Genitourinary Disorders NCLEX 3000
A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?
"Increase your fluid intake to 2 to 3 L per day."
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?
"It must be difficult for you not to know the results of your test."
(SELECT ALL THAT APPLY) 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?
(2) "I need to urinate frequently.", (3) "It burns when I urinate.", (5) "I need to urinate urgently."
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.
(2) Initial insult, (3) Oliguric Phase, (4) Diuretic Phase, (1) recovery phase
(SELECT ALL THAT APPLY) 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?
(2), "Discard the first voiding and record the time.", (4) "Refrigerate the urine sample or keep it on ice.", (5) "At the end of 24 hours, void and save the urine."
Which factor can lead to the formation of renal calculi?
Alkaline urine
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?
Allow her to have a piece of hard candy.
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?
Compare charge slips for supplies used against the inventory left in the supply room every 24 hours.
Which laboratory test is the most accurate indicator of a client's renal function?
Creatinine clearance
When performing a scrotal examination, the nurse finds a nodule. What should the nurse do next?
Notify the physician.
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?
Phenazopyridine (Pyridium)
Which steps should the nurse follow to insert a straight urinary catheter?
Prepare the client and the equipment, create a sterile field, put on gloves, clean the urinary meatus, and insert the catheter until urine flows.
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?
Provide privacy for the conversation.
Which of the following laboratory values supports a diagnosis of pyelonephritis?
Pyuria
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?
Sit in a warm sitz bath.
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?
Stress urinary incontinence
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?
The client reports bladder spasms and the urge to void.
A client is admitted with a diagnosis of acute renal failure. The nurse should monitor closely for:
drug toxicity.
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:
epoetin alfa (Epogen)
The red blood cell (RBC) production in a client with chronic renal failure (CRF) has decreased. The nurse should monitor this client for:
fatigue and weakness.
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:
hyperkalemia
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:
recent streptococcal infection.
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:
retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.
A client receiving total parental nutrition is prescribed a 24-hour urine test. When initiating a 24-hour urine specimen, the collection time should:
start after a known voiding that empties the bladder.
During a routine examination, the nurse notes that the client seems unusually anxious. Anxiety can affect the genitourinary system by:
stimulating or hindering micturition.
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?
The pouch faceplate doesn't fit the stoma.
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?
Urinary tract infection (UTI)
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)?
Urine output of 400 ml/24 hours
The nurse is reviewing the report of a client's routine urinalysis. Which value should the nurse consider abnormal?
Urine pH of 3.0
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?
Use aseptic technique when irrigating the catheter.
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?
Verify the client's identity.
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?
Encourage the client to consume 3 to 4 liters of fluid a day.
A client with a urinary tract infection is prescribed co-trimoxazole (trimethoprim-sulfamethoxazole). The nurse should provide which medication instruction?
"Drink at least eight 8-oz glasses of fluid daily."
A client is frustrated and embarrassed by urinary incontinence. Which of the following measures should the nurse include in a bladder retraining program?
Assessing present elimination patterns
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.
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important?
Limiting fluid intake
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding signals a significant problem during this procedure?
White blood cell (WBC) count of 20,000/mm3
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:
assesses function of the remaining kidney.
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:
continuous inflow and outflow of irrigation solution.
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:
weight loss.
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:
wiping the self-sealing aspiration port or stopcock with antiseptic solution and aspirating urine with a sterile needle and a sterile syringe.
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?
"Make sure to include carbohydrates in your diet."
Which of the following is an appropriate nursing diagnosis for a client with renal calculi?
Risk for 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?
600
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:
7 to 10 days.
The nurse just received the shift report on her group of clients. Based on the information she received, which client should she assess first?
A client who underwent a right nephrectomy yesterday and is complaining of pain
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)?
Maintaining a closed indwelling urinary catheter system and securing the catheter to the leg
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.
The nurse correctly identifies a urine sample with a pH of 5.2 as being which type of solution?
Acidic
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?
Acute pain
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?
Advise the neighbor to seek medical attention.
A client with acute pyelonephritis is prescribed co-trimoxazole (Septra). Which finding best demonstrates that the client has followed the prescribed regimen?
Bacteria are absent on urine culture.
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?
Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl
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?
Milk
A client requires hemodialysis. Which of the following drugs should be withheld before this procedure?
Cardiac glycosides
A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first?
Cardiac rhythm
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?
Check the client's medical record for postoperative orders.
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?
Collect forensic evidence.
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?
Consult the wound-ostomy nurse.
A client reports experiencing vulvar pruritus. Which finding may indicate that the client has an infection caused by Candida albicans?
Cottage cheese-like discharge
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?
Diarrhea
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?
Discard the dressing in a biohazard bag located in the designated receptacle inside the client's room.
The nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence?
Encouraging intake of at least 2 L of fluid daily
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?
Explain that although she is a friend of the client, the nurse can't violate client confidentiality.
Which intervention might safely prevent constipation in a client who has end-stage ovarian cancer and requires high doses of opioids to control pain?
Explaining the importance of increasing the intake of fiber and fluids
The nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way?
Fluid intake should be approximately equal to the urine output.
The nurse is collecting data on a male client diagnosed with gonorrhea. Which symptom likely prompted the client to seek medical attention?
Foul-smelling discharge from the penis
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?
Gentamicin sulfate (Garamycin)
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?
Gonorrhea
The nurse is caring for a client with acute pyelonephritis. Which nursing intervention is most important?
Increasing fluid intake to 3 L/day
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?
Kidney
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?
Nephrotoxic injury secondary to use of contrast media
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?
Notify a physician that the client refuses to give consent.
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?
Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.
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?
Perform nonpharmacologic pain interventions.
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?
Poll the staff to find out their preferences.
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?
Report the suspected abuse according to facility policy.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is most appropriate for this client?
Risk for infection
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?
The charge nurse performs treatments and supervises staff, the LPN administers medications and assists with care, and the nursing assistants provide direct client care.
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?
The client holds the drainage bag below the level of the bladder.
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?
The client keeps the drainage bag below the bladder at all times.
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?
The left kidney usually is slightly higher than the right one.
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?
The nephron
Which statement describes the therapeutic action of loop diuretics?
They block sodium reabsorption in the ascending loop and dilate renal vessels.
A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?
This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.
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?
Transurethral resection of the prostate (TURP)
Which of the following clinical findings would the nurse look for in a client with chronic renal failure?
Uremia
Which statement describing urinary incontinence in the elderly is true?
Urinary incontinence isn't a disease.
Which of the following is a function of antidiuretic hormone (ADH)?
Water reabsorption and urine concentration
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?
Wipe the perineal area from front to back.
A client with dysuria is prescribed phenazopyridine (Pyridium). The nurse should advise the client that his urine will:
appear orange.
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:
breathe deeply.
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:
check the client's pedal pulses frequently.
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:
generalized edema, especially of the face and periorbital area.
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:
hyperkalemia.
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:
notify the physician about cloudy or foul-smelling urine.
The nurse is teaching a client with genital herpes. Education for this client should include an explanation of:
the importance of informing his partner of the disease.
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
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:
wear a condom every time he has sexual intercourse.