HESI EAQ renal, urinary, and reproductive systems

Which nursing action is a priority before administering prescribed furosemide?

1 Weigh the client. 2 Assess skin turgor. Correct 3 Review the potassium level results. 4 Check the 24-hour intake and output.

Which response would the nurse provide to the client who is admitted with torsion of the testes and asks about the reason for urgent surgery?

1 "There is no other way to control the pain." Correct 2 "Irreversible damage occurs after a few hours." 3 "Extreme swelling can cause the testicle to rupture." 4 "The reduction in blood flow leads to rapid death of sperm." When a testis is twisted, its blood supply is decreased. This can result in gangrene. Medication can be given to relieve pain. The testes do not rupture if edema occurs. Sperm are continually produced, so their destruction is not the concern.

A male client reported dysuria, nocturia, and difficulty starting a urinary stream. The client has a cystoscopy and biopsy of the prostate gland scheduled. After the procedure, the client reports an inability to void. Which action would the nurse implement?

1 Insert a urinary retention catheter. Correct 2 Palpate above the pubic symphysis. 3 Limit oral fluids until the client voids. 4 Assure the client that this is expected. A full bladder is palpable with urinary retention and distention, which are common problems after a cystoscopy because of urethral edema. After determining if the bladder is palpable, the nurse would implement conservative nursing methods, such as running water or placing a warm cloth over the perineum, to precipitate voiding; catheterization carries a risk of infection and used as the last resort. Fluids dilute the urine, reduce the chance of infection after cystoscopy, and should not be limited. Although urinary retention can occur, it is not expected; the nurse must assess the extent of bladder distention and discomfort first.

Which medication strengthens the urinary sphincters?

1 Midodrine Correct 2 Duloxetine 3 Oxybutynin 4 Mirabegron Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that strengthens urinary sphincters and has anticholinergic action. Midodrine is an alpha-adrenergic agonist, which increases the contractile force of the urethral sphincter. Oxybutynin is an antispasmodic that causes bladder muscle relaxation. Mirabegron is a beta-3 blocker that relaxes the detrusor smooth muscle, which increases bladder capacity and urinary storage.

The nurse teaches a group of student nurses about the function of the loop of Henle. Which function would the nurse include?

1 Secretion of ammonia in the descending limb 2 Secretion of hydrogen in the descending limb Correct 3 Reabsorption of sodium in the ascending limb 4 Reabsorption of water in the ascending limb The reabsorption of sodium takes place in the ascending limb of the loop of Henle to maintain normal blood serum levels of sodium in the body. Ammonia is secreted from the distal tubule. The secretion of hydrogen occurs in the proximal and distal tubules of the nephron. Reabsorption of water is carried out in the descending limb of the loop of Henle.

A client with a renal disorder is scheduled for an intravenous pyelogram (IVP). Which interventions would the nurse undertake before the procedure? Select all that apply. One, some, or all responses may be correct.

Correct 1 Ensure that the consent form has been signed. Correct 2 Assess the client for iodine sensitivity. 3 Have the client remove all metal objects. Correct 4 Administer an enema or cathartic to the client. 5 Instruct the client to lie still during the procedure. The presence, position, shape, and size of kidneys, ureters, and bladder can be evaluated using an IVP. The contrast medium used in the procedure may cause hypersensitivity reactions. The nurse should assess the client for sensitivity to iodine before the procedure. The nurse should use a cathartic or enema to empty the colon of feces and gas. An IVP does need a consent form because the procedure is invasive. The nurse has the client remove all metal objects before performing a magnetic resonance imaging (MRI) procedure. The nurse instructs the client to lie still during a computed tomographic (CT) scan procedure; during an IVP, the client may be asked to turn certain ways.

Which finding is expected in a client diagnosed with early glomerulonephritis?

1 Anuria 2 Dysuria 3 Polyuria Correct 4 Proteinuria Protein in the urine (proteinuria) and hematuria (blood in the urine) are classic manifestations of the onset of glomerulonephritis because of the increased permeability of the vascular bed in the kidneys. Suppression of urine formation (anuria) is not an initial manifestation of glomerulonephritis; oliguria may be present. Pain or burning on urination (dysuria) is indicative of cystitis, not glomerulonephritis. Excessive urination (polyuria) does not occur as an initial change with glomerulonephritis; polyuria and nocturia may occur later with chronic glomerulonephritis, when the renal structures are destroyed.

A client presents with a sore throat and a generalized rash. The client reports that a chancre that had been present healed approximately 3 months ago. Serological test findings indicate a diagnosis of syphilis. Which stage of syphilis is the client in at this time?

1 Primary Correct 2 Secondary 3 Latent 4 Tertiary The client has secondary syphilis, which occurs 1 to 3 months after healing of the primary lesion and lasts for several weeks to as long as a year; it is the stage at which the individual is most infectious. Primary syphilis is the stage of initial infection and is characterized by the presence of a chancre, a painless lesion at the site of infection. Latent syphilis occurs after the secondary stage and before the late stage of syphilis; in latent syphilis the immune system is able to suppress the infection and there are no clinical signs and symptoms. Tertiary syphilis, also known as late syphilis, is the final stage of syphilis. At this stage, it is a slowly progressive inflammatory disease that can involve many organs; the skin, brain, and heart can be affected.

A client receiving a hemodialysis treatment asks the nurse which substances are being removed. Which substance can the nurse report is being removed during hemodialysis?

1 Blood Correct 2 Sodium 3 Glucose 4 Bacteria Sodium is an electrolyte that passes through the semipermeable membrane during hemodialysis. Red blood cells do not pass through the semipermeable membrane during hemodialysis. Glucose does not pass through the semipermeable membrane during hemodialysis. Bacteria do not pass through the semipermeable membrane during hemodialysis.

A client reports swelling of the scrotum with no pain. Which condition would the nurse anticipate in the client?

1 Chancroid Correct 2 Hydrocele 3 Spermatocele 4 Incarcerated hernia

Which instructions would the nurse provide to a client before a Papanicolaou test (Pap test)? Select all that apply. One, some, or all responses may be correct.

Correct 1 Empty the bladder just before the test. 2 Douche the vagina with soap the evening before the test. Correct 3 Avoid scheduling a Pap test to be performed during menses. Correct 4 Avoid sexual intercourse for at least 24 hours before the test. 5 Refrain from eating or drinking for 6 hours before the test.

Which statement by the nurse indicates effective technique in assessment of a client's renal system?

1 "I must first palpate the abdomen of the client if a tumor is suspected." 2 "I must first listen for normal pulses at the client's wrist region." Correct 3 "I must first auscultate the client's abdomen and then proceed to percussion and palpation." 4 "I must first examine tender abdominal areas and then proceed to non-tender areas."

The nursing student counsels an older 70-year-old female client about changes caused by aging. Which statement made by the client indicates effective learning?

1 "I should reduce my calcium intake." 2 "I should limit my Kegel exercises." Correct 3 "I should have regular breast examinations." 4 "I should avoid eating protein."

After a prostatectomy, the client reported the urinary catheter tubing pulled too tightly on the leg. The nurse observed the excessively taut indwelling catheter tubing and properly taped tubing to the thigh. Which action would the nurse implement?

Correct 1 Explain the tubing traction assists to control bleeding. 2 Adjust the catheter tubing tension to relieve the taut pressure. 3 Untape the urinary catheter and retape the catheter closer to the urinary meatus. 4 Assess the degree of tension on the catheter and contact the primary health care provider. Traction on the indwelling catheter pulls the balloon tight against the prostatic fossa, which promotes hemostasis. The nurse must insure maintenance of the catheter's tension until the primary health care provider determines there is no longer a risk of bleeding. There is not a need to notify the primary health care provider; pressure at the site is an expectation.

A client admitted for diagnostic testing to determine the extent of his or her bladder cancer asks, "If they remove my bladder, how will I be able to urinate?" Which response would the nurse use?

1 "Dialysis is a likely option in your case. The machine removes the urine from your blood." 2 "You will still be able to function normally without a bladder." 3 "The tests you are having will help determine if and when your bladder has to be removed." Correct 4 "When removing a client's bladder, a surgical opening or urostomy allows urine to drain into a collection bag."

Which natural physiological process helps prevent bacterial infections within the client's bladder?

Correct 1 The secretions of the urothelium 2 The relaxation of the detrusor muscle 3 The contraction of the external sphincter 4 The muscle tone of the internal sphincter The urothelium is the innermost epithelial lining of the bladder. The cells of the urothelium naturally produce antibacterial secretions that prevent bacterial growth within the bladder where urine is stored. The combined effect of relaxation of the detrusor muscle, contraction of external sphincter, and muscle tone of the internal sphincter help maintain continence.

Upon review of four clients' urinalysis reports, which client's results support the nurse's suspicion that the client may be developing kidney disease?

1 Client A 2 Client B Correct 3 Client C 4 Client D The normal range of serum creatinine lies between 0.6 and 1.2 mg/dL. The serum creatinine concentration of client C is 2.5 mg/dL, which is greater than the normal value, indicating renal impairment. The laboratory findings of client C support the nurse's suspicion. A serum creatinine concentration of 1.1 mg/dL in client A is a normal finding. The normal range of blood urea nitrogen (BUN) is 10 to 20 mg/dL; therefore the urinalysis reports for clients B and D are normal. Blood urea nitrogen levels are affected by fluid volume deficit or excess; therefore the finding alone does not indicate renal impairment. Finding the serum creatinine concentration is the best way to determine renal function, because the value is not affected by fluid volumes.

Which preoperative plan would the nurse make for a client who will have a cystectomy and creation of an ileal conduit?

1 Limit oral fluid intake for 36 hours. 2 Teach range-of-motion and Kegel exercises. 3 Explain the procedure for irrigating an ileal conduit. Correct 4 Administer cleansing enemas and laxatives as prescribed. Preoperative cleansing of the bowel is necessary before surgical resection and formation of a urinary conduit. Fluids should not be restricted until after midnight or based on the specific prescriptions of the primary health care provider. Range-of-motion and Kegel exercises have no direct effect on this procedure. An ileal conduit is not irrigated.

The nurse observes vaginal packing protruding from the client's vaginal vault after radium implants for cervical cancer were inserted. Which rationale supports the need for the nurse to contact the client's primary health care provider immediately?

Correct 1 The radioactive packing will injure healthy tissue. 2 Removal of the packing will prevent excessive blood loss. 3 Radium exposure to the environment diminishes the effectiveness. 4 Removal of the packing minimizes life-threatening contact with the radiation.

During an 8-hour shift, a client has a 6-oz (180-mL) cup of tea and 360 mL of water. The client vomits 100 mL, and the instilled intravenous (IV) fluids equaled the urinary output. What is this client's fluid balance at the end of this 8-hour period that the nurse must document on the client's intake and output record?

1 240 mL 2 -340 mL Correct 3 440 mL 4 540 mL

Twenty-four hours after a penile implant, the client's scrotum is edematous and painful. Which action would the nurse take?

1 Assist the client with a sitz bath. 2 Apply warm soaks to the scrotum. Correct 3 Elevate the scrotum using a soft support. 4 Prepare for an incision and drainage procedure. Elevating the scrotum using a soft support increases lymphatic drainage, reducing edema and pain. Assisting the client with a sitz bath and applying warm soaks to the scrotum increase circulation to the area, intensifying edema and pain in this client. Preparing for an incision and drainage procedure is not indicated; scrotal swelling is caused by the trauma of surgery, not infection.

Which clinical manifestation would the nurse expect a client with diabetes insipidus to exhibit?

1 Increased blood glucose 2 Decreased serum sodium 3 Increased specific gravity Correct 4 Decreased urine osmolarity Insufficient antidiuretic hormone (ADH) decreases water uptake by the kidney tubules, resulting in very dilute urine with low osmolarity. Diabetes insipidus does not affect glucose levels; diabetes mellitus affects glucose levels. Serum sodium levels increase because of hemoconcentration. Specific gravity decreases with dilute urine.

Which foods would the nurse encourage the client to eat to prevent constipation after a suprapubic prostatectomy? Select all that apply. One, some, or all responses may be correct.

1 Milk Correct 2 Apples Correct 3 Oatmeal Correct 4 Green peas 5 Scrambled eggs

Which clinical manifestation would the nurse expect to find when assessing a client who has acute glomerulonephritis?

1 Nocturia Correct 2 Periorbital edema 3 Increased appetite 4 Recent weight loss

To prepare for hemodialysis, a client schedules his or her surgical procedure for an internal arteriovenous fistula in one arm and placement of an external arteriovenous shunt in the other arm. Which considerations would the nurse integrate into this client's postoperative plan of care?

Correct 1 The graft has a higher risk of hemorrhage, clotting, and infection than the fistula does. 2 Staff will obtain blood pressure readings from the arm with the fistula, but not the one with the shunt. 3 Administer intravenous (IV) fluids in the arm with the shunt, but not the one with the fistula. 4 Cover the fistula with a light dressing, and cover the shunt thoroughly with a heavy dressing. The external shunt may come apart with possible hemorrhage; clotting is a potential hazard. Frequent handling increases risk of infection. The nurse should not obtain blood pressure readings in the extremity with the shunt or the fistula because of the pressure exerted on the circulatory system during the procedure. The nurse should not use an IV in the extremity with the shunt or the fistula to avoid pressure from the tourniquet and to lessen the chance of developing phlebitis. The nurse should leave the ends of the shunt cannula exposed for rapid reconnection to the dialysis equipment in the event of disruption.

After a transurethral prostatectomy (TURP), a client returns to the postanesthesia care unit with a three-way indwelling catheter and a continuous bladder irrigation. Which nursing action would the nurse monitor during the initial recovery phase?

1 Observe the suprapubic dressing for drainage. 2 Maintain the client in a semi-Fowler position. Correct 3 Monitor for bright red blood in the urinary drainage bag. 4 Encourage fluids by mouth as soon as the gag reflex returns. Blood clots are normal 24 to 36 hours after the TURP surgery, but bright red blood can indicate hemorrhage. The surgeon performs the surgery by accessing the prostate through the urinary meatus and urethra; there is no suprapubic incision. The client does not need to maintain a semi-Fowler position. Initially, the client may not have anything by mouth (NPO) until the gag reflex returns and the anesthesia nausea decreases. Then the client advances to clear liquids and to a regular diet as tolerated. Continuous irrigation supplies enough fluid to flush the bladder.

Which action would the nurse take before a client's scheduled hemodialysis treatment?

1 Obtain the client's urine specimen to evaluate kidney function. Correct 2 Weigh the client to establish a baseline for later comparison. 3 Administer medications that are scheduled to be given within the next hour. 4 Explain that the peritoneum serves as a semipermeable membrane to remove wastes.

Which condition would be reported immediately to the primary health care provider?

1 Pelvic pain immediately after colposcopy 2 Light vaginal bleeding for 24 hours after a hysterosalpingogram 3 Rectal bleeding for 48 hours after prostate biopsy Correct 4 Body temperature of 102°F (38.9°C) 48 hours after cervical biopsy The client with cervical biopsy should immediately report to the primary health care provider if experiencing a body temperature of 102°F (38.9°C). This is because fever and vaginal discharge that develops 48 hours after cervical biopsy may be the signs of infection related to the procedure. The client should take pain relievers for pelvic pain after colposcopy. Light vaginal bleeding for 1 to 2 days after hysterosalpingogram is common. If the amount of bleeding increases or extends beyond 2 days, the health care provider should be notified. Light rectal bleeding for a few days is common after prostate biopsy.

Which condition can be prevented when a client with chronic kidney disease receives medication to manage anemia?

1 Uremic frost Correct 2 Chronic fatigue 3 Tubular necrosis 4 Dependent edema Kidney failure results in impaired erythropoietin production, which causes anemia and chronic fatigue; treating the anemia will help in managing the fatigue. Uremic frost results because urea compounds and other waste products of metabolism that are not excreted by the kidneys are brought to the skin by small, superficial capillaries and are excreted and deposited on the skin. Tubular necrosis is a pathological condition of the kidneys that can lead to kidney failure. The anemia and dependent edema associated with kidney failure are not interrelated.