Genitourinary Disorders

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: 1. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. 2. a decreased serum phosphate level secondary to kidney failure. 3. an increased serum calcium level secondary to kidney failure. 4. metabolic alkalosis secondary to retention of hydrogen ions.

1 RATIONALES: A client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to the inability of the kidneys to excrete hydrogen ions.

A client diagnosed with a sexually transmitted disease has been feeling poorly. A friend of the client's who is employed by the hospital asks a nurse why her friend is hospitalized. How should the nurse respond? 1. Explain that although she is a friend of the client, the nurse can't violate client confidentiality. 2. Inform the friend of the client's medical diagnosis. 3. Tell the friend that she should ask the client about her condition. 4. Inform the friend that the client has an infectious disease, which the friend can contract by entering the client's room.

1 RATIONALES: All clients are entitled to confidentiality about their medical records. Informing the friend of the client's diagnosis violates client confidentiality even if the friend is a hospital employee. Telling the friend to ask the client about her diagnosis confirms that the client is hospitalized, which also violates confidentiality. Informing the friend that the client has an infectious disease also violates confidentiality.

A nurse reviews a client's medical record and notes that a physician ordered an indwelling urinary catheter due to client's urine retention. Which action should the nurse perform first? 1. Verify the client's identity. 2. Explain the procedure to the client. 3. Gather the necessary equipment 4. Provide privacy.

1 RATIONALES: Before any invasive procedure, the nurse should verify the client's identity using two client identifiers, such as the name and the medical record number on his identification band. Next, she should provide privacy and explain the procedure to the client. After explaining the procedure, she should gather all necessary supplies.

The nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence? 1. Encouraging intake of at least 2 L of fluid daily 2. Giving the client a glass of soda before bedtime 3. Taking the client to the bathroom twice per day 4. Consulting with a dietitian

1 RATIONALES: By encouraging a daily fluid intake of at least 2 L, the nurse helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn't give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won't address the problem of urinary incontinence.

A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include: 1. generalized edema, especially of the face and periorbital area. 2. green-tinged urine. 3. moderate to severe hypotension. 4. polyuria.

1 RATIONALES: Generalized edema, especially of the face and periorbital area, is a classic sign of acute glomerulonephritis of sudden onset. Other classic signs and symptoms of this disorder include hematuria (not green-tinged urine), proteinuria, fever, chills, weakness, pallor, anorexia, nausea, and vomiting. The client also may have moderate to severe hypertension (not hypotension), oliguria or anuria (not polyuria), headache, reduced visual acuity, and abdominal or flank pain.

The nurse is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 5.9 mEq/L. Correct administration and the effects of this enema would include having the client: 1. retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. 2. retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea. 3. retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn't necessary to reduce the potassium level. 4. retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn't necessary to reduce the potassium level.

1 RATIONALES: Kayexalate is a sodium exchange resin. Thus the client will gain sodium as potassium is lost in the bowel. For the exchange to occur, Kayexalate must be in contact with the bowel for at least 30 minutes. Sorbitol in the Kayexalate enema causes diarrhea, which increases potassium loss and decreases the potential for Kayexalate retention.

The nurse is monitoring the fluid intake and output of a female client recovering from an exploratory laparotomy. Which nursing intervention would help the client avoid a urinary tract infection (UTI)? 1. Maintaining a closed indwelling urinary catheter system and securing the catheter to the leg 2. Limiting fluid intake to 1 L/day 3. Encouraging the client to use a feminine deodorant after bathing 4. Encouraging the client to douche once a day after removal of the indwelling urinary catheter

1 RATIONALES: Maintaining a closed indwelling urinary catheter system helps prevent introduction of bacteria; securing the catheter to the client's leg also decreases the risk of infection by helping to prevent urethral trauma. To flush bacteria from the urinary tract, the nurse should encourage the client to drink at least 10 glasses of fluid daily, if possible. Douching and feminine deodorants may irritate the urinary tract and should be discouraged.

A client with renal cancer who has not yet been informed of his diagnosis asks the nurse what his test results showed. How should the nurse respond? 1. "It must be difficult for you not to know the results of your test." 2. "It's nothing to worry about." 3. "The report isn't back yet." 4. "You should probably talk to your physician."

1 RATIONALES: Option 1 encourages the client to express his feelings about the impending test results. Option 2 offers false reassurance and minimizes the client's concerns. Option 3 provides a dishonest answer; option 4 suggests that there is a problem that only the physician can discuss.

A client with benign prostatic hyperplasia (BPH) doesn't respond to medical treatment and is admitted to the facility for surgical intervention. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for treatment of BPH? 1. Transurethral resection of the prostate (TURP) 2. Suprapubic prostatectomy 3. Retropubic prostatectomy 4. Transurethral laser incision of the prostate

1 RATIONALES: TURP is the most widely used procedure for treatment of BPH. Because it requires no incision, TURP is especially suitable for men with relatively minor prostatic enlargements and for those who are poor surgical risks. Suprapubic prostatectomy, retropubic prostatectomy, and transurethral laser incision of the prostate are less common procedures; they all require an incision.

A charge nurse in a long-term care facility is planning the nursing assignments for the oncoming shift. Her staff consists of four nursing assistants and a licensed practical nurse (LPN). How should she divide nursing care among the staff to adequately ensure safe, effective care? 1. The charge nurse performs treatments and supervises staff, the LPN administers medications and assists with care, and the nursing assistants provide direct client care. 2. The charge nurse supervises staff, the LPN administers medications, and the nursing assistants provide direct client care. 3. The charge nurse supervises staff and administers medications; the LPN and nursing assistants provide direct client care. 4. The charge nurse supervises staff, the LPN performs treatments and administers medication, and the nursing assistants provide direct client care.

1 RATIONALES: The charge nurse can best utilize her resources to provide safe and effective care by supervising the staff and providing treatments. The charge nurse should assign the LPN to administer medication and to help with client care as time allows. The nursing assistants should provide direct client care.

A client with a genitourinary problem is being assessed in the emergency department. When palpating the client's kidneys, the nurse should keep which anatomical fact in mind? 1. The left kidney usually is slightly higher than the right one. 2. The kidneys are situated just above the adrenal glands. 3. The average kidney is approximately 5 cm (2") long and 2 to 3 cm (¾" to 1 1/8") wide. 4. The kidneys lie between the 10th and 12th thoracic vertebrae.

1 RATIONALES: The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4 3/8") long, 5 to 5.8 cm (2" to 2 ¼") wide, and 2.5 cm (1") thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae.

A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region, which radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? 1. Kidney 2. Ureter 3. Bladder 4. Urethra

1 RATIONALES: The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and may lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation.

When performing a scrotal examination, the nurse finds a nodule. What should the nurse do next? 1. Notify the physician. 2. Change the client's position and repeat the examination. 3. Perform a rectal examination. 4. Transilluminate the scrotum.

1 RATIONALES: The nurse should first notify the physician of the abnormal finding, and then perform transillumination as ordered. The nurse can't uncover more information about a scrotal mass by changing the client's position and repeating the examination or by performing a rectal examination.

A client reports experiencing vulvar pruritus. Which finding may indicate that the client has an infection caused by Candida albicans? 1. Cottage cheese-like discharge 2. Yellow-green discharge 3. Gray-white discharge 4. Discharge with a fishy odor

1 RATIONALES: The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of Trichomonas vaginalis. Gray-white discharge and a fishy odor are signs of Gardnerella vaginalis.

A 3-way indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to inflating the balloon, the functions of the three lumens include: 1. continuous inflow and outflow of irrigation solution. 2. intermittent inflow and continuous outflow of irrigation solution. 3. continuous inflow and intermittent outflow of irrigation solution. 4. intermittent flow of irrigation solution and prevention of hemorrhage.

1 RATIONALES: When preparing for continuous bladder irrigation, a 3-way indwelling urinary catheter is inserted. The three lumens inflate the balloon and provide continuous inflow and outflow of irrigation solution.

A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client? 1. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. 2. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. 3. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse. 4. The human papillomavirus (HPV), which causes condylomata acuminata, can't be transmitted during oral sex.

1 RATIONALES: Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about: 1. chronic acetaminophen use. 2. recent streptococcal infection. 3. childhood asthma. 4. family history of pernicious anemia.

2 RATIONALES: A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction.

Which of the following is a function of antidiuretic hormone (ADH)? 1. Sodium absorption and potassium excretion 2. Water reabsorption and urine concentration 3. Water reabsorption and urine dilution 4. Sodium reabsorption and potassium retention

2 RATIONALES: ADH stimulates the renal tubules to reabsorb water, thereby concentrating urine. Aldosterone is responsible for sodium reabsorption and potassium excretion by the kidneys.

The nurse is caring for a client with acute pyelonephritis. Which nursing intervention is most important? 1. Administering a sitz bath twice per day 2. Increasing fluid intake to 3 L/day 3. Using an indwelling urinary catheter to measure urine output accurately 4. Encouraging the client to drink cranberry juice to acidify the urine

2 RATIONALES: Acute pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both kidneys. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. Pyelonephritis may result from procedures that involve the use of instruments (such as catheterization, cystoscopy, and urologic surgery) or from hematogenic infection. The most important nursing intervention is to increase fluid intake to 3 L/day. This helps empty the bladder of contaminated urine and prevents calculus formation. Administering a sitz bath would increase the likelihood of fecal contamination. Using an indwelling urinary catheter could cause further contamination. Encouraging the client to drink cranberry juice to acidify urine is helpful but isn't the most important intervention.

A client is admitted with a diagnosis of acute renal failure. The nurse should monitor closely for: 1. enuresis. 2. drug toxicity. 3. lethargy. 4. insomnia.

2 RATIONALES: Acute renal failure is characterized by oliguria and rapid accumulation of nitrogen waste in the blood. Kidneys excrete medications, so the nurse should monitor the client closely for drug toxicity. With decreased urinary output or no output, enuresis shouldn't occur. The client will most likely feel lethargic, but this isn't as serious a problem as drug toxicity. The client isn't likely to have insomnia but, rather, may want to sleep most of the time.

A client with chronic renal failure must restrict her fluid intake to 500 ml daily. Despite having reached the limit, the client is insisting that she have more fluid. Which intervention by a nurse is appropriate? 1. Provide her with an additional 100 ml of fluid. 2. Allow her to have a piece of hard candy. 3. Ignore her request for more fluids. 4. Reinforce the need to maintain the fluid restriction.

2 RATIONALES: Allowing the client to have a piece of hard candy to suck on will relieve her thirst and maintain the fluid restriction. Exceeding the fluid restriction might cause fluid overload, necessitating an emergency hemodialysis treatment. It's inappropriate to ignore a client request. Reinforcing the need to maintain the fluid restriction doesn't address the client's need.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding signals a significant problem during this procedure? 1. Blood glucose level of 200 mg/dl 2. White blood cell (WBC) count of 20,000/mm3 3. Potassium level of 3.8 mEq/L 4. Hematocrit (HCT) of 35%

2 RATIONALES: An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.8 mEq/L is an acceptable value. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: 1. hematuria. 2. weight loss. 3. increased urine output. 4. increased blood pressure.

2 RATIONALES: Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl. The most therapeutic pharmacologic intervention would be to administer: 1. immune globulin (Sandoglobulin). 2. epoetin alfa (Epogen) 3. filgrastim (Neupogen) 4. enoxaparin (Lovenox)

2 RATIONALES: Chronic renal failure diminishes the production of erythropoietin by the kidneys and leads to a subnormal Hb level. (Normal Hb level is 13 to 18 g/dl in men and 12 to 16 g/dl in women.) An effective pharmacologic treatment is epoetin alfa, a recombinant erythropoietin. Filgrastim (a drug used to stimulate neutrophils), immune globulin (an immunomodulator), and enoxaparin (low-molecular-weight heparin) wouldn't raise the client's Hb level.

Which laboratory test is the most accurate indicator of a client's renal function? 1. Blood urea nitrogen 2. Creatinine clearance 3. Serum creatinine 4. Urinalysis

2 RATIONALES: Creatinine clearance is the most accurate indicator of a client's renal function because it closely correlates with the kidney's glomerular filtration rate and tubular excretion ability. Results from the other options may be influenced by various conditions and aren't specific to renal disease.

The physician prescribes norfloxacin (Noroxin), 400 mg by mouth twice daily, for a client with a urinary tract infection (UTI). The client asks the nurse how long to continue taking the drug. For an uncomplicated UTI, the usual duration of norfloxacin therapy is: 1. 3 to 5 days. 2. 7 to 10 days. 3. 12 to 14 days. 4. 10 to 21 days.

2 RATIONALES: For an uncomplicated UTI, norfloxacin therapy usually lasts 7 to 10 days. Taking the drug for less than 7 days wouldn't eradicate such an infection. Taking it for more than 10 days isn't necessary. Only a client with a complicated UTI must take norfloxacin for 10 to 21 days.

When caring for a client with acute renal failure (ARF), the nurse expects the physician to adjust the dosage or dosing schedule of certain drugs. Which drug would require such adjustment? 1. Acetaminophen (Tylenol) 2. Gentamicin sulfate (Garamycin) 3. Morphine sulfate 4. Atorvastatin calcium (Lipitor)

2 RATIONALES: Gentamicin is metabolized and excreted by the kidney, so the dosage should be adjusted for clients with ARF. Acetaminophen, morphine sulfate, and atorvastatin calcium aren't metabolized and excreted by the kidney, so dosage or dosage scheduling adjustments for clients with ARF aren't needed.

A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders diagnostic tests of the vaginal discharge. Which STD must be reported to the public health department? 1. Chlamydia 2. Gonorrhea 3. Genital herpes 4. Human papillomavirus infection

2 RATIONALES: Gonorrhea must be reported to the public health department. Chlamydia, genital herpes, and human papillomavirus infection don't need to be reported to the public health department.

A client with bladder cancer has had his bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude? 1. The skin wasn't lubricated before the pouch was applied. 2. The pouch faceplate doesn't fit the stoma. 3. A skin barrier was applied properly. 4. Stoma dilation wasn't performed.

2 RATIONALES: If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn't be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn't performed with an ileal conduit, although it may be done with a colostomy if ordered.

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? 1. "Take your temperature every 4 hours." 2. "Increase your fluid intake to 2 to 3 L per day." 3. "Apply an antibacterial dressing to the incision daily." 4. "Be aware that your urine will be cherry red for 5 to 7 days."

2 RATIONALES: Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but then should disappear.

A client with an indwelling urinary catheter is suspected of having a urinary tract infection. The nurse should collect a urine specimen for culture and sensitivity by: 1. disconnecting the tubing from the urinary catheter and letting the urine flow into a sterile container. 2. wiping the self-sealing aspiration port or stopcock with antiseptic solution and aspirating urine with a sterile needle and a sterile syringe. 3. draining urine from the drainage bag into a sterile container. 4. clamping the tubing for 60 minutes and inserting a sterile needle into the tubing above the clamp to aspirate urine.

2 RATIONALES: Most catheters have a self-sealing port for obtaining a urine specimen. Antiseptic solution is used to reduce the risk of introducing microorganisms into the catheter. Tubing shouldn't be disconnected from the urinary catheter. Any break in the closed urine drainage system may allow the entry of microorganisms. Urine in the drainage bags may not be fresh and may contain bacteria, which give false test results. When there is no urine in the tubing, the catheter may be clamped for no more than 30 minutes to allow urine to collect.

The nurse is reviewing the report of a client's routine urinalysis. Which value should the nurse consider abnormal? 1. Specific gravity of 1.03 2. Urine pH of 3.0 3. Absence of protein 4. Absence of glucose

2 RATIONALES: Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal. Urine specific gravity normally ranges from 1.002 to 1.035, making this client's value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, its color ranging from pale yellow to deep amber.

The nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way? 1. Fluid intake should be double the urine output. 2. Fluid intake should be approximately equal to the urine output. 3. Fluid intake should be half the urine output. 4. Fluid intake should be inversely proportional to the urine output.

2 RATIONALES: Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. For example, fluid intake that is double the urine output indicates fluid retention; fluid intake that is half the urine output indicates dehydration. Normally, fluid intake isn't inversely proportional to the urine output.

A client with dysuria is prescribed phenazopyridine (Pyridium). The nurse should advise the client that his urine will: 1. increase in volume. 2. appear orange. 3. smell pungent. 4. be more concentrated.

2 RATIONALES: Phenazopyridine causes urine to appear orange. The drug doesn't increase urine volume or concentration and doesn't cause a pungent odor.

After having a transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded? 1. The urine in the drainage bag appears red to pink. 2. The client reports bladder spasms and the urge to void. 3. The normal saline irrigant is infusing at a rate of 50 drops/minute. 4. About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned.

2 RATIONALES: Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. After TURP, urine normally appears red to pink, and normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility protocol. The amount of returned fluid (1,200 ml) should correspond to the amount of instilled fluid, plus the client's urine output (1,000 ml + 200 ml), which reflects catheter patency.

The nurse suspects that a client with a temperature of 103.6° F (39.8° C) and an elevated white blood cell count is in the initial stage of sepsis. What is the most common cause of sepsis in hospitalized clients? 1. Respiratory infection 2. Urinary tract infection (UTI) 3. Vasculitis 4. Osteomyelitis

2 RATIONALES: Sepsis most commonly results from a UTI caused by gram-negative bacteria. Other causes of sepsis include infections of the biliary, GI, and gynecologic tracts. Respiratory infection, vasculitis, and osteomyelitis rarely cause sepsis in hospitalized clients.

Discharge teaching has been performed for a client who is being discharged with an indwelling urinary catheter. Which action by the client indicates that the teaching was successful? 1. The client clamps the drainage tubing. 2. The client holds the drainage bag below the level of the bladder. 3. The client pulls on the catheter to clear the tubing of urine. 4. The client wipes herself from back to front after moving her bowels.

2 RATIONALES: Teaching is effective when the client is seen holding the indwelling urinary catheter drainage bag below the level of the bladder. This prevents urine from flowing back into the bladder and increasing the risk of infection. The client shouldn't clamp the drainage tubing or pull on the catheter, both of which can cause complications. The client should wipe herself from front to back to decrease the risk of a urinary tract infection.

A stepfather brings a child with a fever to the emergency department. The child is crying, calling for her mother, and attempting to get out of the stepfather's arms. Upon inspection, the nurse notes that the child's underpants are stained with a bloodlike substance. Which action should the nurse take? 1. Realize that the child is exhibiting normal childhood behavior. 2. Report the suspected abuse according to facility policy. 3. Suggest that the mother bring the child to the emergency department when she's sick. 4. Explain to the child that everything is going to be all right.

2 RATIONALES: The findings suggest sexual abuse, not normal childhood behavior. Therefore, the nurse should report the suspected abuse according to facility policy. Suggesting that the mother bring the child to the emergency department doesn't address the suspected abuse. The nurse shouldn't falsely reassure the child by telling her that everything will be all right.

The nurse just received the shift report on her group of clients. Based on the information she received, which client should she assess first? 1. A client who is being discharged after breakfast 2. A client who underwent a right nephrectomy yesterday and is complaining of pain 3. A client who is awaiting a cystoscopic examination 4. A client with a temperature of 101° F (38.3° C)

2 RATIONALES: The nurse should address pain issues first. After tending to the client with pain, the nurse should assess the client who has a fever. The clients awaiting discharge or cystoscopy can be addressed next, according to their scheduling needs.

A client who returns to the surgical floor after undergoing transurethral resection of the prostate complains of pain. Which action should the nurse take first? 1. Increase the flow rate of the continuous bladder irrigation. 2. Check the client's medical record for postoperative orders. 3. Administer pain medication. 4. Increase the infusion rate of the client's I.V. fluids.

2 RATIONALES: The nurse should begin by checking the client's medical record for postoperative orders. If a physician prescribed pain medication, the nurse can administer a dose. The flow rate of the continuous bladder irrigation should be increased with a physician's order if bright red blood is draining through the indwelling urinary catheter. Increasing the flow rate helps stop postoperative bleeding and prevents the catheter from becoming occluded. There is no indication for increasing the I.V. infusion rate, and there must be a physician's order to do so.

Four days after undergoing a right nephrectomy, a client develops a methicillin-resistant Staphylococcus aureus infection in the surgical incision. A physician orders contact isolation and dressing changes 3 times daily. How should the soiled dressing be handled during dressing changes? 1. Place the dressing on the over-the-bed table; then discard it in the dirty utility room after the dressing change. 2. Discard the dressing in a biohazard bag located in the designated receptacle inside the client's room. 3. Pick the dressing up with forceps, and place it in the trash can. 4. Pick up the dressing wearing sterile gloves, and place it in the trash can.

2 RATIONALES: The nurse should discard the soiled dressing immediately in the biohazard bag that is located in a receptacle designated for infectious wastes inside the client's room. The nurse shouldn't dispose of the dressing in the dirty utility room; carrying the dressing outside the client's room might spread the infection. The dressing shouldn't be discarded in a regular trash can; doing so encourages the spread of infection.

A physician informs a client that her renal calculus is small enough that she should be able to pass it without surgical intervention. Which action should the nurse take to help the client pass the renal calculus? 1. Provide the client with fruit juices only. 2. Encourage the client to consume 3 to 4 liters of fluid a day. 3. Maintain the client on bed rest. 4. Administer I.V. fluids.

2 RATIONALES: The nurse should encourage the client to drink 3 to 4 liters of fluid a day to flush the renal calculus from the kidney. The nurse shouldn't encourage the client to limit her intake to juices because some juices contribute to renal calculi formation. The nurse should encourage to the client to ambulate. Bed rest increases the risk of renal calculi formation. The nurse can't administer I.V. fluids without a physician's order.

The nurse is inserting a urinary catheter into a client who is extremely anxious about the procedure. The nurse can facilitate the insertion by asking the client to: 1. initiate a stream of urine. 2. breathe deeply. 3. turn to the side. 4. hold the labia or shaft of penis.

2 RATIONALES: The nurse should facilitate urinary catheter insertion by asking the client to breathe deeply. Doing so will relax the urinary sphincter. Initiating a stream of urine isn't recommended during catheter insertion. Having the client turn to the side or hold the labia or penis won't ease insertion, and doing so may contaminate the sterile field.

A client tells a nurse that her ileoconduit appliance won't adhere to her skin. The nurse inspects the site and notes that the area around the stoma is red, moist, and tender to touch. How should the nurse intervene? 1. Obtain a wound culture. 2. Consult the wound-ostomy nurse. 3. Pat the site dry and apply a new appliance. 4. Apply a skin adhesive spray and then a new appliance.

2 RATIONALES: The skin is most likely excoriated from urine leaking from the appliance. The nurse should consult the wound-ostomy nurse, who can suggest care interventions. Some facilities require a physician's order to obtain a wound culture. Patting the skin dry and applying a new appliance won't address the problem with the appliance. Applying skin adhesive spray to excoriated skin will further irritate the skin and increase the client's discomfort.

When a client with an indwelling urinary catheter insists on walking to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information? 1. The client sets the drainage bag on the floor while sitting down. 2. The client keeps the drainage bag below the bladder at all times. 3. The client clamps the catheter drainage tubing while visiting with the family. 4. The client loops the drainage tubing below its point of entry into the drainage bag.

2 RATIONALES: To maintain effective drainage, the client should keep the drainage bag below the bladder; this allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldn't lay the drainage bag on the floor because it could become grossly contaminated. The client shouldn't clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the client may loop the drainage tubing above — not below — its point of entry into the drainage bag.

Which of the following clinical findings would the nurse look for in a client with chronic renal failure? 1. Hypotension 2. Uremia 3. Metabolic alkalosis 4. Polycythemia

2 RATIONALES: Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.

Which statement describing urinary incontinence in the elderly is true? 1. Urinary incontinence is a normal part of aging. 2. Urinary incontinence isn't a disease. 3. Urinary incontinence in the elderly can't be treated. 4. Urinary incontinence is a disease.

2 RATIONALES: Urinary incontinence isn't a normal part of aging nor is it a disease. It may be caused by confusion, dehydration, fecal impaction, restricted mobility, or other causes. Certain medications, including diuretics, hypnotics, sedatives, anticholinergics, and antihypertensives, may trigger urinary incontinence. Most clients with urinary incontinence can be treated; some can be cured.

The nurse is caring for a male client with gonorrhea. The client asks how he can reduce his risk of contracting another sexually transmitted disease (STD). The nurse should instruct the client to: 1. ask all potential sexual partners if they have a sexually transmitted disease. 2. wear a condom every time he has sexual intercourse. 3. consider intercourse safe if his partner has no visible discharge, lesions, or rashes. 4. expect to limit the number of sexual partners to less than five over his lifetime.

2 RATIONALES: Wearing a condom during intercourse considerably reduces the risk of contracting STDs. The other options may help reduce the risk of contracting an STD but not to the extent wearing a condom will. A monogamous relationship also reduces the risk of contracting STDs.

A client receiving total parental nutrition is prescribed a 24-hour urine test. When initiating a 24-hour urine specimen, the collection time should: 1. start with the first voiding. 2. start after a known voiding that empties the bladder. 3. always be with first morning urine. 4. always be the last evening's void as the last sample.

2 RATIONALES: When initiating a 24-hour urine specimen, have the client void, and then start timing. The collection should start on an empty bladder. The exact time the test starts isn't important, but it's commonly started in the morning.

A client with a urinary tract infection is prescribed co-trimoxazole (trimethoprim-sulfamethoxazole). The nurse should provide which medication instruction? 1. "Take the medication with food." 2. "Drink at least eight 8-oz glasses of fluid daily." 3. "Avoid taking antacids during co-trimoxazole therapy." 4. "Don't be afraid to go out in the sun."

2 RATIONALES: When receiving a sulfonamide such as co-trimoxazole, the client should drink at least eight 8-oz glasses of fluid daily to maintain a urine output of at least 1,500 ml/day. Otherwise, inadequate urine output may lead to crystalluria or tubular deposits. For maximum absorption, the client should take this drug at least 1 hour before or 2 hours after meals. No evidence indicates that antacids interfere with the effects of sulfonamides. To prevent a photosensitivity reaction, the client should avoid direct sunlight during co-trimoxazole therapy.

The nurse is caring for a patient with acute renal failure. Rank in chronological order the phases of acute renal failure. Use all the options. 1. Recovery phase 2. Initial phase 3. Oliguric phase 4. Diuretic phase

2, 3, 4, 1 RATIONALES: Patients with acute renal failure pass through the phases in the following order: initial insult, oliguric phase, diuretic phase, and recovery phase. A small percentage of patients won't progress beyond the oliguric phase and will progress to end-stage renal disease.

The nurse is collecting data on a client who has a urinary tract infection (UTI). Which statements should the nurse expect the client to make? Select all that apply: 1. "I urinate large amounts." 2. "I need to urinate frequently." 3. "It burns when I urinate." 4. "My urine smells sweet." 5. "I need to urinate urgently."

2, 3, 5 RATIONALES: Typical data collection findings for a client with a UTI include urinary frequency, burning on urination, and urinary urgency. The client with a UTI typically reports that he voids frequently in small amounts, not large amounts. The client with a UTI complains of foul-smelling, not sweet-smelling, urine.

The nurse correctly identifies a urine sample with a pH of 5.2 as being which type of solution? 1. Neutral 2. Alkaline 3. Acidic 4. Basic

3 RATIONALES: A pH of less than 7 indicates an acid solution. If the pH is 7, the solution is neutral. A pH over 7 indicates an alkaline or basic solution.

A client in the short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should: 1. keep the client's knee on the affected side bent for 6 hours. 2. apply pressure to the puncture site for 30 minutes. 3. check the client's pedal pulses frequently. 4. remove the dressing on the puncture site after vital signs stabilize.

3 RATIONALES: After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the client's knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse shouldn't remove this dressing for several hours — and only if instructed to do so.

A client with acute pyelonephritis is prescribed co-trimoxazole (Septra). Which finding best demonstrates that the client has followed the prescribed regimen? 1. Urine output increases to 2,000 ml/day. 2. Flank and abdominal discomfort decrease. 3. Bacteria are absent on urine culture. 4. The red blood cell (RBC) count is normal.

3 RATIONALES: Co-trimoxazole is a sulfonamide antibiotic used to treat urinary tract infections. Therefore, absence of bacteria on urine culture indicates that the drug has achieved its desired effect. Although flank pain may decrease as the infection resolves, this isn't a reliable indicator of the drug's effectiveness. Co-trimoxazole doesn't affect urine output or the RBC count.

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important? 1. Encouraging coughing and deep breathing 2. Promoting carbohydrate intake 3. Limiting fluid intake 4. Providing pain-relief measures

3 RATIONALES: During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

The nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: 1. hypernatremia. 2. hypokalemia. 3. hyperkalemia. 4. hypercalcemia.

3 RATIONALES: Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? 1. "Be sure to eat meat at every meal." 2. "Monitor your fruit intake, and eat plenty of bananas." 3. "Make sure to include carbohydrates in your diet." 4. "Drink plenty of fluids, and use a salt substitute."

3 RATIONALES: In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Most salt substitutes are high in potassium and should be avoided. Carbohydrates are needed to prevent protein catabolism.

Which of the following is an appropriate nursing diagnosis for a client with renal calculi? 1. Ineffective tissue perfusion 2. Functional urinary incontinence 3. Risk for infection 4. Decreased cardiac output

3 RATIONALES: Infection can occur with renal calculi from urine stasis caused by obstruction. Retention of urine usually occurs, rather than incontinence (option 2). Options 1 and 4 aren't appropriate for a client with renal calculi.

Which statement describes the therapeutic action of loop diuretics? 1. They block reabsorption of potassium on the collecting tubule. 2. They promote sodium secretion into the distal tubule. 3. They block sodium reabsorption in the ascending loop and dilate renal vessels. 4. They promote potassium secretion into the distal tubule and constrict renal vessels.

3 RATIONALES: Loop diuretics block sodium reabsorption in the ascending loop of Henle, which promotes water diuresis. They also dilate renal vessels. Loop diuretics block potassium reabsorption, but this isn't a therapeutic effect. Thiazide diuretics promote sodium secretion into the distal tubule.

Which steps should the nurse follow to insert a straight urinary catheter? 1. Create a sterile field, drape the client, clean the meatus, and insert the catheter only 6". 2. Put on gloves, prepare the equipment, create a sterile field, expose the urinary meatus, and insert the catheter 6". 3. Prepare the client and the equipment, create a sterile field, put on gloves, clean the urinary meatus, and insert the catheter until urine flows. 4. Prepare the client and the equipment, create a sterile field, test the catheter balloon, clean the meatus, and insert the catheter until urine flows.

3 RATIONALES: Option 3 describes all the vital steps for inserting a straight catheter. Option 1 is incorrect because the nurse must prepare the client and equipment before creating a sterile field. Option 2 is incorrect because the nurse put on gloves before creating a sterile field and performing the other tasks. Option 4 describes the procedure for inserting an indwelling catheter, rather than a straight catheter.

During rounds, a client admitted with gross hematuria asks the nurse about the physician's diagnosis. To facilitate effective communication, what should the nurse do? 1. Ask why the client is concerned about the diagnosis. 2. Change the subject to something more pleasant. 3. Provide privacy for the conversation. 4. Give the client some good advice.

3 RATIONALES: Providing privacy for the conversation is a form of active listening, which focuses solely on the client's needs. Asking why the client is concerned, changing the subject, or giving advice tends to block therapeutic communication.

Which of the following laboratory values supports a diagnosis of pyelonephritis? 1. Myoglobinuria 2. Ketonuria 3. Pyuria 4. Low white blood cell (WBC) count

3 RATIONALES: Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria, and bacteriuria. The client exhibits fever, chills, and flank pain. Because there is often a septic picture, the WBC count is more likely to be high rather than low. Ketonuria indicates a diabetic state.

The red blood cell (RBC) production in a client with chronic renal failure (CRF) has decreased. The nurse should monitor this client for: 1. nausea and vomiting. 2. diarrhea and hypokalemia. 3. fatigue and weakness. 4. thrush and circumoral pallor.

3 RATIONALES: RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Diarrhea, nausea, and vomiting may occur in CRF but don't result from faulty RBC production. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF. Clients with CRF commonly experience hyperkalemia, not hypokalemia.

To treat a urinary tract infection (UTI), a client is prescribed sulfamethoxazole (Gantanol), 2 g by mouth initially, and then 1 g by mouth three times daily. The nurse should teach the client that sulfamethoxazole is most likely to cause which adverse effect? 1. Anxiety 2. Headache 3. Diarrhea 4. Dizziness

3 RATIONALES: Sulfamethoxazole is most likely to cause diarrhea. Nausea and vomiting are other common adverse effects. This drug rarely causes anxiety, headache, or dizziness.

The nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: 1. limit oral fluid intake for 1 to 2 weeks. 2. report the presence of fine, sandlike particles in the nephrostomy tube. 3. notify the physician about cloudy or foul-smelling urine. 4. report bright pink urine within 24 hours after the procedure.

3 RATIONALES: The client should report the presence of foul-smelling or cloudy urine. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris in the nephrostomy tube is normal because of residual stone products. Hematuria is common after lithotripsy.

A client with suspected renal insufficiency is scheduled for a comprehensive diagnostic workup. After the nurse explains the diagnostic tests, the client asks which part of the kidney "does the work." Which answer is correct? 1. The glomerulus 2. Bowman's capsule 3. The nephron 4. The tubular system

3 RATIONALES: The nephron, the functioning unit of the kidney, includes the glomerulus, Bowman's capsule, and tubular system, which work together to form urine.

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? 1. Increased pH with decreased hydrogen ions 2. Increased serum levels of potassium, magnesium, and calcium 3. Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl 4. Uric acid analysis 3.5 mg/dl and phenolsulfonphthalein (PSP) excretion 75%

3 RATIONALES: The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl. The test results in option 3 are elevated, which reflects CRF and the kidneys' decreased ability to remove nonprotein nitrogen waste from the blood. CRF causes decreased pH and increased hydrogen ions — not vice versa. CRF also increases serum levels of potassium, magnesium, and phosphorous, and decreases serum levels of calcium. A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls with the normal range of 60% to 75%.

A nurse's neighbor complains of severe right flank pain. She explains that it began during the night, but she was able to take acetaminophen (Tylenol) and return to bed. When she awoke, the pain increased in intensity. How should the nurse intervene? 1. Explain that she can't give medical advice. 2. Inform the neighbor that she might require surgery. 3. Advise the neighbor to seek medical attention. 4. Tell the neighbor that she'll be fine because she was able to get through the night.

3 RATIONALES: The nurse should advise the neighbor to seek medical attention. Explaining that she can't give medical advice might cause a delay in treatment. It's beyond the nurse's scope of practice to suggest that the neighbor might need surgery. Telling the neighbor she'll be fine might also delay treatment, and it isn't a professional response.

Which intervention might safely prevent constipation in a client who has end-stage ovarian cancer and requires high doses of opioids to control pain? 1. Instructing the client to avoid consuming alcohol 2. Telling the client to avoid taking over-the-counter medications 3. Explaining the importance of increasing the intake of fiber and fluids 4. Informing the client that taking laxatives routinely might help

3 RATIONALES: The nurse should explain the importance of increasing the intake of fiber and fluids to prevent constipation. Avoiding alcohol won't prevent constipation; however, the client should be cautioned about its use with opioids. The client should be instructed to consult with her physician before taking over-the-counter medications. The client should also be cautioned against taking laxatives routinely because they can lead to dependency.

A client with a suspected diagnosis of renal cancer is ordered to undergo a renal biopsy to confirm the diagnosis. The client informs a nurse that she will not sign the informed consent form. Which action should the nurse take? 1. Explain the importance of signing the consent form. 2. Request that the client's husband sign the consent form. 3. Notify a physician that the client refuses to give consent. 4. Inform the client that she's delaying treatment by refusing to sign the consent form.

3 RATIONALES: The nurse should inform the physician of the client's refusal. Although the client has the right to refuse treatment, the physician should make sure that the client understands the implications so that she can make an informed decision. The nurse shouldn't try to coerce the client to sign the consent form; doing so violates the client's right to refuse treatment. The husband can't legally sign the consent form because the client hasn't been deemed incapable. The nurse should not inform the client that she's delaying treatment; instead the nurse should support the client's decision.

A 25-year-old client comes to the emergency department with her clothes torn. She has visible cuts, bruises, and profuse vaginal bleeding. A nurse suspects that this client has been raped. What should the nurse do? 1. Assist the client with bathing. 2. Apply ice packs to the bruised areas. 3. Collect forensic evidence. 4. Notify a psychiatrist who is on call.

3 RATIONALES: The nurse should notify a physician and collect forensic evidence before it's destroyed. After collecting evidence, she should assist the client with bathing and notify a rape intervention specialist or the psychiatrist who is on call. If ice packs have been prescribed, she can apply them to the bruised areas to reduce swelling.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is most appropriate for this client? 1. Sexual dysfunction 2. Toileting self-care deficit 3. Risk for infection 4. Activity intolerance

3 RATIONALES: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. Therefore, the client is at risk for infection. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. The other options may be pertinent but are secondary to the risk for infection.

Two staff nurses on the urology unit are responsible for the unit schedule. The holidays are nearing, and many staff members would like to take vacation days. Which method might fairly solve the holiday staffing problem? 1. Assign each staff member to a holiday based on seniority. 2. Explain that no one can have a holiday off. 3. Poll the staff to find out their preferences. 4. Draw names from a container to determine who can be off on the holiday.

3 RATIONALES: The staff should have the opportunity to solve their holiday staffing issues through polling them and learning their preferences. If the unit can't be adequately staffed by considering preferences, staff should be assigned. Seniority can be considered; however, the unit must be staffed with the appropriate skill mix. It isn't cost effective to have everyone work on the holiday, and it would also be detrimental to unit morale. Drawing names from a container demonstrates a lack of leadership.

The nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point would the nurse want to include? 1. Limit fluid intake to reduce the need to urinate. 2. Take medication prescribed for a UTI until the symptoms subside. 3. Notify the physician if urinary urgency, burning, frequency, or difficulty occurs. 4. Wear only nylon underwear to reduce the chance of irritation.

3 RATIONALES: Urgency, burning, frequency, and difficulty urinating are all common symptoms of a UTI. The client should notify his physician so that a microscopic urinalysis can be done and appropriate treatment can be initiated. The client should be instructed to drink 2 to 3 L of fluid per day to dilute the urine and reduce irritation of the bladder mucosa. To help prevent recurrences, the full amount of antibiotics prescribed must be taken even if the symptoms have subsided. A female client should be told to avoid scented toilet tissue and bubble baths and to wear cotton underwear, not nylon, to reduce the chance of irritation.

A client with a history of chronic cystitis comes to the outpatient clinic with signs and symptoms of this disorder. To prevent cystitis from recurring, the nurse recommends maintaining an acid-ash diet to acidify the urine, thereby decreasing the rate of bacterial multiplication. On an acid-ash diet, the client must restrict which beverage? 1. Cranberry juice 2. Coffee 3. Prune juice 4. Milk

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

During a routine examination, the nurse notes that the client seems unusually anxious. Anxiety can affect the genitourinary system by: 1. slowing the glomerular filtration rate. 2. increasing sodium resorption. 3. decreasing potassium excretion. 4. stimulating or hindering micturition.

4 RATIONALES: Anxiety may stimulate or hinder micturition. Its most noticeable effect is to cause frequent voiding and urinary urgency. However, when anxiety leads to generalized muscle tension, it may hinder urination because the perineal muscles must relax to complete micturition. Anxiety doesn't slow the glomerular filtration rate, increase sodium resorption, or decrease potassium excretion.

A client requires hemodialysis. Which of the following drugs should be withheld before this procedure? 1. Phosphate binders 2. Insulin 3. Acetaminophen 4. Cardiac glycosides

4 RATIONALES: Cardiac glycosides such as digoxin should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity. Phosphate binders, acetaminophen, and insulin can be administered because they aren't removed from the blood by dialysis.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. Which data collection finding suggests that the client is experiencing acute renal failure (ARF)? 1. Blood urea nitrogen (BUN) level of 22 mg/dl 2. Serum creatinine level of 1.2 mg/dl 3. Temperature of 100.2° F (37.8° C) 4. Urine output of 400 ml/24 hours

4 RATIONALES: Characterized by abrupt loss of kidney function, ARF commonly causes oliguria, which is demonstrated by a urine output of 400 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

The nurse is teaching a client with genital herpes. Education for this client should include an explanation of: 1. the need to use petroleum products. 2. why the disease is only transmittable when visible lesions are present. 3. the option of disregarding safer-sex practices now that he's already infected. 4. the importance of informing his partner of the disease.

4 RATIONALES: Clients with genital herpes should inform their partners of the disease. Petroleum products should be avoided because they can cause the virus to spread. The notion that genital herpes is only transmittable when visible lesions are present is false. Anyone not in a long-term, monogamous relationship, regardless of current health status, should follow safer-sex practices.

The client underwent a transurethral resection of the prostate gland 24 hours ago and has a continuous bladder irrigation. Which of the following nursing interventions is appropriate? 1. Tell the client to try to urinate around the catheter to remove blood clots. 2. Restrict fluids to prevent the client's bladder from becoming distended. 3. Prepare to remove the catheter. 4. Use aseptic technique when irrigating the catheter.

4 RATIONALES: If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. The nurse should encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is only removed with a physician's order.

A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure? 1. Poor perfusion to the kidneys 2. Damage to cells in the adrenal cortex 3. Obstruction of the urinary collecting system 4. Nephrotoxic injury secondary to use of contrast media

4 RATIONALES: Intrinsic renal failure results from damage to the kidney, such as that from nephrotoxic injury caused by contrast media, antibiotics, corticosteroids, or bacterial toxins. Poor perfusion to the kidneys may result in prerenal failure. Damage to the epithelial cells of the renal tubules results from nephrotoxic injury, not damage to the adrenal cortex. Obstruction of the urinary collecting system may cause postrenal failure.

When a client returns from the operating room after undergoing a left nephrectomy, a nurse must make sure that urine is draining through the client's indwelling urinary catheter. This assessment is important for this client because it: 1. helps determine the volume of I.V. fluid the client requires. 2. monitors bladder control. 3. prevents the client from dehydrating. 4. assesses function of the remaining kidney.

4 RATIONALES: Monitoring urine flow from the indwelling urinary catheter helps assess function of the remaining kidney. It can also help determine the client's I.V. fluid needs and thereby prevent dehydration. However, the physician is responsible for prescribing the amount of I.V. fluids appropriate to the client's needs. Bladder control can't be monitored with an indwelling urinary catheter.

A 25-year-old female client seeks care for a possible urinary tract infection (UTI). Her symptoms include burning on urination and frequent, urgent voiding of small amounts of urine. She's placed on trimethoprim-sulfamethoxazole (Bactrim) to treat the possible infection. Another medication is prescribed to decrease the client's pain and frequency. Which of the following is most likely the second medication prescribed? 1. Nitrofurantoin (Macrodantin) 2. Ibuprofen (Motrin) 3. Acetaminophen with codeine 4. Phenazopyridine (Pyridium)

4 RATIONALES: Phenazopyridine may be prescribed in conjunction with an antibiotic for painful bladder infections to promote comfort. Because of its local anesthetic action on the urinary mucosa, phenazopyridine specifically relieves bladder pain. Nitrofurantoin is a urinary antiseptic with no analgesic properties. Although ibuprofen and acetaminophen with codeine are analgesics, they don't exert a direct effect on the urinary mucosa.

A client with a history of heart failure is found to have a cystocele. When planning care for this client, the nurse is likely to formulate which nursing diagnosis? 1. Total urinary incontinence 2. Functional urinary incontinence 3. Reflex urinary incontinence 4. Stress urinary incontinence

4 RATIONALES: Stress urinary incontinence is a urinary problem associated with cystocele — herniation of the bladder into the vagina. Other problems associated with this disorder include urinary frequency, urinary urgency, urinary tract infection (UTI), and difficulty emptying the bladder. Total incontinence, functional incontinence, and reflex incontinence usually result from neurovascular dysfunction, not cystocele.

The nurse is collecting data on a male client diagnosed with gonorrhea. Which symptom likely prompted the client to seek medical attention? 1. Rashes on the palms of the hands and soles of the feet 2. Cauliflower-like warts on the penis 3. Painful red papules on the shaft of the penis 4. Foul-smelling discharge from the penis

4 RATIONALES: Symptoms of gonorrhea in men include purulent, foul-smelling discharge from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.

A client who returned from a cystoscopic examination complains of pain while attempting to void. Which intervention should a nurse suggest to ease the client's pain while attempting to void? 1. Drink plenty of fluids. 2. Pour water over the perineal area. 3. Run water in the bathroom sink. 4. Sit in a warm sitz bath.

4 RATIONALES: The best intervention is for the client to sit in a warm sitz bath when trying to void. Warm water relieves pain and increases circulation to the perineal area and relaxes the muscles, which helps start the voiding process. Drinking plenty of fluids will hydrate the kidneys and cause the client to make more urine. Pouring water over the perineal area will stimulate the client to urinate. Running water in the bathroom sink will also stimulate the client to void but does not address the client's pain.

A client is frustrated and embarrassed by urinary incontinence. Which of the following measures should the nurse include in a bladder retraining program? 1. Establishing a predetermined fluid intake pattern for the client 2. Encouraging the client to increase the time between voidings 3. Restricting fluid intake to reduce the need to void 4. Assessing present elimination patterns

4 RATIONALES: The guidelines for initiating bladder retraining include assessing the client's intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should actually be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

A nurse-manager on the urology unit tells the staff that supplies have been disappearing at an alarming rate. A staff nurse has been assigned to monitor supply use. Which method can best help the nurse monitor supply use? 1. Limit the supplies allocated each day. 2. Provide each staff member with a daily allocation of supplies. 3. Inventory the supplies as they are brought to the unit. 4. Compare charge slips for supplies used against the inventory left in the supply room every 24 hours.

4 RATIONALES: The nurse can best monitor supply use by comparing charges for those items that were used against the supplies that remain in the supply room. This reconciliation should be performed every 24 hours. If supplies aren't adequately charged, the nurse should follow-up immediately with staff members to see which supplies were used without being charged. Inventorying supplies as they arrive on the unit doesn't help account for their use. Supplies should be allocated based on the client's needs; they shouldn't be limited. Staff members shouldn't be allocated supplies individually; supplies should be allocated for the floor based on client needs.

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? 1. Blood pressure 2. Respirations 3. Temperature 4. Cardiac rhythm

4 RATIONALES: The nurse should assess the client's cardiac rhythm using electrocardiography because an elevated serum potassium level may lead to a life-threatening cardiac arrhythmia. The client's blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also can delay assessing respirations and temperature because these aren't affected by the serum potassium level.

A client diagnosed with renal calculi is experiencing severe pain despite having received pain medication. A nurse pages a physician. Which intervention can the nurse perform while awaiting the physician's response? 1. Assist the client to ambulate in the hallway. 2. Explain that the client can't safely take any more pain medication. 3. Provide the client with a heating pad. 4. Perform nonpharmacologic pain interventions.

4 RATIONALES: The nurse should institute nonpharmacologic pain measures to help control the client's pain until the physician responds. These include repositioning, massage, and distraction. A client experiencing severe pain will most likely be able to tolerate a higher dose of pain medication. Although ambulation is sometimes effective in mobilizing renal calculi, the client is most likely experiencing too much pain to ambulate at this time. The nurse can't apply a heating pad without a physician's order.

A female client with a history of four urinary tract infections (UTIs) in the past 3 months comes to the urology clinic complaining of burning and urinary urgency and frequency. A physician makes the diagnosis of UTI. Which instruction should the nurse give the client to help prevent recurring infections? 1. Increase the intake of carbonated beverages. 2. Change laundry detergents frequently. 3. Take antibiotics until symptoms abate. 4. Wipe the perineal area from front to back.

4 RATIONALES: The nurse should reinforce the importance of good hygiene practices, such as wiping the perineal area from front to back for a client with a UTI. Consuming carbonated beverages should be discouraged. Instead the client should be encouraged to drink plenty of water to maintain adequate hydration. Drinking cranberry juice should also be encouraged because it helps promote urine acidity, which inhibits bacterial growth. The client should also be cautioned against changing laundry detergents frequently. Some laundry detergents cause irritation, which might place the client at risk for a UTI. The client should be instructed to complete the entire course of antibiotics even after symptoms abate, to prevent another infection.

The nurse is completing an intake and output record for a client who is receiving continuous bladder irrigation after transurethral resection of the prostate. How many milliliters of urine should the nurse record as output for her shift if the client received 1,800 ml of normal saline irrigating solution and the output in the urine drainage bag is 2,400 ml?

600mL RATIONALES: To calculate urine output, subtract the amount of irrigation solution infused into the bladder from the total amount of fluid in the drainage bag.

The nurse is caring for a client with a cystostomy for urine drainage. Identify the area where the nurse should check for cystostomy placement.

In a cystostomy, a catheter is inserted percutaneously through the suprapubic area into the bladder.

A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign highest priority to which nursing diagnosis? 1. Acute pain 2. Risk for infection 3. Deficient knowledge related to medication regimen 4. Imbalanced nutrition: Less than body requirements

1 RATIONALES: Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of Acute pain takes highest priority. Diagnoses of Risk for infection and Deficient knowledge related to medication regimen are appropriate when the client's pain is controlled. A diagnosis of Imbalanced nutrition: Less than body requirements isn't pertinent at this time.

The nurse is teaching a client how to collect a 24-hour urine specimen for creatinine clearance. Which of the following directions should the nurse give the client? Select all that apply: 1. "Save the first voiding and record the time." 2. "Discard the first voiding and record the time." 3. "Clean the perineal area before each voiding." 4. "Refrigerate the urine sample or keep it on ice." 5. "At the end of 24 hours, void and save the urine." 6. "At the end of 24 hours, void and discard the urine."

2, 4, 5 RATIONALES: When collecting a 24-hour urine sample, the client should void, discard the urine, and record the time. This assures that the client starts the collection period with an empty bladder. At the end of the 24-hour collection period, the client should void and save the urine. The first voiding isn't used because it isn't known how long the urine has been in the bladder. The urine sample should be refrigerated or kept on ice to keep it fresh. The perineum should be cleaned before obtaining a clean-catch urine specimen for culture and sensitivity. It isn't necessary to clean the perineum for a 24-hour urine sample.

The nurse is collecting a sterile urine sample for culture and sensitivity from an indwelling urinary catheter. Identify the area on the indwelling urinary catheter where the nurse should insert the sterile syringe to obtain the urine sample.

A sterile urine specimen is obtained from an indwelling urinary catheter by clamping the catheter briefly, cleaning the rubber port with an alcohol wipe, and using a sterile syringe and needle to withdraw the urine.

A client develops acute renal failure (ARF) after receiving an I.V. nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for: 1. hyperkalemia. 2. paresthesia. 3. dehydration. 4. hypokalemia.

1 RATIONALES: As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. ARF doesn't cause paresthesia (sensations of numbness and tingling). Dehydration doesn't occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase.

Which factor can lead to the formation of renal calculi? 1. Hypocalcemia 2. Heart failure 3. Hypothyroidism 4. Alkaline urine

4 RATIONALES: Urine that's consistently alkaline produces a medium for renal calculi formation. Hypercalcemia, not hypocalcemia, also places the client at risk. Heart failure and hypothyroidism don't place the client at risk for renal calculi formation.