to consume.
A client with chlamydial infection has received instructions on self-care and prevention of further infection. The nurse determines that the client needs further teaching if the client states that he or she will take which action? 1.Use latex condoms to prevent disease transmission. 2.Return to the clinic as requested for follow-up culture in 1 week. 3.Reduce the chance of reinfection by limiting the number of sexual partners. 4.Take an antibiotic so as to prophylactically prevent symptoms of Chlamydia.
4.Take an antibiotic so as to prophylactically prevent symptoms of Chlamydia. Antibiotics are not taken prophylactically to prevent acquisition of chlamydial infection. The risk of reinfection can be reduced by limiting the number of sexual partners and by the use of condoms. In some cases, follow-up culture is requested in 4 to 7 days to confirm a cure. The remaining options are correct measures.
A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the prostate examination for which characteristic of this disorder? 1.Soft and swollen prostate gland 2.Swollen and boggy prostate gland 3.Tender and edematous prostate gland 4.Tender, indurated prostate gland that is warm to the touch
4.Tender, indurated prostate gland that is warm to the touch The client with bacterial prostatitis has a swollen and tender prostate gland that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection, which often accompany the disorder.
The nurse is caring for a client with a bladder infection. The nurse plans care understanding that the primary risk factor for spread of infection in this client is dysfunction of which structure? 1.Urethra 2.Nephron 3.Glomerulus 4.Ureterovesical junction
4.Ureterovesical junction The ureterovesical junction is the point at which the ureters enter the bladder. At this juncture, the ureter runs obliquely for 1.5 to 2 cm through the bladder wall before opening into the bladder. This anatomical pathway prevents reflux of urine back into the ureter and, in essence, acts as a valve to prevent urine from traveling back into the ureter and up to the kidney.
