Genito-Urinary Nursing Care
What does the nurse determine is the most likely cause of renal calculi in clients with paraplegia?
Accelerated bone demineralization Calcium that has left the bones as a response to prolonged inactivity enters the blood and may precipitate in the kidneys, forming calculi. Increased fluid intake is helpful in avoiding this condition by preventing urinary stasis. Calcium intake usually is limited to prevent the increased risk for calculi. Calculi may develop despite adequate kidney function; kidney function may be impaired by the presence of calculi and urinary tract infections associated with urinary stasis or repeated catheterizations.
A nurse is caring for a client with glomerulonephritis. What should the nurse instruct the client to do to prevent recurrent attacks?
Seek early treatment for respiratory tract infections. Hemolytic streptococci, common in throat infections, can initiate an immune reaction that damages the glomeruli. Baths may be linked to urethritis, not glomerulonephritis. Fluid restriction is moderated as the client improves; fluid helps prevent urinary stasis. Activity helps prevent urinary stasis.
Which statement regarding treatment with interferon indicates that the client understands the nurse's teaching?
"I will drink two to three quarts of fluid a day." Adequate fluid intake helps to flush the kidneys and prevent nephrotoxicity, especially during the early phase of treatment. Reconstituted solution may be stored in the refrigerator for one month. Confusion, dizziness, and hallucinations are side effects of this drug; the client should avoid hazardous tasks, such as driving or using machinery. Activity may have to be altered because fatigue and other flu-like symptoms are common with this drug.
A nurse is preparing to discharge a client who had a transurethral prostatectomy for benign prostatic hyperplasia. The nurse evaluates that the client understands the discharge teaching when the client makes which statement?
"I will use stool softeners regularly for the next one to two months." Straining at stool should be avoided for four to six weeks after surgery, or until permitted by the health care provider; avoiding straining supports healing and limits precipitation of bleeding. Eight glasses of fluid a day is insufficient fluid; between 2500 and 3000 mL/day should be consumed to ensure adequate flushing of the bladder and urethra. The client should have continued medical supervision. Sexual intercourse should be avoided until permitted by the health care provider.
A client is suspected of having late-stage (tertiary) syphilis. When obtaining a health history, the nurse determines that which client statement most supports this diagnosis?
"I'm having trouble keeping my balance." Neurotoxicity, as manifested by ataxia, is evidence of tertiary syphilis, which may involve the central nervous system (CNS); other CNS signs include confusion, paralysis, delusions, impaired judgment, and slurred speech. A sore on the penis occurs in the secondary stage. Sores in the mouth occur in the secondary stage. Alopecia is not a sign of late-stage syphilis.
A client has a permanent colostomy. During the first 24 hours, there is no drainage from the colostomy. What does the nurse conclude that this is a result of?
Absence of intestinal peristalsis Absence of peristalsis is caused by manipulation of abdominal contents and the depressant effects of anesthetics and analgesics. Edema will not interfere with peristalsis; edema may cause peristalsis to be less effective, but some output will result. An absence of fiber has a greater effect on decreasing peristalsis than does decreasing fluids. A nasogastric tube decompresses the stomach; it does not cause cessation of peristalsis.
A client has surgery to repair a bladder laceration. What is the nursing intervention that takes priority in the postoperative care of this client?
Repositioning frequently Frequent position changes are important to ensure efficient urinary drainage; gravity promotes flow, which prevents obstruction. Back care is necessary but is not a priority. ROM is of minimal importance because the client will be able to move without limitation. Teaching information related to discharge care is not a priority at this time.
A client with chronic renal failure has been on hemodialysis for two years. The client communicates with the nurse in the dialysis unit in an angry, critical manner and is frequently noncompliant with medications and diet. The nurse can best intervene by first considering that the client's behavior is most likely what?
A defense against underlying depression and fear Both hostility and noncompliance are forms of anger that are associated with grieving. The client's behavior is not a conscious attempt to hurt others but a way to relieve and reduce anxiety within the self. The client's behavior is a self-destructive method of coping, which can result in death. The client's behavior is an effort to maintain control over a situation that is really controlling the client; it is an unconscious method of coping, and noncompliance may be a form of denial.
A client is admitted to the hospital with severe flank pain, nausea, and hematuria caused by a ureteral calculus. A lithotripsy is scheduled. What should be the nurse's initial intervention?
Administer the prescribed analgesic Pain of renal colic may be excruciating; unless relief is obtained, the client will be unable to cooperate with other therapy. Urine can be saved and strained after the client's priority needs are met. Increasing fluid intake helps to mobilize the stone, but a client in severe pain may be nauseated and unable to drink. Although a culture generally is prescribed, this is not the priority when a client has severe pain.
A client reports to a health clinic because a sexual partner recently was diagnosed as having gonorrhea. The health history reveals that the client has engaged in receptive anal intercourse. What should the nurse assess the client for?
Anal itching Anal itching and irritation are related to erythema and edema of the anal crypts caused by the gonococci. Frank rectal bleeding, not upper gastrointestinal bleeding, occurs. Diarrhea, not constipation, occurs. The shape of formed stool does not change; however, diarrhea does occur.
A nurse is caring for a client with end-stage renal disease. Which clinical indicators of end-stage renal disease should the nurse expect? Select all that apply.
Azotemia Hypertension Azotemia is an increase in nitrogenous waste, particularly urea, in the blood; this is common in end-stage renal disease. Hypertension occurs as a result of fluid and sodium overload and dysfunction of the rennin-angiotensin-aldosterone system. Excessive nephron damage in end-stage renal disease causes oliguria, not polyuria; excessive urination is common in early kidney insufficiency from an inability to concentrate urine. Jaundice is common with biliary obstruction, not end-stage renal disease. Anemia, not polycythemia, occurs because of decreased erythropoietin, decreased red blood cell (RBC) production, and decreased RBC survival time.
A nurse is reviewing the clinical record of a client with a diagnosis of benign prostatic hyperplasia (BPH). Which test result confirmed the diagnosis?
Biopsy of prostatic tissue A definitive diagnosis of the cellular changes associated with benign prostatic hyperplasia is made by biopsy, with subsequent microscopic evaluation. Palpation of the prostate gland through rectal examination is not a definitive diagnosis; this only reveals size and configuration of the prostate. The serum phosphatase level will provide information as to the activity of phosphorus in the body; a definitive diagnosis cannot be made with this test. The Pap smear of prostatic fluid test will not yield a definitive diagnosis because malignant cells might not be present in the fluid.
A client reports a sudden warm feeling and the nurse identifies the condition as a hot flash. What other changes may be occurring in this client? Select all that apply.
Brittleness of bones Reduction in adipose tissue in breasts and vulva Characterized by a sudden overheated feeling, hot flashes occur in women during menopause as a result of a decrease in estrogen production. As a woman's age increases, her bones become more brittle. Adipose tissue in the breasts and vulva also decreases, resulting in a loss of tissue turgor. Decreased production of sperm and testosterone are male issues; hot flashes do not occur in men.
A client is diagnosed as having kidney failure. During the oliguric phase what should the nurse assess the client for?
Hyperkalemia The kidneys retain potassium during the oliguric phase of kidney failure; an elevated potassium level is one of the main indicators of the need for dialysis. Hypercalcemia occurs, not hypocalcemia. Hyponatremia occurs, not hypernatremia. Hyperproteinemia occurs, not hypoproteinemia.
Monitoring vital signs, particularly the blood pressure and the rate and quality of the pulse, is essential in detecting physiologic adaptations in a preschool child with nephrotic syndrome. Which clinical manifestation should the nurse be able to detect from these vital signs?
Hypovolemia The shift of fluid from the intravascular to the interstitial compartment predisposes the child to hypovolemia; a weak, thready pulse and hypotension are signs of impending shock. Heart failure is usually not a complication of nephrotic syndrome; however, it is a major complication of glomerulonephritis. The development of a pulmonary embolus is not a complication of nephrotic syndrome. Chest pain and dyspnea are signs of a pulmonary embolus. Hypokalemia, not hyperkalemia, occurs. Tubular reabsorption of sodium is increased to replenish the vascular volume; therefore potassium is excreted.
A client in a nursing home is diagnosed with urethritis. What should the nurse plan to do before initiating antibiotic therapy prescribed by the health care provider?
Obtain a urine specimen for culture and sensitivity. The causative organism should be isolated before starting antibiotic therapy. Catheterization is not a routine intervention for urethritis. Although client teaching is important, it is not the priority at this time. A 24-hour urine test will not determine the infective organism causing the problem.
The nurse is caring for a client who recently was diagnosed with urinary phosphate calculi. What should the nurse plan to teach this client to include in the diet?
Pears All fresh fruits are low in phosphate, which should be limited in a client with urinary phosphate calculi. Beef and fish contain phosphate; all protein foods are high in phosphate. Cheddar cheese is made with milk, which contains phosphate; dairy products are high in phosphorus.
The nurse is providing dietary teaching to a 40-year-old client who is receiving hemodialysis. The nurse should encourage the client to include what in the client's dietary plan?
Rice Foods high in carbohydrates and low in protein, sodium, and potassium are encouraged for these clients. Potatoes are high in potassium, which is restricted. Canned salmon is high in protein and sodium, which usually are restricted. Barbecued beef is high in protein, sodium, and potassium, which usually are restricted.
After surgery to create an ileal conduit, a client is admitted to the postanesthesia care unit. Which clinical finding during the first hour of the postoperative period should the nurse report to the health care provider?
Absence of urinary output Urine should drain continually from the conduit because there is no sphincter control, unless a continent conduit is created. The stoma may be edematous for several weeks after surgery. Vomiting is a common occurrence after anesthesia. Diminished bowel sounds are expected; peristalsis is decreased because of anesthesia and the stress of intestinal manipulation during surgery.
An older adult client is demonstrating mild confusion after surgical repair of a hernia. What should the nurse do to provide for this client's safety?
Activate the position-sensitive bed alarm A positional bed alarm is a noninvasive device to protect a client who attempts to get out of bed unassisted. Staff members must immediately respond to the alarm to ensure that clients are protected from potential injury. Although a nightlight may help orient a client at night, it does not help during the daylight hours. A vest restraint is a measure of last resort when all other less restrictive measures have proven to be ineffective. Confused clients often become more agitated when all the side rails are raised, posing an increased, not a decreased, risk of injury. Confused clients may try to climb over the side rails or try to exit from the end of the bed, placing them at risk for entrapment or a fall.
A client has acute tubulointerstitial renal disease and is experiencing fluid and electrolyte imbalances. The client is confused and complains of nausea and muscle weakness. What does the nurse anticipate will be prescribed to help correct the electrolyte imbalance associated with this diagnosis?
Administer a cation-exchange resin Kayexalate, a potassium-exchange resin, permits sodium to be exchanged for potassium in the intestine, reducing the serum potassium level. Intravenous normal saline will cause fluid retention in the oliguric phase of acute tubular necrosis and is contraindicated. Dairy products will increase calcium levels, not reduce potassium levels. Foods high in fiber will not alter the electrolyte imbalance.
After reviewing the urine diagnostic reports of four clients, a nurse suspects a client is at risk to develop end-stage kidney disease. Which client's findings support the nurse's suspicion?
Client D Clients with urinary albumin levels greater than 300 mg/24 hr (200 mcg/min) are at risk of developing end-stage kidney disease. Client D has a serum albumin concentration of 398 mg/24 hr, which indicates that the client may develop end-stage kidney disease. Therefore, the findings of client D support the nurse's suspicion. Serum albumin levels in the range of 30 to 299 mg/24 hr indicate persistent albuminuria, which is an early stage of nephropathy, especially in clients with diabetes. Therefore, the serum albumin concentrations of clients A, B, and C, which are 98, 198, and 298 mg/24 hr, respectively, are indicative of microalbuminuria.
Which diagnostic test is instrumental in achieving direct visualization of the cervix and vagina?
Colposcopy A colposcopy provides direct visualization of the vagina and cervix under low-power magnification. A biopsy involves a sample tissue taken to observe masses, ectopic pregnancies and pelvic inflammatory diseases. A culdoscopy involves the insertion of a culdoscope through the posterior vaginal vault into the cul-de-sac for the visualization of the Fallopian tubes and ovaries. A laparoscopy involves the insertion of a small laparascope through the abdominal wall to view the pelvic organs
A client with a history of chronic kidney disease is hospitalized. The nurse assesses the client for signs of related kidney insufficiency, which include what?
Edema and pruritus The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur after prostate surgery. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease.
A client has a kidney transplant. The nurse should monitor for which signs associated with rejection of the transplant? Select all that apply.
Fever Oliguria Weight gain Fever is a characteristic of the systemic inflammatory response to the antigen (transplanted kidney). Oliguria (100 to 400 mL daily) or anuria (less than 100 mL daily) occurs when the transplanted kidney is rejected and fails to function. Weight gain can occur from fluid retention when the transplanted kidney fails to function or as a result of steroid therapy. This response must be assessed further. Jaundice is unrelated to rejection. Moon face is a side effect of steroid therapy; it is not a sign of rejection.
A nurse is reviewing the admission laboratory report of an infant with severe gastroenteritis. The serum potassium is 3 mEq/L. Potassium chloride 20 mEq/L is prescribed to be added to the infant's intravenous (IV) line. What should the nurse do next?
Find out when the infant last had a wet diaper. Potassium chloride is excreted by functioning kidneys; if there is anuria, which is a sign of kidney failure, the potassium should be withheld and the practitioner notified. There is no reason to question the order because the laboratory value is below the expected level for an infant, which is 4.1 to 5.3 mEq/L. Potassium is a component of body fluid and will not cause an allergic response. Administering the potassium without confirming adequate kidney function is unsafe because potassium can accumulate and cause lethal cardiac dysrhythmias.
A client with acute glomerulonephritis reports thirst. Which is the most appropriate choice that the nurse can offer to relieve the client's thirst?
Hard candy Sucking on a hard candy will relieve thirst and increase carbohydrates but does not supply extra fluid. Low protein, low sodium, and fluid restrictions are needed for a client with acute glomerulonephritis. The goal is to minimize unnecessary fluid intake. Carbonated beverages contain sodium and provide additional fluid, which must be restricted. A milkshake contains both fluid and protein, which must be restricted. Broth contains sodium and provides additional fluid, which increases fluid retention.
The nurse is caring for a client who has been diagnosed with glomerulonephritis. What initial urinary finding supports this diagnosis?
Hematuria Blood in the urine (hematuria) and red blood cell casts 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.
The nurse assesses a male client with a preliminary diagnosis of cancer of the urinary bladder. The nurse recalls that which sign or symptom is a common early sign of cancer of the urinary system?
Hematuria Research statistics indicate that hematuria is the most common early sign of cancer of the urinary system, probably because of the urinary system's rich vascular network. Dysuria is not specific for bladder cancer; usually it is associated with an enlarged prostate in the male. Retention is not specific for bladder cancer; usually it is associated with an enlarged prostate in the male. Hesitancy is not specific for bladder cancer; usually it is associated with an enlarged prostate in the male.
A client who had a transurethral resection of the prostate is transferred to the postanesthesia care unit with an intravenous (IV) line and a urinary retention catheter. For which major complication is it most important for the nurse to assess during the immediate postoperative period?
Hemorrhage After transurethral surgery, hemorrhage is common because of venous oozing and bleeding from many small arteries in the area. Following transurethral surgery, sepsis is unusual, and if it occurs, it will manifest later in the postoperative course; phlebitis is assessed for, but it is not the most important complication; and leaking around the IV catheter is not a major complication.
A client who had a transurethral resection of the prostate is transferred to the post-anesthesia care unit with an IV and a urinary retention catheter. For which major complication is it most important for the nurse to assess during the immediate postoperative period?
Hemorrhage After transurethral surgery, hemorrhage is common because of venous oozing and bleeding from many small arteries in the area. Sepsis is unusual, and if it occurs it will manifest later in the postoperative course. Leaking around the catheter is not a major complication. Urinary retention is unlikely with an indwelling catheter in place.
A 12-year-old boy with nephrotic syndrome has been in remission for several months. One day the mother calls the clinic to report that for the past week her child's skin has had a pale, muddy appearance; his appetite is poor; and he has been unusually tired after school. In light of the mother's description, what does the nurse suspect?
Impending renal failure The anemia associated with renal failure accounts for the pallor and decreased energy; the decreased appetite and decreased energy are related to the accumulation of toxic wastes. Excessive activity should not cause the signs and symptoms identified by the mother if the child is in remission. An increased temperature will probably be present with an infection; an infection does not cause a muddy pallor. Discontinuing the corticosteroids and diuretics, if they have been prescribed, might result in a recurrence of edema in the steroid-dependent child; it is not a sign of renal failure.
A client is admitted to the hospital with urinary retention, and an indwelling urinary catheter is prescribed by the health care provider. What should the nurse do to help prevent the client from developing a urinary tract infection?
Maintain the prescribed hydration Promoting hydration maintains urine production that flushes the bladder, thereby preventing urinary stasis and possible infection. Although assessing urine specific gravity may help identify a urinary tract infection, it will not prevent it. Although collecting a weekly urine specimen for culture and sensitivity may help identify a urinary tract infection, it will not prevent it. The collection bag is emptied once every shift unless the bag is full and needs to be emptied sooner; changing the bag periodically, not emptying it, may help prevent infection.
When receiving hemodialysis, the complication of the removal of too much sodium may occur. For which clinical findings associated with hyponatremia should the nurse assess the client? Select all that apply.
Muscle cramps Extreme fatigue Sodium is the most abundant cation in the extracellular fluid and functions as part of the sodium/potassium pump. In the presence of a deficit, the client will exhibit confusion, lethargy, headache, and muscle cramps. Lethargy results in the presence of a deficit. Spasm of the facial muscles following a tap over the facial nerve (Chvostek sign) indicates hypocalcemia. Cardiac dysrhythmias are associated with increases or decreases in potassium and calcium. An increase in body temperature reflects a possible infection, not an electrolyte imbalance.
A client who is 5 feet, 8 inches tall and weighs 220 pounds is admitted to the hospital with ureteral colic, blood in the urine, and a blood pressure of 150/90. The immediate objective of nursing care for this client is to decrease what?
Pain Sharp, severe pain (renal colic) radiating toward the genitalia and thigh is associated with ureteral distention and must be relieved. Weight loss is a long-term goal; reducing pain is the priority. Although the hematuria will be addressed, pain reduction is the priority. Although the client's hypertension will be addressed, pain reduction is the priority.
Which structures are included in the external genitalia in males? Select all that apply.
Penis Scrotum The male reproductive system is divided into primary reproductive organs and secondary reproductive organs. Secondary reproductive organs include ducts, sex glands, and external genitalia. The external genitalia consists of the penis and the scrotum. Testes are the primary reproductive organs. The urethra is the duct, and the seminal vesicles are sex glands.
A nurse is teaching the importance of annual physical examinations to an adult health and wellness class. The nurse reinforces that it is important for men who are middle-aged and older to have what laboratory test annually?
Prostate-specific antigen (PSA) Cancer of the prostate occurs mainly in men over the age of 60; screening via palpation and testing for PSA should be performed at regular medical checkups. ELISA is related to HIV, and the largest percentage of individuals who are positive for human immunodeficiency virus (HIV) is found in the 20- to 39-year-old age group, not in those in the 45- to 65-year-old age group and over 65-year-old age group. Triglyceride levels should be measured at all regular physical examinations irrespective of age; evidence of plaque formation has been found in young children, adolescents, and young adults, as well as in older adults.
A nurse is caring for a client with chronic kidney failure. What should the nurse teach the client to limit the intake of to help control uremia associated with end stage renal disease (ESRD)?
Protein The waste products of protein metabolism are the main cause of uremia. The degree of protein restriction is determined by the severity of the disease. Fluid restriction may be necessary to prevent edema, heart failure, or hypertension; fluid intake does not directly influence uremia. Sodium is restricted to control fluid retention, not uremia. Potassium is restricted to prevent hyperkalemia, not uremia.
A nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet because of what reason?
Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats Salt substitutes usually contain potassium, which can lead to hyperkalemia; dysrhythmias are associated with hyperkalemia. Sodium, not salt substitutes, in the diet causes retention of fluid. Salt substitutes do not contain substances that influence blood urea nitrogen (BUN) and creatinine levels; these are the result of protein metabolism. There is no such substance in salt substitutes that interferes with the transfer of fluid across capillary membranes.
A sexually active client presents with a sore throat and a generalized rash. The client states that a chancre that had been present healed approximately three months ago. The physical assessment and the serologic test findings indicate a diagnosis of syphilis. The nurse recognizes that the client is experiencing what stage of syphilis?
Secondary The client has secondary syphilis, which occurs one to three 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; 20% to 40% do not demonstrate signs and symptoms during this stage. At this stage it is a slowly progressive inflammatory disease that can involve many organs; common complications include paresis, brain attack, dementia, psychosis, aortitis, and meningitis.
A nurse is caring for a client who had a kidney transplant. Which test is most important for determining whether a client's newly transplanted kidney is working effectively?
Serum creatinine Serum creatinine, a test of renal function , measures the kidneys' ability to excrete metabolic wastes; creatinine, a nitrogenous product of protein breakdown, is elevated in renal insufficiency. Renal scan will not provide information about the filtering ability of the transplanted kidney. Although intake and output will be monitored, this will not provide information about the ability of kidney to excrete metabolic wastes. The WBC count will not reflect functioning of a transplanted kidney.
A client is diagnosed as having invasive cancer of the bladder, and radiation therapy is scheduled. What should the nurse expect the client to demonstrate that indicates success of radiation therap
Shrinkage of the tumor on scanning Radiation interferes with cell multiplication, which should control the growth and metastasis of cancerous tumors. Radiation affects healthy as well as abnormal cells; urinary frequency and diarrhea can result. Malaise, not an increase in physical strength, is an effect of radiation therapy. Bone marrow sites may be affected by radiation, resulting in a reduction of WBCs.
A male client has discharge from his penis. Gonorrhea is suspected. To obtain a specimen for a culture, what should the nurse do?
Swab the drainage directly from the urethra to obtain a specimen Swabbing the drainage directly from the urethra obtains a specimen uncontaminated by environmental organisms. Instructing the client to provide a semen specimen is not as accurate as obtaining the purulent discharge from the site of origin. Swabbing the discharge when it appears on the prepuce will contaminate the specimen with organisms external to the body. Teaching the client how to obtain a clean catch specimen of urine will dilute and possibly contaminate the specimen.
A nurse checking the perineum of a client with a radium implant for cervical cancer observes the packing protruding from the vagina. The nurse notifies the primary healthcare provider to have the packing removed. What is the primary reason that the packing needs to be removed immediately?
The radioactive packing will injure healthy tissue. Packing maintains a radium implant in its correct placement; correct placement minimizes the effect on healthy tissue. There should not be active bleeding with a radium implant; cellular sloughing is expected. Although exposure to the radioactive packing damages healthy tissue, it is not life threatening.
Which natural physiologic process helps prevent bacterial infections within the client's bladder containing urine?
The secretions of the urothelium 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.
After prostate surgery a client's indwelling catheter and continuous bladder irrigation (CBI) are to be removed. The nurse discusses the procedure with the client. The nurse evaluates that the teaching is understood when the client makes which statement?
"After the catheter is removed I probably will experience some burning on urination." Because of the trauma to the mucous membranes of the urinary tract, burning on urination is an expected response that should subside gradually. The urine should no longer be dilute after the continuous bladder irrigation is discontinued and removed. However, the urine may have a slight pink tinge because of the trauma from the surgery and the presence of the catheter. An inability to urinate should not occur unless the indwelling catheter is removed too soon and there is still edema of the urethra. Production of dark red urine is a sign of hemorrhage, which should not occur.
A nurse teaches a client who is scheduled for a kidney transplant about the need for immunosuppressive medications. The nurse determines that the client understands the teaching when the client makes which statement?
"I must take these medications for the rest of my life." These drugs must be taken continuously to prevent rejection of the transplanted organ. The danger of rejection always exists. The client must take the medications longer than after the surgery or until the anastomosis heals or during the intraoperative period.
A diet that contains restricted amounts of protein, sodium, and potassium has been prescribed for a client with end-stage renal disease who is receiving dialysis. The nurse is providing dietary instructions. Which statement by the client indicates teaching is effective?
"I should avoid using salt substitutes." Commercially prepared salt substitutes are high in potassium. Some complete protein foods must be included in the diet. Seasoning that contains neither sodium nor potassium, such as lemon juice, pepper, and herbs, can be used to make food more palatable. Low-sodium canned vegetables contain high potassium concentrations.
A client who has had a transurethral prostatectomy (TURP) experiences dribbling after the indwelling catheter is removed. To address this problem, what is an appropriate nursing response?
"Increase your fluid intake and urinate at regular intervals." Increasing fluid intake and urinating at regular intervals will improve bladder tone, which should alleviate dribbling. The response "I know you're worried, but it will go away in a few days" identifies feelings but does not actively help the client solve the problem. Limiting fluid intake and urinating at the urge do not increase bladder tone; fluids should be increased and the time between voidings should be increased gradually. Continuous bladder decompression will reduce bladder tone; reduced bladder tone will persist when the indwelling catheter is removed until bladder tone improves.
A client with acute kidney failure is to receive peritoneal dialysis and asks why the procedure is necessary. What is the nurse's best response?
"It helps perform some of the work usually done by the kidneys." Dialysis removes chemicals, wastes, and fluids usually removed from the body by the kidneys. The mention of heart problems is a threatening response to the patient and may cause increased fear or anxiety. Stating that peritoneal dialysis "removes toxic chemicals from the body so you will not get worse" is threatening to the patient and can cause an increase in anxiety. Dialysis helps maintain fluid and electrolyte balance; there are no data to indicate the cause of the acute kidney failure or previous therapy.
A client with chronic kidney disease is admitted to the hospital with severe infection and anemia. The client is depressed and irritable. The client's spouse asks the nurse about the anticipated plan of care. What is an appropriate nursing response?
"The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products." One of the kidney's functions is to excrete nitrogenous waste from protein metabolism; restriction of protein intake decreases the workload of the damaged kidneys. The client is encouraged to be as active and independent as possible. Medications are avoided because they may mask symptoms. Iron supplements are not tolerated well by clients in kidney failure and reduce the client's own stimulus to produce red blood cells; folate usually is prescribed.
A client who is dehydrated is to receive an intravenous (IV) solution of normal saline to be infused at 175 mL/hr. The drop factor of the IV set is 15 gtts/mL. At what drop rate should the nurse adjust the flow to provide the prescribed solution? Record your answer using a whole number. __________ gtts/min
44 gtts/min is a correct calculation. Multiply the amount of fluid to be infused (175 mL) by the drop factor (15) and divide this result by the amount of time in minutes (1 hr x 60 min).
During the postoperative period after surgery for a kidney transplant, the client's creatinine level is 3.1 mg/dL. What should the nurse do first in response to this laboratory result?
Assess for decreased urine output The expected serum creatinine range is 0.5 to 1.2 mg/dL. The nurse should obtain additional information that may indicate acute rejection; therefore, the nurse must first assess for decreased urine output and changes in vital signs. Once additional data are collected (e.g., urine output, current blood work reports) and the IV infusions are checked, the nurse should contact the health care provider, explain the situation, and implement further prescriptions. Eventually the nurse should ensure that proper infusion rates, along with IV medications, are being maintained after the client is first assessed for decreased urine output and for changes in vital signs. Current blood work reports should be obtained after the client is assessed for decreased urine output and changes in vital signs.
A client with phosphate-based urinary calculi asks why aluminum hydroxide gel has been prescribed. The nurse explains that the medication decreases serum phosphorus by which action?
Binding with phosphorus in the intestine Aluminum hydroxide binds phosphorus in the intestine, preventing its absorption; this decreases serum phosphorus. Preventing absorption of phosphorus in the stomach, promoting excretion of excessive urinary phosphorus, and dissolving stones as they pass through the urinary tract are not actions of this drug.
A client with the diagnosis of chronic kidney disease develops hypocalcemia. Which clinical manifestations should the nurse expect the client with hypocalcemia to exhibit? Select all that apply.
Chvostek sign Muscle cramps Chvostek sign is elicited by tapping the face in front of the ear over the facial nerve; a positive sign is evidence of tetany and is caused by decreased serum calcium. Muscle cramps result from decreased serum calcium; functions of calcium include muscle contraction and transmission of nerve impulses. Acidosis decreases calcium that binds to albumin, resulting in more ionized calcium (free calcium) in the blood. Lethargy and weakness are associated with hypercalcemia. Hypercalcemia greater than 11 mg/dL causes bone pain and fractures; it is related to demineralization of bone.
A nurse is teaching a client about drug therapy for gonorrhea. Which fact about drug therapy should the nurse emphasize?
Cures the infection Ceftriaxone (Rocephin), followed by doxycycline (Vibramycin), is specific for Neisseria gonorrhoeae and eradicates the microorganism; other treatment regimens are available for resistant strains. If the disease progresses before the diagnosis is made, complications such as sterility, heart valve damage, or joint degeneration may occur. Transmission is not controlled; the organism is eliminated. If tubal structures, heart valves, or joints degenerate, the pathologic changes will not be reversed by antibiotic therapy.
A female client's blood-work report shows increased estrogen and progesterone levels. What period of the menstrual phase was the client at when the blood was drawn?
Days 15 through 28 The menstrual cycle comprises three phases that together generally last about 28 days. During days 15 through 28, the developing corpus luteum releases estrogen and progesterone, which in turn increases their levels in blood. Between days 1 and 5 of the menstrual cycle, the endometrium is sloughed off, resulting in menses. Between days 6 and 13, estrogen is released from the maturing Graafian follicle. On day 14, the anterior pituitary gland releases luteinizing hormone (LH), which causes the Graafian follicle to rupture and release a mature ovum.
The nurse is caring for a client with a diagnosis of acute kidney failure associated with drug toxicity. When the client complains of thirst, what should the nurse offer?
Hard candy Sucking on candy will relieve thirst and provide calories without supplying extra fluid. Ice chips add to the restricted fluid intake. Milk contains both fluids and proteins, which should be restricted with acute kidney failure. Carbonated beverages may be high in sodium and provide additional fluid; both should be restricted.
The nurse is caring for a client with acute renal failure. What is the most serious complication for this client?
Infection Infection is responsible for one third of the traumatic or surgically induced deaths of clients with acute renal failure, as well as for medically induced acute renal failure.
Which statement is true regarding varicocele?
It causes elongation of the veins of the spermatic cord. Varicocele is characterized by dilation and elongation of the veins of the spermatic cord that is presently superior to a testicle. It is rarely seen in prepubertal children. Testicular torsion results in partial or complete venous occlusion. In cases of severe torsion, the scrotum becomes red, warm, and edematous and appears to be immobile.
Which structure extends from the mons pubis to the perineal floor?
Labia majora The labia majora are two large folds that extend from the mons pubis to the perineal floor. The walls of the vagina normally lie in folds called rugae. The external opening of the vagina is covered by a fold of mucus membrane, skin, and fibrous tissue called a hymen. The vestibule is the space enclosing the structures located beneath the labia minora.
A nurse is caring for a client with a diagnosis of renal calculi secondary to hyperparathyroidism. Which type of diet should the nurse explore with the client when providing discharge information?
Low calcium Calcium and phosphorus are components of these stones; foods high in calcium and phosphorus should be avoided. Low purine and high alkaline ash diets are indicated for clients with gout. Foods high in phosphorus must be avoided.
A client's urine specific gravity is being measured. For what condition should the nurse conduct a focused assessment when a client's specific gravity is increased?
Low-grade fever An elevated temperature can lead to dehydration and an increased urine specific gravity (more than 102.5). When there is edema or fluid overload, the accumulating body fluid will cause a decrease in the specific gravity of the urine. A client with diabetes insipidus excretes a large amount of dilute urine; dilute urine will have a decreased specific gravity. In chronic kidney disease there is an inability to concentrate urine and urine will be dilute.
A client with an ileal conduit is being prepared for discharge. As part of the discharge teaching, what does the nurse instruct the client to do?
Maintain fluid intake of at least 2 L daily High-fluid intake flushes the ileal conduit and prevents infection and obstruction caused by mucus or uric acid crystals. Alcohol is not contraindicated with an ileal conduit. Notifying the health care provider if the stoma size decreases is expected; as edema decreases, the stoma will become smaller. Soap and water on the peristomal area help prevent irritation from waste products.
A nurse is caring for a client with a ureteral calculus. Which are the most important nursing actions? Select all that apply.
Monitoring intake and output Straining the urine at each voiding Administering the prescribed analgesic A urinary calculus may obstruct urine flow, which will be reflected in a decreased output; obstruction may result in hydronephrosis. Urine is strained to determine whether any calculi or calcium gravel is passed. Reduction of pain is a priority. A calculus obstructing a ureter causes flank pain that extends toward the abdomen, scrotum and testes, or vulva; the pain begins suddenly and is severe (renal colic). Fluids should be encouraged to promote dilute urine and facilitate passage of the calculi. Blood pressure assessment is of no particular importance to the client with kidney stones (calculi).
The treatment regimen for a female diagnosed with Hodgkin disease, stage III, will start with nodal irradiation. Because the client and her husband have been trying to conceive a child, the client becomes visibly anxious when she learns that the radiation therapy includes the pelvic nodal area. The nurse refers the client to the primary healthcare provider when the client starts to question the treatment. What is the rationale for the nurse's actions?
Reproductive ability may be preserved through a variety of interventions Reproductive ability may be preserved through shielding the ovaries or harvesting ova. Radiation can influence or destroy ovarian functioning. Sterilization can occur. Women in the childbearing years should be informed of all options available to preserve ovarian function. Once ova are destroyed, they cannot regenerate.
A client was treated with a radium implant for cancer of the cervix. What information is important for the nurse to teach the client when giving discharge instructions?
Return for follow-up care Before discharge it is important for the nurse to instruct the client to return for follow-up care at specified intervals. Fluids are not reduced unless cardiac or renal pathology is present. When the implant is in place, a low-residue diet is indicated to avoid pressure from a distended colon; when the radium implant is removed, the client can return to a regular diet. If the diet is adequate, mineral supplements are unnecessary.
A nurse is providing preoperative teaching for a client who is scheduled for a transurethral resection of the prostate. What should the nurse include in the client's postoperative teaching plan?
Spasms of the bladder occur during the first 24 to 48 hours Spasms result from irritation of the bladder during surgery; they decrease in intensity and frequency as healing occurs. Urine that is bright red for 24 to 48 hours is too long; this indicates hemorrhage. Drainage should be dark red and after the first few hours gradually turn pink. The Valsalva maneuver should be avoided because it may initiate prostatic bleeding, not bladder contractions. The presence of continuous bladder irrigation (CBI) is unrelated to the amount of oral fluids that should be consumed; once the continuous bladder irrigation is discontinued, oral fluids should be encouraged.
Which statement regarding a mastectomy is true?
The physiology of the vagina is affected by radiation after a mastectomy The physiology of the vagina deteriorates as a result of radiation therapy that is administered after a mastectomy. A mastectomy results in both physical and emotional trauma. Rather than helping a woman have a proper figure, a mastectomy results in disfigurement. A mastectomy affects the ability to nurse an infant.
After a nephrectomy a client arrives in the post-anesthesia care unit in the supine position. Which action should be employed by the nurse to assess the client for signs of hemorrhage?
Turn the client to observe the dressings Because of the anatomic position of the incision, drainage will flow by gravity and accumulate under the client lying in the supine position. Nail beds indicate peripheral perfusion, not early hemorrhage. Respiratory hemorrhage is not common after kidney surgery. The blood pressure decreases and the pulse rate increases with hemorrhage.
A lithotripsy to break up renal calculi is unsuccessful, and a nephrolithotomy is performed. Which postoperative clinical indicator should the nurse report to the health care provider?
Urine output of 20 to 30 mL/hr Output should be at least 30 mL/hr or more; a decreased output may indicate obstruction or impaired kidney function. Blood, tinting the urine pink, is expected. Drainage may be pink; bright red drainage should be reported. The intake of 1750 mL in 24 hours is adequate; however, a higher intake usually is preferred (e.g., 2000 to 3000 mL).
When performing a peritoneal dialysis procedure, what should the nurse do?
Warm dialysate solution slightly before instillation The infusion should be warmed to body temperature to lessen abdominal discomfort and promote dilation of peritoneal vessels. The side-lying position may restrict fluid inflow and prevent maximum urea clearance; the client should be placed in the semi-Fowler position. The infusion of dialysate solution should take approximately 5 to 10 minutes. Routine medications should not interfere with the infusion of dialysate solution.
A client is to have hemodialysis. What must the nurse do before this treatment?
Weigh the client to establish a baseline for later comparison A baseline weight must be obtained to be able to determine the net fluid loss from dialysis. Obtaining a urine specimen to evaluate kidney function is not necessary; clients with advanced kidney disease may not produce urine. Medications often are delayed until after dialysis to prevent them from being filtered into the dialysate. Explaining that the peritoneum serves as a semipermeable membrane to remove wastes applies to peritoneal dialysis, not hemodialysis.
