Renal/ Urologic Disorder Nursing Care of Clients with Urinary Incontinence ➱ Nursing Care of Clients with Infectious and Infl ammatory Urologic Disorders ➱ Nursing Care of Clients with Renal Failure ➱ Nursing Care of Clients with Urologic Obstructions ➱

To gather more information about symptoms associated with benign prostatic hypertrophy (BPH), which question is most important to ask next? [ ] 1. "Have you noticed any changes in sexual function?" [ ] 2. "Have you felt any lumps in your scrotum recently?" [ ] 3. "Do you have difficulty starting to void?" [ ] 4. "Do you have problems controlling urination?"

"Do you have difficulty starting to void?" Because of obstruction of the urethra from an enlarging prostate gland, men with benign prostatic hypertrophy (BPH) often describe hesitancy when initiating urination. In other words, they feel the need to urinate but it takes some time before urine is released. The stream of urine is also diminished.

If the client makes the following statements, which information is most important to report to the physician before the client undergoes an intravenous pyelography (IVP)? [ ] 1. "The barium they give me to drink causes me to have constipation." [ ] 2. "I have a low tolerance for pain during p rocedures." [ ] 3. "I had a reaction when my gallbladder was X-rayed before." [ ] 4. "I get claustrophobic when I am put into that big round machine."

"I had a reaction when my gallbladder was X-rayed before." A history of a previous allergic reaction to radiopaque dye indicates the client is at risk for a similar episode. The physician may prescribe a corticosteroid or antihistamine before the test to reduce the potential for an allergic reaction.

Which statements made by a diabetic client at the clinic strongly suggest that the client has a urinary tract infection? Select all that apply. [ ] 1. "I need to urinate frequently." [ ] 2. "I can't hold my urine." [ ] 3. "I have a burning sensation when I urinate." [ ] 4. "I have itching in my perineal area." [ ] 5. "I pass a large quantity of urine." [ ] 6. "My urine is foul-smelling."

"I need to urinate frequently." "I have a burning sensation when I urinate." "My urine is foul-smelling." The client with a urinary tract infection (UTI) typically reports symptoms of urinary frequency, burning on urination, urinary urgency, and concentrated, foul-smelling urine. The client might also report passing a small amount of urine with each frequent voiding.

An older man makes an appointment with a physician concerning urinary symptoms he has been experiencing. When the office nurse obtains the client's history, which statements provides the best indications that the client has benign prostatic hypertrophy (BPH)? Select all that apply. [ ] 1. "There is some burning when I urinate." [ ] 2. "I wake up each night needing to urinate." [ ] 3. "I feel pressure in my back before voiding." [ ] 4. "My urine is almost colorless, like water." [ ] 5. "My urine stream is really thin and narrow." [ ] 6. "I dribble for several minutes after I urinate."

"I wake up each night needing to urinate." "My urine stream is really thin and narrow." "I dribble for several minutes after I urinate." Benign prostatic hypertrophy (BPH) is the enlargement of the prostate. The prostate gland encircles the male urethra like a donut. As the gland enlarges, the client notices that it takes more effort to void, and the urinary stream becomes narrower. Nocturia, being awakened by a need to urinate, is a common finding among clients with BPH. Burning on urination is more likely a sign of a bladder infection, which could be secondary to BPH. "I wake up each night needing to urinate."

The client is scheduled for extracorporeal shock wave lithotripsy (ESWL) to pulverize the stone. After the nurse explains the ESWL procedure to the client, which statements provide the best evidence that the client understands the scheduled procedure? Select all that apply. [ ] 1. "I'll be placed on a fluid-filled pillow." [ ] 2. "Radiation will be focused on my bladder." [ ] 3. "A laser beam will be aimed at my kidneys." [ ] 4. "I'll experience a tingling sensation." [ ] 5. "I cannot eat or drink anything before the test." [ ] 6. "I will have general anesthesia for the test."

"I'll be placed on a fluid-filled pillow." "I cannot eat or drink anything before the test." Extracorporeal shock wave lithotripsy (ESWL) is a procedure that is performed while the client's lower body is submerged in a tank of water or surrounded by a fluid-filled pillow. The client is not allowed to eat or drink anything several hours before the procedure.

The physician prescribes estradiol (Estrace) for the client after the prostatectomy. Which statement by the client provides the best evidence that he understands the potential side effects associated with hormonal therapy? Select all that apply. [ ] 1. "My breasts may enlarge." [ ] 2. "I may have spontaneous erections." [ ] 3. "My sperm count will be higher." [ ] 4. "I'll have strong sexual urges." [ ] 5. "My voice may become higher." [ ] 6. "I may have a rapid weight gain."

"My breasts may enlarge." "My voice may become higher." Men with advanced prostate cancer are candidates for hormone therapy. Hormone therapy involving estrogens may be prescribed to slow the progression of the malignancy. Men who receive estrogen therapy are prone to developing feminizing characteristics, such as a high voice, breast enlargement, breast tenderness, and testicular atrophy. An alternative approach is to remove both testicles to reduce the production of testosterone. The other effects do not occur as a result of estrogen hormone therapy in males.

Which statements made by the client's spouse most closely correlate with the diagnosis of acute glomerulonephritis? Select all that apply. [ ] 1. "My spouse's face looks rather puffy lately." [ ] 2. "Recently my spouse has been quite forgetful." [ ] 3. "My spouse has been salting food heavily." [ ] 4. "It seems that my spouse sleeps quite poorly." [ ] 5. "My spouse hasn't been eating very well." [ ] 6. "My spouse gets up at night to use the bathroom."

"My spouse's face looks rather puffy lately." "My spouse hasn't been eating very well." "My spouse gets up at night to use the Glomerulonephritis is an inflammatory condition that causes significant kidney damage. More than half of the clients are asymptomatic or have vague symptoms that they feel do not require medical attention. Family members often notice that the face of a person with glomerulonephritis appears pale and puffy. Other symptoms include poor appetite, nocturia, hematuria, ankle edema, and hypertension.

An ileal conduit will be created to facilitate urine elimination. 85. When the client asks the nurse to clarify the surgeon's explanation of the procedure, which statement is most accurate? [ ] 1. "Your urine will be deposited in your small intestine." [ ] 2. "Urine will be eliminated with stool from the rectum." [ ] 3. "Urine will drain from an abdominal opening." [ ] 4. "Your urine will empty from a special catheter."

"Urine will drain from an abdominal opening." An ileal conduit, or ileal loop procedure, involves implanting the ureters into a section of the ileum that has been removed from the small intestine. The section of ileum is fashioned into a stoma that opens onto the abdomen, from which urine will drain. When a ureterosigmoidostomy is performed, the ureters are attached to the sigmoid colon and urine is eliminated with stool by way of the rectum.

The nurse receives orders to provide continuous bladder irrigation (CBI) through a three-way catheter after the client undergoes a transurethral resection of the prostate (TURP).As the nurse instructs the client about CBI, which information should the nurse provide? Select all that apply. [ ] 1. "You may feel the urge to urinate even though the bladder is empty." [ ] 2. "Do not to try to urinate around the catheter, because this will cause bladder spasms." [ ] 3. "You need to limit your fluids to 4 glasses per day." [ ] 4. "It is normal for the urine to be bloody immediately after surgery." [ ] 5. "The catheter will be removed in about a week." [ ] 6. "By the time you are ready to go home, your urine should be pink with a few clots."

"You may feel the urge to urinate even though the bladder is empty." "Do not to try to urinate around the catheter, "It is normal for the urine to be bloody immediately after surgery." Bladder irrigation is the process of flushing the bladder to prevent or treat clot formation after a transurethral resection of the prostate (TURP). Bladder irrigation may also be used to instill medications such as antibiotics for treating bladder infections. Bladder irrigation is done over a period of time and runs continuously, instilling normal saline solution hung from an I.V. pole through one lumen of the urinary catheter. Instructing the client that it is normal to feel the urge to urinate even though the bladder is empty is an appropriate nursing action

When applying an external catheter to a male client, which action by the nurse is correct? [ ] 1. Lubricate the penis before applying the catheter. [ ] 2. Measure the length and circumference of the penis. [ ] 3. Leave space between the end of the penis and the catheter's drainage end. [ ] 4. Retract the foreskin before rolling the catheter sheath over the penis.

. 3. Allowing space between the end of the penis and the drainage end of the catheter helps prevent irritation to the urinary meatus and promotes urine drainage. External catheters are similar to latex condoms; they stretch to fit; therefore, measuring the penis is unnecessary. The foreskin of an uncircumcised man is never left in a retracted position because it could have a tourniquet effect and interfere with circulation of blood to the tissue.

When asked about factors that are linked to bladder cancer, the nurse correctly identifies which factors? Select all that apply. [ ] 1. Stress incontinence [ ] 2. Frequent intercourse [ ] 3. Sexual promiscuity [ ] 4. Cigarette smoking [ ] 5. History of prostate cancer [ ] 6. Exposure to asbestos

.There is a correlation between cigarette smoking, even passive exposure to cigarette smoke, and the development of bladder cancer. Other carcinogenic factors include long-term exposure to chemical solvents and dyes, but exposure to asbestos is related to cancer of the lung, not the bladder. Because of the proximity of the prostate gland to the bladder, clients who have been diagnosed with prostate cancer are at higher risk for cancer of the bladder.

When teaching a client with cystitis about urinary tract irritants, the nurse correctly identifies which of the following substances as potential irritants to avoid? Select all that apply. [ ] 1. Alcohol [ ] 2. Milk [ ] 3. Tea [ ] 4. Chocolate [ ] 5. Coffee [ ] 6. Pears

1, 3, 4, 5. Alcohol, tea, chocolate, and coffee are all urinary irritants. Urinary irritants may exacerbate such conditions as interstitial cystitis. Possible substitutes include apricots, pears, papaya juice, herbal tea, and carob.

Which nursing assessment is most important before beginning bladder retraining for this client? [ ] 1. Recording the times at which the client is incontinent [ ] 2. Checking the specific gravity of the urine [ ] 3. Monitoring the extent of bladder distention [ ] 4. Weighing the client's incontinence pad

1. Recording the times at which the client is incontinent Keeping an incontinence log helps the nurse identify patterns in the frequency of urination. The data are then used to schedule toilet activities to correspond to the filling and emptying patterns demonstrated by the client.

After inserting an indwelling catheter into a male client, which technique is most appropriate for stabilizing the catheter to avoid damage to the penis? [ ] 1. Tape the catheter to the abdomen. [ ] 2. Pass the catheter under the client's leg. [ ] 3. Fasten the drainage tubing to the bed with a safety pin. [ ] 4. Insert the catheter into the tubing of a collecting bag.

1. Tape the catheter to the abdomen. Anchoring the indwelling catheter to the abdomen and allowing for slack before taping eliminates pressure and irritation at the penoscrotal angle. Pressure in this area predisposes to fistula formation. The catheter and tubing are passed over a client's leg to prevent obstruction of drainage from body weight.

If this client's condition is similar to that of others in the oliguric phase of renal failure, the nurse would anticipate the client's urine output to be within what range? [ ] 1. 50 to 100 mL/hour [ ] 2. 100 to 150 mL/hour [ ] 3. 500 to 1,000 mL/day [ ] 4. 100 to 500 mL/day

100 to 500 mL/day Normal urine output is between 1,000 and 2,000 mL/day. The first stage of renal failure is generally characterized by oliguria—that is, a urine output of less than 500 mL in 24 hours. The nurse would expect to note a diuretic phase following a period of oliguria or anuria as the client's condition improves.

A client comes to the emergency department for relief from severe, stabbing, colicky flank pain. The physician makes a tentative diagnosis of urolithiasis. When the nurse examines the voided urine specimen, which finding is most supportive of the diagnosis of urolithiasis? [ ] 1. Cloudy pale urine [ ] 2. Blood-tinged urine [ ] 3. Light yellow urine [ ] 4. Strong-smelling urine

BLOOD-TINGED URINE Urolithiasis refers to stones that form in the kidneys or urinary tract. Stones are usually made of mineral salts that typically are dissolved in the urine. Stones may be smooth, jagged, or staghorn-shaped. Gross or microscopic hematuria (blood-tinged urine) is more characteristic of trauma from a moving urinary stone than cloudy, light yellow, or strong-smelling urine.

The nurse is caring for another client with renal failure who is being treated with peritoneal dialysis. Which assessment before and after peritoneal dialysis is most valuable in evaluating the outcome of treatment? [ ] 1. Pulse rate [ ] 2. Body weight [ ] 3. Abdominal girth [ ] 4. Urine output

BODY WEIGHT Peritoneal dialysis is a method of filtering fluid, wastes, and chemicals from the body using the peritoneum, the semipermeable lining of the abdomen. Along with measuring the volume of infused and drained dialysis solution, comparing the client's weight before and after the procedure provides the best objective data for evaluating the outcome of peritoneal dialysis.

Which medication is most appropriate to administer to the client who is having bladder spasms? [ ] 1. Aspirin by mouth [ ] 2. Acetaminophen (Tylenol) by mouth [ ] 3. Meperidine hydrochloride (Demerol) intramuscularly [ ] 4. Belladonna and opium (B&O) rectal suppository

Belladonna and opium (B&O) rectal suppositories are considered the most effective drug for relieving bladder spasms after transurethral resection of the prostate (TURP). The belladonna component relaxes smooth muscles in the bladder, and the opium is a centrally acting analgesic. Aspirin is avoided because it increases the tendency to bleed. Meperidine (Demerol) is a synthetic opioid analgesic. Opioids alone do not lessen the spasms but may decrease the pain. Acetominophen is better for mild pain.

When the nurse reviews the results of the client's urinalysis, which substance in the urine is most suggestive of a bladder infection? [ ] 1. Glucose [ ] 2. Blood [ ] 3. Bilirubin [ ] 4. Protein

Blood. Infectious and inflammatory conditions affecting the urinary tract are accompanied by blood and pus in the urine, which may be grossly visible or microscopic. Glucose in the urine may be caused by a metabolic problem such as diabetes mellitus. Liver and gallbladder disorders are evidenced by the presence of bilirubin in the urine.

When the nurse interviews the client, which symptoms will the client most likely report if a bladder infection has been acquired? Select all that apply. [ ] 1. Sharp flank pain [ ] 2. Urethral discharge [ ] 3. Strong-smelling urine [ ] 4. Burning on urination [ ] 5. Urgency [ ] 6. Frequency

Burning on urination , Urgency , Frequency . One of the classic symptoms of a urinary tract infection (cystitis) is pain or burning on urination. Other symptoms include urinary frequency and urgency. The client's urine may contain white blood cells, causing it to appear cloudy, but a purulent discharge is not a common complaint. Although the urine may develop an odor depending on bacterial growth and amount of urine retained, clients do not commonly report this finding.

Several days after the client's procedure, the physician removes the catheter from the abdominal incision.Which nursing intervention is most important to add to the client's care plan after removal of the suprapubic catheter? [ ] 1. Check the client's urine specific gravity every shift. [ ] 2. Measure the client's abdominal girth daily. [ ] 3. Change wet abdominal dressings as needed. [ ] 4. Perform a credé maneuver every 4 hours.

Change wet abdominal dressings as needed. After a suprapubic catheter is removed, urine may leak from the incisional area and saturate the sterile dressing. A wet dressing provides a wicking action by which microorganisms are attracted in the direction of the impaired tissue. A dressing saturated with urine also leads to skin breakdown. Checking the specific gravity is important only if fluid status is a concern but is not related to removal of the suprapubic catheter.

Which nursing assessment is most important to perform regularly when a client has an arteriovenous fistula? [ ] 1. Checking the color and temperature of the client's hand [ ] 2. Monitoring the client's wrist and finger range of motion [ ] 3. Observing the tone and coordination of the client's arm muscles [ ] 4. Inspecting the client's forearm skin turgor

Checking the color and temperature of the client's hand An arteriovenous fistula is a surgical procedure connecting an artery and vein located in the forearm. When dialysis is needed, two venipunctures are performed at either end of the fistula. The color and temperature of the hands are assessed regularly for signs of inadequate circulation. Blood clots may form in the joined vessels and occlude tissue perfusion.

Which menu choice is best for the nurse to recommend? [ ] 1. Hot dog with potato salad [ ] 2. Beef bouillon and crackers [ ] 3. Chicken breast on lettuce [ ] 4. Cheese pizza with thin crust

Chicken breast on lettuce is the menu item that contains the least amount of sodium among the options provided. Processed meats are highly salted

Immediately after the dialysate solution has been instilled, which nursing action is correct? [ ] 1. Clamping the tubing from the infusion [ ] 2. Draining the infused dialysate solution [ ] 3. Restricting the client's movement as much as possible [ ] 4. Encouraging the client to drink fluids

Clamping the tubing from the infusion The dialysate infusion tubing is clamped, usually for 15 to 45 minutes, to allow osmosis and diffusion to take place between the dialysate and the peritoneum. The peritoneal cavity is then drained after the dwell time. The client is free to ambulate, change positions, or remain in bed during peritoneal dialysis. The amount of activity depends on the client's safety needs.

When the client with cystitis has difficulty visualizing the urinary tract, the nurse shows the client a diagram that includes all the primary structures involved. Identify with an X on the diagram the area of inflammation associated with the client's cystitis. A female paraplegic client is being taught to catheterize herself before being discharged from the rehabilitation unit.

Cystitis is an inflammation of the urinary bladder It is usually caused by a bacterial infection.

Concentrated urine has a strong odor, but this usually does not occur among those with cystitis.

Cystitis.

Before peritoneal dialysis begins, the nurse correctly informs the client that the procedure involves the movement of urea and creatinine through the peritoneum by means of which force? [ ] 1. Osmosis [ ] 2. Diffusion [ ] 3. Filtration [ ] 4. Gravity

DIFFUSION In peritoneal dialysis, the peritoneum serves as a semipermeable membrane. Urea and creatinine, metabolic end products normally excreted by the kidneys, are cleared from the blood by diffusion as the waste products move from an area of higher concentration (the peritoneal blood supply) to an area of lower concentration (the peritoneal cavity). Osmosis, also helpful in the dialysis process, is the movement of water through the semipermeable membrane.

When the nurse mistakenly inserts the catheter into the client's vagina rather than the urinary meatus, which action is best to take next? [ ] 1. Wipe the catheter tip with an alcohol swab. [ ] 2. Clean the catheter tip with povidone-iodine solution (Betadine). [ ] 3. Discard the catheter and use another sterile one. [ ] 4. Withdraw the catheter and insert it in the urethra.

Discard the catheter and use another sterile one. The urinary tract is a sterile environment; therefore, a contaminated catheter should be discarded and a new one obtained before proceeding with the catheterization. Wiping the contaminated catheter with an alcohol swab or cleaning it with povidone-iodine (Betadine) solution will not ensure sterility. If the catheter contaminated from the vagina is reinserted into the urethra, pathogens may be transferred to the urinary tract.

Which nursing instruction is most appropriate for preventing crystal formation in this client's urine? [ ] 1. Eat more acidic citrus fruits. [ ] 2. Avoid carbonated soft drinks. [ ] 3. Drink 3 quarts (3 L) of water daily. [ ] 4. Take the medication with food.

Drink 3 quarts (3 L) of water daily. Clients who take sulfonamides such as trimethoprim and sulfamethoxazole (Bactrim) can reduce the risk of developing crystalluria by consuming 3 to 4 quarts (3 to 4 L) of fluid per day. Water is preferred for a diabetic client because it is calorie-free. Sulfonamides are best taken on an empty stomach unless gastric irritation occurs.

Which recommendations by the nurse are most effective in reducing bacterial growth in a female client's bladder? Select all that apply. [ ] 1. Drink a large quantity of fluids. [ ] 2. Change underclothing each day. [ ] 3. Avoid the use of public restrooms. [ ] 4. Use only white toilet tissue. [ ] 5. Urinate after having sexual intercourse. [ ] 6. Drink fluids that are highly acidic.

Drink a large quantity of fluids. Urinate after having sexual intercourse. A large intake of fluids promotes frequent urinary elimination, which causes pathogens to pass out of the bladder with the urine. Decreasing the number of pathogens present in the urinary tract reduces their growth rate. Voiding after intercourse is important to flush the bacteria out of the urethra that may have entered during intercourse.

After the cystoscopy, which urinary symptom can the nurse expect the client to experience? [ ] 1. Polyuria [ ] 2. Dysuria [ ] 3. Anuria [ ] 4. Pyuria

Dysuria Because of the instrumentation and dilation of the urethra, many clients complain of burning when urinating after a cystoscopy. The nurse can reduce or relieve the discomfort by promoting a liberal fluid intake, providing sitz baths, and administering a prescribed mild analgesic. Polyuria, anuria, and pyuria indicate other complications or conditions affecting the renal system, but these are not directly related to having a cystoscopy.

What is the primary reason for administering a laxative before the procedure? [ ] 1. Emptying the bowel aids in examining the lower GI tract. [ ] 2. Emptying the bowel prevents accidental stool incontinence during the X-ray. [ ] 3. Emptying the bowel reduces the potential for constipation or impaction. [ ] 4. Emptying the bowel improves the ability to visualize the urinary structures.

Emptying the bowel improves the ability to visualize the urinary structures. An intravenous pyelogram (IVP) is an X-ray examination of the kidneys, ureters, and urinary bladder that uses contrast material. The client should be instructed not to eat or drink after midnight on the night before the examination and to take a mild laxative (in either pill or liquid form) the evening before the procedure.

Which nursing intervention is most helpful in assisting the client undergoing hemodialysis to cope with the client's chronic health condition? [ ] 1. Giving the client literature to read about renal failure [ ] 2. Advising the client's spouse to cook the client's favorite dishes [ ] 3. Keeping the client informed of the latest research findings [ ] 4. Exploring with the client how this disorder has affected life

Exploring with the client how this disorder has affected life Discussing an actual or potential stressor helps to place the event in more realistic perspective. Giving a client an opportunity for discussion empowers the client to confront the issues and acquire support in the process.

Because the client also has diabetes mellitus, which statement by the nurse best explains why that client is at higher risk for acquiring a bladder infection? [ ] 1. Glucose in urine supports bacterial growth. [ ] 2. Diabetes suppresses white blood cell activity. [ ] 3. Diabetic clients urinate more frequently. [ ] 4. The urine is more concentrated in diabetic clients.

Glucose in urine supports bacterial growth. Many chronic health states, such as diabetes mellitus, multiple sclerosis, and spinal cord injuries, predispose affected clients to urinary tract infections (UTIs). Glucose in the urine provides a supportive environment for bacterial growth.

The client is scheduled to undergo a transurethral resection of the prostate (TURP). After the TURP, which assessment finding would the nurse expect to observe during the immediate postoperative period? [ ] 1. Light pink to clear urine [ ] 2. Mucoid sediments in urine [ ] 3. Decreased volume of urine [ ] 4. Grossly bloody urine

Grossly bloody urine Transurethral resection of the prostate (TURP) is a procedure frequently performed on older men to treat benign prostatic hypertrophy (BPH). Historically it was one of the most common major surgeries performed on men age 65 and older but is rapidly being replaced by laser prostatectomy and other less invasive procedures. Hematuria is generally present for at least 24 hours after a TURP. Vital signs are monitored to evaluate if the volume of blood loss is causing shock.

Which nursing action is most appropriate when the client complains about being thirsty because of the fluid restrictions? [ ] 1. Giving the client hard candy to suck [ ] 2. Providing the client with ice chips [ ] 3. Offering the client an ice cream bar [ ] 4. Supplying the client with fresh fruit

Hard candy, especially if sour or tart-flavored, increases salivation and reduces the sensation of thirst without increasing fluid intake. Clients in renal failure, unless they are diabetic, are not generally restricted in the amount of carbohydrates they may consume

Which nursing action is most appropriate in relation to collecting the client's urine specimen? [ ] 1. Have the client void at 8 a.m., and refrigerate the specimen. [ ] 2. Have the client void at 8 a.m., and dispose of the specimen. [ ] 3. Have the client void at 8 a.m., and send the specimen to the laboratory. [ ] 4. Have the client void at 8 a.m., and place the specimen in a preservative.

Have the client void at 8 a.m., and dispose of the specimen. Urine that formed before a 24-hour urine collection starts should not be included with the collected urine. Valid results require that the urine collected be produced within the 24-hour period. Properly collected urine is refrigerated in a large container or kept in the container in a basin of ice. After all the urine from the 24-hour period is collected, the entire specimen is sent to the laboratory

57. Which problem is the nurse's immediate concern after kidney transplant surgery? [ ] 1. Hypovolemic shock caused by postoperative bleeding [ ] 2. Abdominal distention secondary to delayed peristalsis [ ] 3. Postoperative paralyticileus due to colon manipulation [ ] 4. Pneumonia secondary to ineffective breathing patterns Nursing Care of Clients with Urologic Obstructions

Hypovolemic shock caused by postoperative bleeding. Because the kidney is a highly vascular organ, hemorrhage and shock are the most immediate complications of renal surgery. Abdominal distention, paralytic ileus, and pneumonia also are potential complications during the postoperative period, but they are not likely to occur immediately after surgery

Which nursing intervention is essential for the client who is diagnosed with urolithiasis at this time? [ ] 1. Increase the client's fluid intake to prevent further stone formation. [ ] 2. Interrupt the voiding pattern to strengthen the bladder muscles. [ ] 3. Limit the client's voiding to allow for releasing a larger stream of urine. [ ] 4. Increase the client's dietary calcium to replace losses to renal calculi.

Increasing fluid intake it is helps to move the stone so it may be spontaneously eliminated. The nurse should also encourage the client to increase fluids following stone removal to dilute the urine, prevent further stone production, and flush bacteria from the urinary system. Strengthening the bladder muscles, voiding a larger stream, and increasing calcium in the diet are not related to urolithiasis.

When the client complains about the bland taste of the food, the nurse appropriately recommends substituting salt with which condiment? [ ] 1. Catsup [ ] 2. Mustard [ ] 3. Soy sauce [ ] 4. Lemon juice

Lemon juice It is used to enhance the flavor of seafood, fish, eggs, and some vegetables. Other recommended seasonings include fresh herbs, such as parsley, dill, and oregano. Fresh onion is also acceptable.

Which nursing assessment is essential to add to the client's care plan? [ ] 1. Monitor body temperature. [ ] 2. Measure intake and output. [ ] 3. Assess for urine retention. [ ] 4. Check the urine for glucose.

Measuring intake and output accurately Is a priority when planning the care of a client with renal failure. This information aids in evaluating fluid balance and adjusting fluid restrictions. Urine retention is not common in renal failure because the client is not producing much urine. Generally, a urinary catheter is inserted to aid in monitoring the output of a person in renal failure.

Which nursing intervention is essential for evaluating the patency of the suprapubic catheter? [ ] 1. Inspecting the client's skin around the insertion site [ ] 2. Monitoring the client's urine output every 2 hours [ ] 3. Attaching the catheter to a leg bag when the client ambulates [ ] 4. Encouraging the client to consume 100 mL of oral fluid hourly

Monitoring the client's urine output every 2 hours Ensuring that there is adequate urine output from the suprapubic catheter is the best nursing intervention for evaluating patency of the catheter. Inspecting the skin is essential for detecting breakdown or infection. Attaching the catheter to a leg bag promotes the client's ability to move. Encouraging oral intake promotes urine formation, but increased fluid intake is not a measure of catheter patency.

Considering the client's diagnosis, which nursing intervention is the priority at this time? [ ] 1. Ambulating the client twice daily [ ] 2. Instructing the client how to self-catheterize [ ] 3. Monitoring the client's weight daily [ ] 4. Encouraging the client to increase fluid intake

Monitoring the client's weight daily Because glomerulonephritis impairs renal function, monitoring weight on a daily basis is essential for evaluating how much fluid the person is retaining.

Which finding provides the best evidence that peritoneal dialysis is achieving a therapeutic effect? [ ] 1. Urine output increases. [ ] 2. Appetite improves. [ ] 3. Potassium level falls. [ ] 4. Red blood cell count is lower.

POTASSIUM LEVEL FALLS. One beneficial effect of dialysis is the lowering of the serum potassium level. A goal of dialysis therapy is to maintain a safe concentration of serum electrolytes. A lower red blood cell count is not a desired effect. Most people with renal failure become anemic because the kidneys' ability to produce erythropoietin is impaired. Blood transfusions or injections of erythropoietin are commonly necessary.

81. If this client is typical of others who acquire bladder cancer, which symptoms are most likely to have manifested in the early stage of this disease? Select all that apply. [ ] 1. Diffi culty voiding [ ] 2. Persistent oliguria [ ] 3. Painless hematuria [ ] 4. Urethral discharge [ ] 5. Painful urination [ ] 6. Postvoid dribbling

Painless hematuria The most common symptom of bladder cancer is painless hematuria. Oliguria occurs later as the disease becomes more advanced and obstruction occurs. Bladder cancer that has not spread to adjacent pelvic structures is not usually associated with an unusual discharge from any body orifice. Postvoid dribbling and difficulty voiding are associated with an enlarged prostate gland.

If this client is typical of others with glomerulonephritis, which finding would the nurse expect to observe when conducting a head-to-toe physical assessment? [ ] 1. Skin hemorrhages [ ] 2. Absence of body hair [ ] 3. Flushed appearance [ ] 4. Peripheral edema

Peripheral edema A common sign associated with glomerulonephritis is peripheral edema that ranges from slight ankle edema in the evening to generalized fluid retention that may compromise cardiac function.

Because of the client's impaired urine elimination, which potential skin problem will require additional team planning? [ ] 1. Reduced perspiration [ ] 2. Extreme oiliness [ ] 3. Loss of skin turgor [ ] 4. Pronounced itching

Pronounced itching The skin of a client in renal failure becomes dry and intensely itchy due to the excretion and evaporation of nitrogenous wastes through the skin (uremic frost). Skin care involves frequent cleaning with plain, warm water, then patting the skin dry. The skin typically becomes dry, not oily.

whether a client has cancer of the prostate gland. To avoid erroneous test results caused by the manipulation of the prostate, the nurse should schedule which diagnostic test before the client's rectal examination? [ ] 1. Kidneys, ureters, bladder X-ray [ ] 2. Needle biopsy of the prostate gland [ ] 3. Prostate specific antigen (PSA) test [ ] 4. Transrectal ultrasound examination

Prostate specific antigen (PSA) Is believed to be a tumor marker for malignancies involving the prostate gland. At this time, the evidence that detecting an increased level improves healthy outcomes is mixed and incomplete. However, clients who are at high risk for prostate cancer or who prefer to have the test performed after being advised of its advantages and disadvantages may be tested. To avoid a falsely elevated finding, the test should be performed before a digital rectal examination or instrumentation around the prostate gland, such as occurs during a cystoscopy.

When preparing the client for catheterization, how should the nurse position the client? [ ] 1. Lithotomy position [ ] 2. Recumbent [ ] 3. Knee-chest position [ ] 4. Prone

Recumbent. Pyelonephritis is a bacterial infection of the kidneys and the renal pelvis and can be acute or chronic. When it is necessary to insert a catheter, the recumbent position is best for most female clients For women who have arthritis of the hips or another condition that interferes with recumbent positioning, a side-lying position is used as an alternative.

The nursing team meets to address the client's early renal failure in relation to the care plan. Which diagnostic test, considered a sensitive indicator of advanced kidney disease, will need to be closely monitored by the nursing team? [ ] 1. Serum creatinine level [ ] 2. Serum sodium level [ ] 3. Uric acid level [ ] 4. Urine specific gravity

Serum creatinine levels should be closely monitored because they are helpful in determining kidney functioning. High serum creatinine levels are commonly noted in conjunction with glomerular damage.

If the physician orders the following laboratory tests, which one is most important for the nurse to monitor when caring for this client? [ ] 1. Serum amylase [ ] 2. Blood glucose [ ] 3. Blood urea nitrogen (BUN) [ ] 4. Complete blood count (CBC)

The blood urea nitrogen (BUN) test is primarily used, along with the creatinine level, to evaluate kidney function and to monitor clients with acute or chronic kidney dysfunction or failure. The results of BUN testing indicate how efficiently the glomeruli are removing nitrogen wastes from the blood

Which assessment finding strongly suggests that a client's reduced volume of voided urine is due to an obstructive disorder such as an enlarged prostate gland? [ ] 1. The client feels a continued need to void. [ ] 2. The client's urine appears dark amber. [ ] 3. The client's bladder is below the pubis. [ ] 4. The client experiences abdominal cramps.

The client feels a continued need to void. Subjective data that are associated with obstructive urinary disorders include a persistent feeling of needing to void and dull flank pain. Feeling the urge to void is related to urine accumulating in the bladder secondary to incomplete emptying. A palpable bladder above the pubis is an objective sign that urine is being retained. Dark urine is associated with fluid volume deficit.

Considering the amount of time the client must remain in bed, why is it imperative for the nurse to monitor for a urinary tract infection? [ ] 1. The client will not be able to complete hygiene needs. [ ] 2. The client who in fully eliminating urine from the bladder [ ] 3. The client will not be able to maintain bladder control. [ ] 4. The client will not be able to drink sufficient fluids.

The client who must remain on bed rest due to traction has difficulty in fully eliminating urine from the bladder due to the positioning within the bed. This can lead to residual urine in the bladder that prompts bacterial growth. Urinary stagnation can also result in stone formation. Hygiene needs are also important but can be met with regular nursing care.

When a client asks the clinic nurse why women have more bladder infections than men, which answer is most accurate? [ ] 1. The male urethra is straighter, which facilitates elimination of pathogens. [ ] 2. The male urethra is lined with a layer of mucous membrane, which traps microorganisms. [ ] 3. The female urethra is shorter, and pathogens enter the bladder more easily. [ ] 4. The female urethra has a larger diameter and is more easily contaminated.

The female urethra is shorter, and pathogens enter the bladder more easily. Because the female urethra is shorter (about 1½″ or nearly 4 cm), pathogens travel to the bladder at a much faster rate than in a man. Also, the female urethra is more easily contaminated with organisms from the rectum and vagina if hygiene is inadequate.

When teaching a female client how to catheterize herself, how far into the urethra should the nurse instruct the client to insert the catheter? [ ] 1. 1 ″ (2.5 cm) [ ] 2. 2 ″ (5 cm) [ ] 3. 3 ″ (7.5 cm) [ ] 4. 4 ″ (10 cm)

The nurse should teach the client to catheterize herself by inserting a catheter 3″ (7.5 cm) into the urinary meatus in a downward and backward direction. At approximately 3″, the client should see urine in the tubing.

The client has one catheter in the urethra and another in an abdominal incision. When documenting the client's urine output in the medical record, which measurement is correct for the nurse to record? [ ] 1. Only the output from the urethral catheter [ ] 2. Only the output from the wound catheter [ ] 3. The outputs from each catheter separately [ ] 4. The combined output from both catheters

The outputs from each catheter separately The best method for recording urine output when a client has more than one catheter is to record the volumes drained from each catheter as separate entries in the medical record. Recording only the output from the urethral catheter or the output from the wound catheter does not provide accurate data on total output. If the two volumes are added and recorded as a single entry, it is diffi cult to evaluate the status of urine drainage from each catheter.

When the nurse inspects the client's urine specimen, which finding best indicates that the urine contains red blood cells? [ ] 1. The urine appears cloudy. [ ] 2. The urine appears smoky. [ ] 3. The urine appears bright orange. [ ] 4. The urine appears dark yellow.

The presence of blood gives a smoky appearance to urine. Cloudy urine suggests the presence of white blood cells. If the urine appears bright orange, the nurse might investigate whether the client has ingested a substance containing a water-soluble dye or has taken a urinary analgesic such as phenazopyridine (Pyridium) for a urinary tract infection

It is most appropriate for the nurse to advise the client that taking this medication will have which effect on the urine? [ ] 1. The urine will look cloudy. [ ] 2. The urine will appear orange. [ ] 3. The urine will become scant. [ ] 4. The urine will have a strong odor.

The urine will appear orange. Phenazopyridine (Pyridium) changes the color of the urine to orange. It will not cause the urine to look cloudy, decrease in volume, or smell strong. This drug will also cause staining of the underwear.

When the client questions why both drugs are not taken daily, which response by the nurse is best? [ ] 1. The medications are too toxic if taken on a daily basis. [ ] 2. This alternating schedule maintains adrenal function. [ ] 3. Each medication has a prolonged period of action. [ ] 4. Most people cannot tolerate the medications' daily side effects.

This alternating schedule maintains adrenal function. Steroids are prescribed to treat the inflammatory response caused by the disease process. Alternate-day therapy is used when administering glucocorticoid drugs to prevent adrenal suppression. Alternating oral hormone therapy allows the adrenal cortex to produce natural hormones as the blood level drops the day the hormone replacement is not given . Steroids have many undesirable side effects, but most are tolerable. Steroids can be and are administered on a daily basis when clients require short-term therapy. The duration of action is generally 24 hours.

Which urinary change provides the best evidence that the phenazopyridine (Pyridium) is achieving its intended therapeutic effect? [ ] 1. Urinary frequency is decreased. [ ] 2. Urinary urgency is decreased. [ ] 3. Urinary burning is decreased. [ ] 4. Urine output is increased.

Urinary burning is decreased. Phenazopyridine (Pyridium) is a urinary analgesic that rapidly decreases the burning associated with urinary tract infections (UTIs). Reducing discomfort eventually results in less frequent and urgent urination, but these are secondary effects.

Which statements should be included when the nurse instructs a female client about the technique for collecting a clean-catch midstream urine specimen for routine urinalysis? Select all that apply. [ ] 1. Clean the urethral area using several circular motions. [ ] 2. Void into the plastic liner under the toilet seat. [ ] 3. Void a small amount, and then collect a sample of urine. [ ] 4. Mix the antiseptic solution with the collected urine specimen. [ ] 5. Collect the urine in the nonsterile cup. [ ] 6. Drink several caffeinated beverages before collecting the urine.

Void a small amount, and then collect a sample of urine. The initial voided stream is discarded and a portion of what follows is collected as the specimen. Women are instructed to clean the urethral area from front to back; men clean the penis using a circular motion.

The physician recommends that the client's bladder cancer be treated conservatively by instilling an antineoplastic drug within the bladder. When administering the bladder instillation containing the chemotherapeutic drug, which safety precaution is most important for the nurse to take? [ ] 1. Wear two pairs of latex gloves. [ ] 2. Use a glass syringe for the drug. [ ] 3. Avoid wearing clothing with long sleeves. [ ] 4. Limit contact time with the client.

Wear two pairs of latex gloves. Recommendations for safe handling of toxic chemotherapeutic agents include wearing two pairs of surgical latex gloves, which are less permeable than polyvinyl gloves. A gown with cuffs and a mask or goggles are also worn to prevent direct contact with the drug. Pregnant nurses should use extreme caution when handling chemotherapeutic agents.

.A nurse is assigned to care for a client with a cutaneous ureterostomy. Which of the following images correlates with the client's urinary diversion? A client whose bladder cancer has been unresponsive to treatment will have the bladder surgically removed.

When a cutaneous ureterostomy is created, a ureter is detached from the bladder and brought through the abdominal wall. This type of urinary diversion requires the application of an ostomy appliance that collects urine from the diverted ureter.

Postoperatively, the client tells the nurse that he is having a great deal of discomfort in his bladder area. The physician has written several analgesic drug orders for the client in anticipation of the pain associated with transurethral resection of the prostate (TURP). Before administering an analgesic to the client, which information is most important for the nurse to assess? [ ] 1. Whether the urine is bloody [ ] 2. Whether the client has been up walking in the room [ ] 3. Whether the catheter is draining urine [ ] 4. Whether the client has been drinking adequate fluids

Whether the catheter is draining urine. The nurse should assess whether the catheter is draining well before administering an analgesic for bladder discomfort. Obstruction of the catheter causes bladder spasms. The nurse may need to know about the client's most recent activities, such as walking in the room or drinking fluids, but the patency of the catheter is more important at this time.

Which of the following measures performed by the client would offer the best protection against acquiring a urinary tract infection? [ ] 1. Wiping away from the urinary meatus after bowel elimination [ ] 2. Performing appropriate hand washing after bowel elimination [ ] 3. Using a feminine hygiene spray after bowel elimination [ ] 4. Drying the perineum thoroughly after bowel elimination

Wiping away from the urinary meatus after bowel elimination The most important technique for preventing future urinary tract infections is to eliminate the introduction of organisms from the rectum or vagina through improper wiping. Hand washing after elimination assists in reducing the transmission of pathogens to other body structures, such as the eyes and mouth.

People who have pyelonephritis more commonly experience?.

flank pain

A cystoscopy is scheduled to help diagnose the client's suspected condition. If the client asks the nurse to outline the benefits of the cystoscopy procedure, which ones should the nurse list as positive outcomes? Select all that apply. [ ] 1. Involves visual examination of the internal structure of the kidney [ ] 2. Helps identify the sources of hematuria, incontinence, and urine retention [ ] 3. Allows for collection of tissue samples, cell washings, and urine samples [ ] 4. Requires no sedation because it is painless [ ] 5. Uses a light source to visualize the internal structure [ ] 6. Requires no surgical incision because the scope is introduced into the urethra

2. Helps identify the sources of hematuria, incontinence, and urine retention 3. Allows for collection of tissue samples, cell washings, and urine samples 5. Uses a light source to visualize the internal structure 6. Requires no surgical incision because the scope is introduced into the urethra cystoscopy is the visual examination of the inside of the bladder, not the kidneys. The cystoscope consists of a lighted tube with a telescopic lens. It is used to help identify the cause of painless hematuria, urinary incontinence, and urine retention. It also helps to evaluate structural and functional changes of the bladder. The cystoscope is introduced through the urethra while the client is under local, spinal, or general anesthesia; no surgical incision is required. Biopsy samples of tissue, cell washing, and a urine sample may be obtained during the procedure.

Which response by the nurse is most appropriate? [ ] 1. "His bladder retraining is coming along, and before long he will be urinating like normal." [ ] 2. "He seems to have more incontinence in the afternoon and evening." [ ] 3. "In order to protect his privacy, I can't give you that information." [ ] 4. "Bladder retraining is slow work. We have to take him to the toilet every 2 hours."

3. "In order to protect his privacy, I can't give you that information." According to the Health Insurance Portability and Accountability Act (HIPAA), health care providers may not disclose any information about the client's medical condition unless the client authorizes them to do so. HIPAA maintains client confidentiality.

On the basis of the nurse's knowledge of patient rights, which Federal law has the PCT violated? [ ] 1. Good Samaritan Act [ ] 2. Hippocratic Oath [ ] 3. Health Insurance Portability and Accountability Act (HIPAA) [ ] 4. Emergency Medical Treatment and Liability Act (EMTALA)

3. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects a client's health information. It ensures that information regarding the client's age; birthdate; Social Security number; address; and past, present, and future medical diagnoses, care, and treatment remains private.

Which comment is the best response the nurse can offer? [ ] 1. "You're a very nice person." [ ] 2. "Cheer up. You can't be serious." [ ] 3. "You should expect this at your age." [ ] 4. "You're discouraged right now."

4. "You're discouraged right now." Reflecting feelings is a useful therapeutic communication technique that demonstrates empathy. It lets the client know that the nurse has recognized the emotion underlying the spoken words in the verbal statement.

Which response by the nurse is best? [ ] 1. Encourage the client to restrict fluid intake because it shows evidence of client cooperation. [ ] 2. Encourage the client to restrict fluid intake because it leads to accomplishing the goal. [ ] 3. Discourage the client from restricting fluid intake because it contributes to constipation. [ ] 4. Discourage the client from restricting fluid in take because it potentiates fluid imbalance.

4. Discourage the client from restricting fluid in take because it potentiates fluid imbalance. The nurse should discourage the client from restricting fluid intake because it can lead to fluid imbalance. In general, maintaining an adequate fluid intake is important because fluids flush toxins and organisms from the body and maintain a state of homeostasis.

When the client is definitively diagnosed with urolithiasis, which nursing interventions are most appropriate to add to the care plan? Select all that apply. [ ] 1. Restrict fluids to 1,000 mL/day. [ ] 2. Maintain the client in Fowler's position. [ ] 3. Limit activity to bed rest. [ ] 4. Strain all voided urine. [ ] 5. Maintain patency of the indwelling catheter. [ ] 6. Administer antibiotics per physician order.

4. Urine is strained to assess for evidence that the urinary stone or stones have passed. 6. Antibiotics are administered to treat the cause of a urinary tract infection related to urolithiasis and urinary stasis. Fluids are encouraged rather than restricted. Activity promotes movement of urinary stones. Fowler's position is unlikely to benefit or interfere with the passage of a urinary stone. Indwelling catheters are not used.

Which catheter is the best choice to use for a client with BPH? [ ] 1. A Coudé catheter [ ] 2. A silicone catheter [ ] 3. A rubber catheter [ ] 4. A flexible catheter

A Coudé catheter is used in a client with benign prostatic hypertrophy (BPH) because it has a curved tip that is able to move through the narrowed urethra. An instillable anesthetic lubricant is commonly used to facilitate the procedure.

When performing a physical assessment, which sensation would the nurse expect to detect when palpating the site of the arteriovenous fistula? [ ] 1. A pulse [ ] 2. A bruit [ ] 3. A thrill [ ] 4. A click

A THRILL While assessing the arteriovenous fistula, the nurse palpates a thrill, or vibration over the vascular access. The nurse should also expect to hear a bruit—a loud sound caused by turbulent blood fl ow—at the connection site. Both the thrill (vibration) and bruit (sound) must be present. If they are absent, the nurse should postpone further use of the device and notify the physician.

A client with renal failure is just informed about being a potential candidate for a kidney transplant. When the client asks about the source of donated kidneys, the nurse correctly identifies which of the following as the preferred donor? [ ] 1. A recently deceased human [ ] 2. A sibling or living relative [ ] 3. An unrelated living human [ ] 4. A chimpanzee or other primate

A sibling or living relative Relatives, especially siblings who were conceived by the same father and mother, prove to be the most compatible genetic matches for clients who receive transplanted organs. Immunosuppressive drugs make it possible to reduce the potential for rejection regardless of the

A nephrectomy is performed on a client with a kidney tumor. Postoperatively, which assessment finding is most suggestive that the client is hemorrhaging? [ ] 1. Acute flank pain [ ] 2. Abdominal distention [ ] 3. Flushed, warm skin [ ] 4. Nausea and vomiting

ACUTE FLANK PAIN The sudden onset of flank pain along with other signs of shock, such as hypotension, restlessness, and tachycardia, is suggestive of hemorrhage. With shock, the skin is generally pale and cool. A distended abdomen is usually caused by the accumulation of intestinal gas. Pain sometimes causes nausea and vomiting, but these signs and symptoms may be due to multiple etiologies.

If the reagent strip can detect the following substances, which one would the nurse expect to be present in the urine of a client with glomerulonephritis? [ ] 1. Glucose [ ] 2. Bilirubin [ ] 3. Albumin [ ] 4. Acetone

ALBUMIN People with glomerulonephritis generally test positive for albuminuria. Albumin is present in the urine due to the increased permeability of the glomerular membrane.

The physician orders a fluid challenge of 500 mL of I.V. fluid infused at a rapid rate, followed by the administration of a loop diuretic to sustain or improve renal function. While the fluid is being administered, which nursing assessment is most important? [ ] 1. Checking for pedal edema [ ] 2. Assessing for rapid weight gain [ ] 3. Monitoring specific gravity [ ] 4. Auscultating breath sounds

AUSCULTATING THE BREATH SOUNDS It is necessary to assess the client's breath sounds in this situation because administering fluid to someone with oliguria or anuria may lead to heart failure and pulmonary edema.

If the physician inserts a suprapubic cystostomy tube to drain the accumulating urine, the nurse should assess the characteristics of urine from a catheter that exits from which location? [ ] 1. Urethra [ ] 2. Abdomen [ ] 3. Ureter [ ] 4. Flank

Abdomen A cystostomy tube is surgically inserted directly into the bladder through the abdominal wall. A ureterostomy tube is inserted into one of the ureters through a flank incision. A retention catheter, such as a Foley catheter, is inserted through the urethra

When the nurse is advising the client about the potential complications associated with peritoneal dialysis, which complication is most important to include? [ ] 1. Pulmonary edema [ ] 2. Abdominal peritonitis [ ] 3. Abdominal hernia [ ] 4. Ruptured aorta

Abdominal Peritonitis Is the most serious and common complication in 60% to 80% of clients on long-term peritoneal dialysis. An abdominal hernia is common in clients undergoing long-term peritoneal dialysis because of the continuous increased intra-abdominal pressure; however, a hernia is not as common or as serious as peritonitis.

In evaluating multiple clients with UTIs, the clinic nurse would anticipate which client to be at least risk for developing a UTI? [ ] 1. A client with urethral mucosa damage [ ] 2. A client with an altered mental condition [ ] 3. A client with an altered metabolic state [ ] 4. An immunocompromised client

Altered mental states do not necessarily place a client at higher risk for urinary tract infections (UTIs), especially if the client can still attend to personal hygiene. A client is at risk for a UTI if immunocompromised and unable to fight bacteria growth, has suffered trauma to the urethral mucosa, or has an altered metabolic state that could change the composition of the urine.

Which of the following findings is the most significant information to report when caring for a client undergoing peritoneal dialysis? [ ] 1. Loss of body weight [ ] 2. Decreased serum creatinine [ ] 3. Elevated body temperature [ ] 4. Output that exceeds intake

An elevated body temperature is unexpected. Its presence indicates that an infection is occurring, and the nurse should suspect peritonitis. It is expected that a client undergoing peritoneal dialysis will lose weight and have an output that exceeds intake. Clients who require dialysis typically do not have a normal serum creatinine level (1.2 mg/dL).

When the nurse reviews the client's medical history, which finding most likely precipitated the present illness? [ ] 1. Trauma to the lower abdomen [ ] 2. An upper respiratory infection [ ] 3. Treatment with an antibiotic [ ] 4. An allergic reaction to X-ray dye

An upper respiratory infection. Although definite evidence linking a streptococcal infection with glomerulonephritis has not been established, many people recall that they experienced an upper respiratory infection or sore throat 2 to 3 weeks before the onset of glomerulonephritis.

A client who has chronic glomerulonephritis has deteriorated to the early stages of renal failure. Which symptom indicative of renal failure would the nurse expect to note when assessing this client? [ ] 1. Anemia [ ] 2. Hypotension [ ] 3. Weight loss [ ] 4. Fever

Anemia Is common in clients with renal failure. The kidneys produce erythropoietin, which stimulates the production of red blood cells (RBCs). If kidney function is diminished, anemia occurs from the decreased RBC production. Clients with renal failure typically have weight gain, not weight loss, related to fluid retention and hypertension not hypotension. Renal failure does not generally produce a fever.

The client with a history of benign prostatic hypertrophy (BPH) tells the nurse that he has been unable to urinate for 18 hours. The physician instructs the nurse to insert a urethral catheter. Which technique is best for helping the nurse insert the tip of the catheter past the enlarged prostate gland? [ ] 1. Angle the penis in the direction of the toes. [ ] 2. Massage the tissue below the base of the penis. [ ] 3. Push the catheter with additional force. [ ] 4. Grasp the penis firmly within the hand.

Angle the penis in the direction of the toes. Lowering the penis from an upright position to one in which the penis is pointed in the direction of the toes sometimes helps to pass a catheter beyond the narrowing caused by an enlarged prostate gland. The penis is grasped firmly whenever a catheter is inserted. A catheter is never forced if resistance is met during insertion.

When the client with glomerulonephritis reports having a headache that is rated a 7 on a scale of 0 to 10, with 10 being the most pain, which nursing action should be performed next? [ ] 1. Administer a prescribed analgesic. [ ] 2. Assess the client's blood pressure. [ ] 3. Reduce environmental stimuli. [ ] 4. Change the client's position.

Assess the client's blood pressure. After assessing the severity of the client's pain on the pain scale, it is important for the nurse to assess the client's blood pressure. People with glomerulonephritis are typically hypertensive; hypertension can be accompanied by the headache

Postoperatively, the client has an indwelling (Foley) catheter in place. When managing catheter care, which nursing action is most important for promoting wound healing? [ ] 1. Avoid tension on the catheter. [ ] 2. Encourage oral fluid intake. [ ] 3. Clean the urethral meatus daily. [ ] 4. Clamp and release the catheter every 2 hours.

Avoid tension on the catheter. Tension on the catheter may disrupt healing where the bladder and the urethra have been surgically reconnected after removal of the prostate gland and its capsule. Encouraging oral fl uids and cleaning the urinary meatus are appropriate postoperative nursing measures, but they are not likely to have as significant an effect on wound healing.