Urinary System

An 80 year old man is admitted for cystoscopy with biopsy of the bladder. After obtaining a history, surgery is postponed. Which reason would be cause to postpone this clients surgery? 1. The client stopped taking his anticoagulant 3 days ago 2. The client has a UTI 3. The client has previously been treated for carcinoma of the bladder 4. The client took an antibiotic prior to the procedure.

2. Bladder biopsies shouldn't be done when active an active UTI is present because sepsis may result.

A client with renal insufficiency is admitted with a diagnosis of pneumonia. He's being treated with IV antibiotics, which can be nephrotoxic. Which laboratory value(s) should be monitored closely? 1. Blood urea nitrogen (BUN) and creatinine levels 2. Arterial blood gas (ABG) levels 3. Platelet count 4. Potassium level

1. BUN and creatinine levels should be monitored closely to detect elevations due to nephrotoxicity. ABG determinations are inappropriate for this situation. Platelets and potassium levels should be monitored according to routine.

A client presents with a possible urinary tract infection. Which urine characteristic should the nurse assess FIRST? 1. Urine clarity 2. Urine specific gravity 3. Urine acetone 4. Urine protein

1. First, the nurse should assess urine clarity; cloudy urine usually indicated drainage, which may reflect infection. Urine specific gravity yields information about fluid balance. Neither urine acetone nor urine protein indicated infection.

The nurse administers tamsulosin (Flomax) to a client with benign prostatic hyperplasia (BPH). The nurse is aware that which of the following is a priority assessment? 1. Voiding pattern 2. Size of the prostate 3. Creatinine clearance 4. Serum testosterone level

1. The alpha-adrenergic blocker tamsulosin (Flomax) relaxes the smooth muscle of the bladder neck and prostate, so the urinary voiding symptoms (frequency, urgency, hesitancy) of BPH are reduced in many clients. These drugs don't affect the size of the prostate, renal function, or production or metabolism of testosterone.

The nurse is caring for a client who is receiving hemodialysis treatments. Which of the following interventions would be the most appropriate for this client? 1. Palpate for a thrill on the arm with the fistula 2. Palpate for a thrill on the arm without the fistula. 3. Document the absence of a bruit as a normal finding 4. Take blood pressure on the arm with the fistula

1. The nurse would palpate for a thrill and auscultate for a bruit on the arm with a fistula but no procedures ( blood pressure, IV access, or blood draw) should be done on the arm with a fistulae because it could damage the fistula.

A client with acute renal failure has a serum potassium level of 7.0 mEq/L. The nurse's priority for this client is to assess which of the following? 1. Urine specific gravity 2. Electrocardiogram (ECG) results 3. Mental status 4. Blood pressure

2. Acute renal failure can result in hyperkalemia, which can manifest in widening of the PR and QRS intervals on the ECG. Urine specific gravity, mental, status, and blood pressure are not a priority with this client.

Which symptom may indicate acute rejection of a transplanted kidney? 1. Increased urine output 2. Hypotension 3. Pain at the graft site 4. Decreased WBC count

3. Signs and symptoms of acute rejection of a transplanted kidney include pain a the graft site, decreased ( not increased) urine output, hypertension (not hypotension), elevated (not decreased) WBC count, fever, and elevated creatinine level

A client newly diagnosed with genital herpes is crying and wringing her hands as the nurse approaches her. Which nursing diagnosis is the most appropriate to this situation? 1. Acute pain 2. Impaired tissue integrity 3. Anxiety 4. Deficient knowledge

3. The client is demonstration anxiety; this problem needs to be incorporated into the plan of care. Acute pain and impaired tissue integrity are not nursing diagnoses for the client. The client may have deficient knowledge concerning the new diagnosis; however, the is not being demonstrated at this time.

A client is undergoing peritoneal dialysis. The dialysate dwell time is completed, and the clamp is opened to allow the dialysate to drain. The nurse notes that drainage has stopped and that only 500 ml has drained; the amount was 1,500 ml. Which intervention should be done FIRST? 1. Change the client's position 2. Call the physician 3. Check the catheter for kinks or obstruction 4. Clamp the catheter and instill more dialysate at the next exchange time.

3. The first intervention should be to check for kinks and obstructions because that could be preventing drainage. After checking for kinks, have the client change position to promote drainage. Don't give the next scheduled exchange until the dialysate is drained because abdominal distention will occur, unless the output is within the parameters set by the physician. If unable to get more output despite checking for kinks and changing the client's position, the nurse should then call the physician to determine the proper intervention.

The nurse is caring for a client with urine retention. The physician has ordered the client to be catheterized. Which of the following catheters would be the most appropriate for the nurse to select to perform the procedure> ? 1. Coude 2. Indwelling urinary 3. straight 4. Three way

3. Urine retention is usually a temporary problem that requires insertion of a straight catheter.

62. Which laboratory test is uysed to diagnose pancreatitis? 1. Amylase level 2. hemoglobin level 3. Blood glucose level 4. White blood cell (WBC) count

Answer 1 Amylase is an enzyme secreted by the pancreas; when elevated, it's useful in diagnosing pancreatitis. Hemoglobin level can be low in pancreatitis, but there are other causes for this. The blood glucose level may be elevated with pancreatitis, but this factor isn't diagnostic. The WBC count may also be elevated in pancreatitis, but this symptom can be due to infection.

74. Which measure should the nurse focus on for a client with esophageal varices

Answer 1 Recognizing the rupture of esophageal varices, or hemorrhages, is the focus of nursing care because the client could succumb to this quickly. Controlling blood pressure is also important because it helps reduce the risk of variceal rupture. It's also important to teach the client what foods he should avoid, such as spicy foods, and what varices are.

71. Which finding would strongly indicate the possibility of cirrhosis? 1. Dry skin 2. Hepatomegaly 3. Peripheral edema 4. Pruritus

Answer 2 The client with cirrhosis has a liver that is enlarged (hepatomegaly), fibrotic, and nodular, which makes it palpable. The client may develop dry skin, pruritus, and peripheral edema, but these symptoms may have other causes.

66. If a gastric ulcer perforates, which action should be included in the management of the client? 1. Removal of the nasogastric (NG) tube 2. Antacid administration 3. H2-receptor antagonist administration 4. Fluid and electrolyte replacement

Answer 4 The client should be treated with antibiotics as well as fluid, electrolyte, and blood replacement. NG tube suction should also be performed to prevent further spillage of stomach contents into the perineal cavity. Antacids and H2-receptor antagonists aren't helpful in this situation.

Giving instructions for breast self-examination is particularly important for clients with which medical problem? 1. Cervical dysplasia 2. A dermoid cyst 3. Endometrial polyps 4. Ovarian cancer

Answer: 4 Clinets with ovarian cancer are at increased risk for breast cancer. Breast self-examination supports early detection and treatment and is very important. There isn't a known relationship between breast cancer and cervical dysplasia, or endometrial polyps, or dermoid cysts, so examinations are no more or less important in these clients.

52. A client admitted for acute pyelonephritis is about to start antibiotic therapy. Which symptom would be expected in this client? 1. HTN 2. Flank pain on the affected side 3. Pain that radiates toward the unaffected side 4. No tenderness with deep palpation over the costovertebral angle

answer 2 The client may complain of pain on the affected side because the kidney is enlarged and might have formed an abscess. HTN is associated w/chronic pyelonephritis. Pain may radiate down the ureters or to the epigastrium. The client would have tenderness with deep palpation over the costovertebral angle.

51. A client with pneumonia is transferred to the intensive care unit for mechanical ventilation. His BP is 70/40, HR is 115 beats/min with accessory muscle use. IV's are infusing at 150 ml/hr. Urine output is 50ml for the past 4 hours. This client is most at risk for which of the following? 1. Postrenal Failure 2. Prerenal failure 3. Intrarenal failure 4. Chronic renal failure

answer 2 Prerenal refers to renal failure due to an interference with renal perfusion. Decreased CO causes a decrease in renal perfusion Which leads to a lower glomerular filtration rate. The other answers don't apply to this scenerio

The nurse is assessing a client who reports painful urination during and after voiding. The nurse suspects the client may have a problem with which area of the client's urinary system? 1. Bladder 2. Kidneys 3. Ureters 4. Urethra

1. Pain during or after voiding indicates a bladder problem, usually infection.

A 26-year-old client with chronic renal failure plans to receive a kidney transplant. Recently, the physician told the client that he's a poor candidate for transplant because of chronic uncontrolled hypertension and diabetes mellitus. Now the client tells the nurse, "I want to go off dialysis. I'd rather not live than be on this treatment for the rest of my life." Which response is appropriate? Select all the apply. 1. Take a seat next to the client and sit quietly. 2. Say to the client "We all have days when we don't feel like going on." 3. Leave the room to allow the client to collect his thoughts. 4. Say to the client, "You're feeling upset about the news you got about the transplant." 5. Say to client, "The treatments are only 3 days a week. You can live with that."

1 and 4. Silence is a therapeutic communication technique that allows the nurse and client to reflect on what has taken place or been said. By waiting quietly and attentively, the nurse encourages the client to initiate and maintain conversation. By reflecting the client's implied feelings, the nurse also promotes communication.

The nurse is aware that the highest risk for developing a postoperative wound infection exists with a client who has experienced which of the following? 1. Radical prostatectomy 2. Perioneal prostatectomy 3. Suprapubic prostatectomy 4. Transurethral resection of the prostate (TURP)

2. The incision in a peritoneal prostatectomy is close to the rectum, which normally contains gram-negative organisms that can cause infection if introduced into other areas of the body. Therefore, a perineal incision will become contaminated more often than either no external incision, as with TURP, or abdominal incisions, as with radical or suprapubic prostatectomy.

A client has returned from surgery with continuous bladder irrigation. The nurse is aware that proper maintenance of a continuous bladder irrigation system includes: 1. regulating irrigant flow to maintain red urine. 2. regulating irrigant flow to maintain pink urine. 3. maintaining a slow flow rate of irrigant to prevent bladder distention. 4. stopping the irrigation if there's leakage of large amounts of urine around the catheter.

2. The irrigant should be infused at the rate fast enough to maintain pink urine. Red urine indicates inadequate irrigation and possible clot formation. Bladder distention shouldn't occur as long as the system is draining properly and no clots are obstructing the outflow of urine. Leakage of urine around the catheter indicated clod formation on the catheter tip, needing manual irrigation. The irrigation shouldn't be stopped because of the potential for clot formation.

A client has an indwelling urinary catheter, and urine is leaking from a hole in the collection bag. Which nursing intervention would be MOST APPROPERATE? 1. Cover the hole with tape. 2. Remove the catheter and insert a new on using sterile technique. 3. Disconnect the drainage bag from the catheter and replace it with a new bag. 4. Place a towel under the bag to prevent spillage of urine on the floor, which could cause the client to slip and fall.

2. The system is not longer a closed system, and bacteria might have been introduced into the system, so a new sterile catheter should be inserted. Taping up the hole and placing a towel under the bad leave the system open, which increases the risk of infection. Replacing the drainage bag by disconnection the old one form the catheter opens up the entire system and isn't recommended because of the increased risk of infection.

A client diagnosed with chronic renal failure and is told he must start hemodialysis. What is the most important client teaching for the nurse to provide? 1. Follow the high-potassium diet. 2. Strictly follow the hemodialysis schedule. 3. There will be few changes in your lifestyle. 4. Use alcohol on the skin to clean it because of integumentary changes.

2. To prevent life-threatening complications, the client must follow the dialysis schedule. the client should follow a low-potassium diet because potassium levels increase in chronic renal failure. The client should know that hemodialysis is time-consuming and will definitely cause a change in current lifestyle. Alcohol would further dry the client's skin more than it already is.

Which intervention would be the most appropriated for a client with post op urinary retention? 1. Give a diuretic 2. Pour warm water over the perineum 3. Consider inserting a bladder catheter 4. Lay the client flat in bed

2. Urinary retention reflects bladder distention from urine.

A client is ordered diuretics. Which of the following would be the best time of day for the nurse to schedule this medication? 1. Anytime 2. Nighttime 3. Morning 4. Noon

3. A diuretic given in the morning has time to work throughout the day.

Two days after a transrectal biopsy of the prostate, a client calls the clinic to report that his stool is streaked with blood. Which response by the nurse is appropriate? 1. Tell the client to take a laxative. 2. Tell the client to come in for examination. 3. Reassure the client that this an expected occurrence. 4. Ask the client to collect a stool specimen for testing.

3. After a transrectal prostatic biopsy, blood in the stool is expected for a number of days. Because blood in the stool is expected, testing the stool or examining the client isn't necessary. Stool softeners are prescribed if the client complains of constipation; straining at stool can precipitate bleeding, but laxatives generally aren't necessary.

75. Several children at a daycare center have been infected with hepatitis A virus. Which instruction by the nurse would reduce the risk of hepatitis A to other children and staff members? 1. Hand washing after diaper changes 2. Isolation of the sick children 3. Use of masks during contact with the children 4. Sterilization of all eating utensils

Answer 1 Children in day care centers are at risk of hepatitis A infection which is transmitted via fecal-oral route due to poor hand hygiene practices and poor sanitation. Isolation of sick children, use of mask during contact, and sterilization of all eating utensils would not be useful in breaking the chain of infection.

Which assessment finding is ABNORMAL in a 72-year old male client? 1. Decreased sperm count 2. Small, firm testes on palpation 3. History of slowed sexual response 4. Decreased plasma testosterone level

Answer: 1 Sperm continues to be produced despite the age-related degenerative changes that occur in the male reproductive system. Among the normal age-related changes are decreased size and increased firmness of the testes, a decrease in sexual potency, and decreased produconi of testosterone and progesterone.

A nurse is caring for a client with chronic renal failure. The laboratory results indicate hypocalcemia and hypophosphatemia. When assessing the client, the nurse should be alert fro which symptom(s)? Select all that apply. 1. Trousseau's sign 2. Cardiac arrhythmias 3. Constipation 4. Decreased clotting time 5. Drowsiness and lethargy 6. Fractures

1,2, and 6. Hypocalcemia is a calcium deficit that causes nerve fiber irritability and repetitive muscle spasms. Signs and symptoms of hypocalcemia include Trousseau's sign, cardiac arrhythmias, diarrhea, increased clotting, anxiety, and irritability. the calcium-phosphorus imbalance leads to brittle bones and pathological fractures.

A client receiving hemodialysis treatments arrives at the hospital with a blood pressure of 200/100 mmHg, a heart rate of 110 beats/minute, and a respiratory rate of 36 breaths/minute. Oxygen saturation on room air is 89%. He complains of shortness of breath, and plus 2 pedal edema is noted. His last hemodialysis treatment was yesterday. Which intervention should be done first? 1. Administer oxygen 2. Elevate the foot of the bed 3. Restrict the client's fluids 4. Prepare the client for hemodialysis

1. Airway and oxygenation are always the first priority. Because the client is complaining of shortness of breath and his oxygen saturation is only 89%, the nurse needs to try to increase the partial pressure of arterial oxygen by administering oxygen. The foot of the bed may be elevated to reduce edema, but this isn't a priority. The client is in pulmonary edema from fluid overload and will need to be dialyzed and have his fluids restricted, but the first intervention should be aimed at the immediate treatment of hypoxia.

An 80 year old male client reports urine retention. Which factor may contribute to this clients problem? 1. BPH 2. Diabetes 3. Diet 4. Hypertension

1. BPH is common among elderly men and typically results in urine retention, frequency, dribbling, and difficulty starting the urine stream.

Kegel exercises are used to gain control of bladder function in women with stress incontinence and in some men after prostrate surgery. Which instruction would help the client perform these exercises? 1. Completely empty the bladder 2. Do the exercise 200 times per day 3. Sit or stand with your legs together 4. Drink small amounts of fluid frequently

2. Exercises begin with tightening and relaxing the vagina, rectum, and urethra four or five times during each session and gradually increasing to 25 times for each session.

Which medication is MOST LIKELY to be prescribed for a client with gonorrhea? 1. Penicillin G benzathine (Bacillin) 2. Azithromycin (Zithromax) 3. Ceftriaxone (Rocephin) 4. Trichloroacetic acid (TCA)

3. According to the Centers for Disease Control guidelines, ceftriaxone (Rocephin) or cefixime (Suprax) is the drug of choice for treating gonorrhea. Penicillin is used to treat syphilis. Azithromycin is used for chlamydial infection. Topical trichloroacetic acid is used for human papillomavirus.

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 wasnt lubricated before the pouch was applied 2. The pouch faceplate doesnt fit the stoma 3. A skin barrier was applied properly 4. Stoma dilation wasnt performed.

3. Water diuresis causes low urine specific gravity, low urine osmolarity, and a normal to elevated serum sodium level.

A nurse suspects that a client with polyuria is experiencing water diuresis. Which laboratory value suggests water diuresis? 1. High urine specific gravity 2. High urine osmolarity 3. Normal to low urine specific gravity 4. Elevated urine pH

3. Water diuresis causes low urine specific gravity, low urine osmolarity, and a normal to elevated serum sodium level.

When a client with nephrotic syndrome manifests anasarca, the nurse relates this assessment finding to which abnormally low laboratory value? 1. Cholesterol 2. Prothrombin time 3. Albumin 4. Calcium

3. When the glomeruli are damaged, as in nephrotic syndrome, the kidneys are excessively permeable to plasma protein, causing proteinuria and hypoalbuminemia. This leads to a decreased oncotic pressure, which results in anasarca (massive generalized edema).

33. Which symptoms is an ADVERSE REACTION of hydrocodone with acetaminophen that a client with metastatic prostate cancer should be instructed to report to the physician? 1. Blurred vision 2. Diarrhea 3. Unusual dreams 4. Vomiting

Answer: 4 Vomiting is an adverse reactions to the drug that should be reported because it impairs the client's quality of life an places the client at risk for dehydration. Taking the medication with food may prevent vomiting. If not, other opiate analgesics may be better tolerated. Blurred vision and diarrhea aren't associated with the use of hydrocodone with acetaminophen. Unusual dreams are a common adverse effect but don't need to be reported unless they're bothersome to the client.

After radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. He then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first? 1. Kegel exercises 2. Fluid restriction 3. Artificial sphincter use 4. Self-catheterization

1. Kegel exercises are noninvasive and are recommended as the initial intervention for incontinence. Fluid restriction is useful for a client with increases detrusor contraction related to acidic urine. Artificial sphincter use isn't a primary intervention for postprostatectomy incontinence. Self-catheterization may be used as temporary measure but isn't a primary intervention.

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 wasnt lubricated before the pouch was applied 2. The pouch faceplate doesnt fit the stoma 3. A skin barrier was applied properly 4. Stoma dilation wasnt performed

2. If the pouch faceplate doesnt fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, painful skin.

A client is injected with radiographic contrast medium and immediately shows signs of dyspnea, flushing, and pruritis,. Which intervention should take priority? 1. Check vital signs 2. Make sure the airway is patent 3. Apply a cold pack to the IV site 4. Call the physican

2. The client is showing symptoms of an allergy to the iodine in the contrast medium.

A 27-year-old client, who became paraplegic after a swimming accident, is experiencing autonomic dysreflexia. Which condition is the MOST COMMON cause of autonomic dysreflexia? 1. Upper respiratory infection 2. Incontinence 3. Bladder distention 4. Diarrhea

3. Autonomic dysreflexia is a potentially life-threatening complication of spinal cord injury, occurring from obstruction of the urinary system or bowel. An upper respiratory infection could obstruct the respiratory system but not the urinary or bowel system. Incontinence and diarrhea don't result in obstruction of the urinary system or bowel, respectively.

A client is describing how she palpates her breasts for breast self-examination. Which statement indicates the need for further teaching? 1. "I put lotion on my breasts before I begin to palpate them." 2. I palpate both breasts standing up and then lying on my back." 3. "I'm careful to palpate under each arm and up to 2 in. below my collarbone." 4. "I start at the outer edge of the breast and work in to the nipple in smaller and smaller circles."

3. Breast self-examination requires palpitation of all breast tissue. This includes checking the area above the breast up to the collarbone and all the way over to the shoulder as well as the area between the breast and the underarm, including the underarm itself. Lotion or powder helps the fingers glide over the skin and facilitates palpitation. Breasts need to be palpated in both erect and lying positions. Any pattern of palpitation may be used in performing breast self-examination as long as each quadrant of the breast, tail, and axilla are examined.

Which intervention should be done for a client with urinary calculus? 1. Save any calculi larger than 0.25 cm 2. Strain the urine, limit oral fluids, and give pain medications 3. Encourage fluid intake, strain the urine, and give pain medications 4. Insert an indwelling urinary catheter, check intake and output, and give pain medications

3. Encourage fluid intake and strain all urine, saving all calculi, including flecks.

A client has just received a renal transplant and has started cyclosporine therapy to prevent graft rejection. What is the most important information for the nurse to tell the client? 1. Report any signs of depression or a decreased appetite. 2. Report any dizziness and bleeding from the incision. 3. Report any fever, a flushed feeling, or lethargy. 4. Report any stomach discomfort or dyspepsia.

3. Fever, a flushed feeling, or lethargy suggests infection, which is the major complication to watch for in clients on cyclosporine therapy because it's an immunosuppressive drug. The other symptoms aren't indicative of cyclosporine therapy.

When teaching a client how to prevent recurrences of acute glomerulonephritis, which instruction should the nurse include? 1. avoid physical activity 2. strain all urine 3. seek early treatment for respiratory infection 4. monitor urine specific gravity every day

3. Hemolytic streptococci are common in throat infections and can cause an immune reaction that causes glomerular damage. Therefore, the client should seek early treatment for respiratory infection. Avoiding physical activity may promote urination but doesn't prevent recurrent of glomerulonephritis. Straining all urine helps identify renal calculi that have passed through the urine. Daily monitoring of urine specific gravity helps assess hydration status but doesn't aid in glomerulonephritis prevention.

When teaching a client about cystitis, a nurse explains that females are more prone to the disorder than males. Which factor explains a female's increased susceptibility? 1. Higher estrogen levels 2. Inadequate fluid intake 3. Urethral proximity to the rectum 4. continuous nature of the mucosa

3. In females, the urethra and rectum are in close proximity, posing a greater risk for urethral contamination with feces after a bowel movement. Decreased estrogen levels may reduce vaginal and urethral lubrication, increasing the chance of irritation during coitus. Males and females can have equivalent fluid intake. The mucous is continuous in both males and females.

A 70-year-old male client is diagnosed with syphilis in the secondary state. Which finding should the nurse expect during assessment? 1. Chronic bone and joint irritation 2. Tender lymphadenopathy 3. Generalized rash on the palms and soles 4. Personality changes and mental confusion

3. In secondary syphilis, a maculopapular nonprurtic rash appears in the palms and soles. Chronic bone and joint irritation aren't related to secondary syphilis. During the second stage of syphilis, nontender lymphadenopathy occurs. Personality changes occur during the late state of syphilis.

A client is diagnosed with prostate cancer. The physician is most likely to order which test to monitor the clients progress? 1. Serum creatinine 2. CBC 3.Prostate specific antigen PSA 4. Serum potassium

3. The PSA test is used to monitor prostate cancer progression; higher PSA levels indicate a greater tumor burden.

Unless there are post op complications, a cystoscopy client is discharged to home w/n 24 hrs. Which instruction is given at discharge? 1. Expect bloody urine for about a week 2. Drink 8 to 10 glasses of water every 8 hrs 3. Try to urinate frequently and measure your output 4. Check the color, consistency, and amount of urine in the indwelling urinary catheter bag every 4 to 8 hrs?

3. The bladder needs to be emptied frequently, and output should be measured to make sure the bladder is emptying.

A client has passed a renal calculus. The nurse sends the specimen to the laboratory so it can be analyzed for which factor? 1. Antibodies 2. Type of infection 3. Composition of calculus 4. Size and number of calculi

3. The calculus should be analyzed for composition to determine appropriate interventions such as dietary restrictions.

A 75 year old client is admitted with dehydration. The clients laboratory results are serum sodium 145 mg/dL, serum potassium 5.0 mEq/L, BUN 23 mg/dL, and serum creatinine 3.0 mg/dL. Based on these results, the nurse determines that the client is at risk for developing which of the following conditions? 1. Acute confusion 2. Urinary retention 3. Acute renal failure 4. Cardiac arrhythmias

3. The laboratory results indicate an elevated serum creatinine ( normal ranges are from 0.7-1.5 mg/dl), which is reflective of dehydration.

A client with an overactive neurogenic bladder is complaining of a dry mouth from his medication oxybutynin (Ditropan). The nurse is aware that this adverse effect is commonly found with which of the flowing drug classifications? 1. Anti-infective 2. Corticosteriod 3. Urinary antiseptic 4. Spasmolytic

4. Oxybutynin belongs to the spasmolytic drug classification.

A client is admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed, and postobstructive diuresis is occurring. What is the most important intervention by the nurse? 1. Take vital signs every 8 hours. 2. Weigh the client every other day. 3. Assess the urine output every shift. 4. Monitor the client's electrolyte levels.

4. Postobstructive diuresis seen in hydronephrosis an cause electrolyte imbalances; laboratory values must be checked so electrolytes can be replaced as needed. Vital signs should initially be taken every 30 minutes for the first 4 hours and then every 2 hours. Urine output needs to be assessed hourly. The client's weight should be taken daily to assess fluid status more closely.

A client had not voided 10 hours following an inguinal hernia repair. The nurse determines that the nursing diagnosis for this client would be Urinary retention related to which of the following? 1. Dehydration 2. History of smoking 3. Duration of surgery 4. Pre op atropine

4. Anticholinergic medications, such as atropine, may cause urinary retention, particularly for the client who has surgery in the pelvic area (inguinal hernia, hysterectomy). Dehydration, smoking, and duration of surgery aren't risk factors for retention, although opiate analgesics are risk factors.

Before renal biopsy, which info is most important to tell the physician? 1. The client signed a consent form 2. The client understands the procedure 3. The client has normal urinary elimination 4. The client is regularly take aspirin or NSAID

4. Aspirin and NSAIDs cause increased bleeding times and commonly result in hemorrhaging biopsies are performed.

A client has a history of chronic renal failure and receives hemodialysis treatments three times a week through an atreriovenous (AV) fistula in the left arm. What is the most important intervention for the nurse to provide? 1. Keep the AV fistula site dry. 2. Keep the AV fistula wrapped in gauze. 3. Take the blood pressure in the left arm. 4. Assess the AV fistula for a bruit and thrill.

4. Assessment of the AV fistula for a bruit and thrill is important because, if not present, it indicates a nonfunctioning fistula. When not being dialyzed, the AV fistula site may get wet. Immediately after a dialysis treatment, the access site is covered with adhesive bandages. No blood pressures or venipunctures should be taken in the arm with the AV fistula.

A client had transurethral prostatectomy for BPH. He's currently being treated with continuous bladder irrigation and is complaining of an increase in severity of bladder spasms. What should the nurse do first for this client? 1. Administer an oral analgesic 2. Stop the irrigation and call the physician 3. Administer a belladonna and opium suppository as ordered by the physician 4. Check for the presence of clots, and make sure that the catheter is draining properly

4. Blood clots and blocked outflow of urine can increase spasms

Which instruction is given to clients with chronic pyelonephritis? 1. Stay on bed rest for up to 2 weeks 2. Use analgesia on a regular basis for up to 6 months 3. Have a urine culture every 2 weeks for up to 6 months 4. Antibiotic treatment may be needed for several weeks or months.

4. Chronic pyelonephritis can be a longterm condition requiring antibiotic treatment for several weeks or months as well as close monitoring to prevent permanent damage to the kidneys.

Which client is at greatest risk for developing acute renal failure? 1. A dialysis client who gets influenza 2. A teenager who has an appendectomy 3. A pregnant woman who has a fractured femur 4. A client with diabetes who has a heart catheterization

4. Clients with diabetes are prone to renal insufficiency and renal failure

A client received a kidney transplant 2 months ago. He's admitted to the hospital with the diagnosis of acute rejection. Which assessment finding should the nurse anticipate? 1. Hypotension 2. Normal body temperature 3. Decreased white blood cell (WBC) count 4. Elevated blood urea nitrogen (BUN) and creatinine levels

4. In a client with acute renal graft rejection, evidence of deteriorating renal function (elevated BUN and creatinine levels) is expected. The client would most likely have acute hypertension. The nurse would see fever and elevated WBC counts because the body is recognizing the graft as foreign and is attempting to fight it.

During a routine physical examination, a firm mass is palpated in the right breast of a 35-year-old female client. Which finding or client history would suggest cancer of the breast as opposed to fibrocystic disease? 1. Mass located in upper, outer quadrant 2. Cyclic change in mass size 3. History of anovulatory cycles 4. Increased vascularity of the breast.

4. Increase in breast size or vascularity is consistent with cancer of the breast. Masses associated with fibrocystic disease of the breast are firm, most commonly located in the upper outer quadrant of the breast, and increase in size prior to menstruation. They may be bilateral in a mirror image and are typically well demarcated and freely moveable.

A nurse is caring for clients who have a history of genital herpes infection. Which client is MOST at risk for an outbreak of genital herpes? 1. A client who complains of a headache and fever. 2. A client who complains of vaginal and urethral discharge. 3. A client who complains of dysuria and lymphadenopathy. 4. A client who complains of genital pruritus and paresthesia.

4. Pruritus and paresthesia as well as redness of the genital area are prodromal symptoms of recurrent herpes infection. These symptoms occur 30 minutes to 48 hours before the lesions appear. Headache and fever are symptoms of viremia associated with the primary infection. Vaginal and urethral discharge is also a local sign of primary infection. Dysuria and lymphadenopathy are local symptoms of primary infection that may also occur with recurrent infection.

During a health history, which statement by a client indicates a risk of renal calculi? 1. "Ive been drinking a lot of cola soft drinks lately." 2. "Ive been jogging more than usual" 3. Ive had more stress since we adopted a child last year 4. Im a vegetarian and eat cheese two or three times each day

4. Renal calculi are commonly composed of calcium. Diets high in calcium may predispose a person to renal calculi.

In a client with renal failure, which assessment finding may indicate hypocalcemia? 1. Headache 2. Serum calcium level of 10mg/dl 3. Increased blood coagulation 4. Diarrhea

4. Renal failure, calcium absorption form the intestine declines, leading to increased smooth-muscle contractions, causing diarrhea. Central nervous system changes in renal failure rarely cause headache. A serum calcium level of 9 to 10.5 mg/dl is a normal calcium level. As renal failure progresses, bleeding tendencies increase.

Adverse reactions of prednisone therapy include which conditions? 1. Acne and bleeding gums 2. Sodium retention and constipation 3. Mood swings and increased temperature 4. Increased blood glucose levels and decreased wound healing

4. Steroid use tends to increase blood glucose levels, particularly in clients with diabetes and borderline diabetes.

Steroids, such as prednisone and methylprednisolone, are used to suppress the inflammatory immune response following a kidney transplant. Which information should be give to a client with a transplant? 1. Alopecia may occur 2. Weight loss is common 3. Cholesterol levels may become elevated 4. Hypokalemia may result

4. Steroids may decrease serum potassium levels but dont increase cholesterol levels.

Which instruction should be given to a female client newly diagnosed with genital herpes? 1. Obtain a Papanicolaou (Pap) test every year. 2. Have your partner use a condom when lesions are present. 3. Use a water-soluble lubricant for relief of pruritus. 4. Limit stress and emotional upset as much as possible.

4. Stress, anxiety, and emotional upset seem to predispose to recurrent outbreaks of genial herpes. Because a relationship has been found between genital herpes and cervical cancer, a Pap test is recommended every 6 months. Sexual intercourse should be avoided during outbreaks, and a condom should be used between outbreaks; it isn't known if the virus can be transmitted at this time. During an outbreak, creams and lubricants should be avoided because they may prolong healing.

A client is admitted with sever nausea, vomiting, and diarrhea. He is hypotensive and is noted to have severe oliguria with elevated blood urea nitrogen (BUN) and creatinine levels. The nurse anticipates the physician will most likely write an order for which treatment? 1. Force oral fluids. 2. Give furosemide 20 mg IV 3. Start hemodialysis after a temporary access is obtained. 4. Start IV fluid of normal saline solution bolus followed by a maintenance dose.

4. The client is prerenal secondary to hypovolemia. IV fluids should be given to rehydrate the client,, urine output should increase, and the BUN and creatinine levels will normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid overloaded, and his urine output wont increase with furosemide. The client wont need dialysis because the oliguria and increased BUN and creatinine levels are due to dehydration.

A client is to under go a kidney transplantation with a living donor. What is the most important preoperative assessment by the nurse? 1. Urine output 2. Signs of graft rejection 3. Signs of symptoms of infection 4. Client's support system and understanding of lifestyle changes.

4. The client undergoing a renal transplantation will need vigilant follow-up care and must adhere to the medical regimen. The client is most likely anuric or oliguric preoperatively but postoperatively will require close monitoring of urine output to make sure the transplanted kidney is functioning optimally. Rejection can occur postoperatively. Although the client will always need to be monitored for signs and symptoms of infection, it's most important postoperatively because of the initiation of immunosuppressive therapy.

When providing discharge teaching for a client with uric acid calculi, the nurse should include an instruction to AVOID which type of food? 1. Cottage cheese 2. Beets 3. Spinach 4. Organ meats

4. To control uric acid calculi, the client should avoid high-purine foods such as organ meats. Beets and spinach are high in oxalate. Cottage cheese is high in calcium.

69. A client with cirrhosis complains that his skin always feels itchy. The nurse recognizes that the itching is a result of which abnormality associated with cirrhosis? 1. Prolonged prothrombin time 2. Decreased protein level 3. Increased bilirubin level 4. Increased aspartate aminotransferase level

Answer 3 High bilirubin levels irritate peripheral nerves, causing an intense itching sensation. Itching isn't a symptom of prolonged prothrombin time, decreased protein levels, or increased aspartate aminotransferase levels

59. When performing a physical assessment, the nurse discovers a clients urinary drainage bag lying next to him. Based on this finding, the nurse identifies which priority nursing diagnosis? 1. risk for infection 2. reflex urinary incontinence 3. impaired comfort 4. risk for compromised human dignity

Answer 1 The drainage bag shouldn't be placed alongside the client or on the floor because of the increased risk of infection caused by microorganisms. It should hang on the bed in a dependent position. The other nursing diagnoses ar3e not appropriate for this assessment finding.

54. A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which intervention is important? 1. Strain all urine 2. Limit fluid intake 3. enforce strict bed rest. 4. Encourage a high-calcium diet

Answer 1 urine should be strained for calculi and sent to the laboratory for analysis. Fluid intake of 3 to 4 (3-4 L)/day is encouraged to flush the urinary tract and prevent further calculi formation. Ambulation is encouraged to help pass the calculi through gravity. A low-calcium diet is recommended to help prevent the formation of calcium calculi.

58. A Client is diagnosed with cystitis. Client teaching aimed at preventing a recurrence should include which instruction? 1. bathe in a tub. 2. wear cotton underwear 3. use a feminine hygiene spray. 4. limit your intake of cranberry juice.

Answer 2 Cotton underwear prevents infection because it allows for air to flow to the perineum. Women should shower instead of taking a tub bath to prevent infection. Feminine hygiene spray can act as an irritant. Cranberry juice helps prevent cystitis because it increases urine acidity; alkaline urine supports bacterial growth, so cranberry juice intake should be increased, no limited.

61. A client with a history of chronic renal failure is admitted to the unit with pulmonary edema after missing his dialysis treatment yesterday. His lab result levels are serum potassium 6.0 mEq/L, serum sodium 130 mEq/L, and serum bicarbonate 18mEq/L. The nurse interprets that the client has which of the following conditions?

Answer 2 The kidneys are responsible for excreting potassium. In renal failure, the kidneys are no longer able to excrete potassium, resulting in hyperkalemia. The kidneys are responsible for regulating the acid-base balance; in renal failure, acidemia would be seen. Generally, hyponatremai would be seen because of the dilutional effect of water retention. Hypoikalemia is generally seen in clients undergoing diuresis.

56. A client has undergone a radical cystectomy and has an ileal conduit for the treatment of bladder cancer. Which postoperative assessment finding must be reported to the physician immediately? 1. A red, moist stoma 2. A dusky colored stoma 3. Urine output more than 30ml/hr 4. Slight bleeding from the stoma when changing the appliance

Answer 2 The stoma should be red and moist, indicating adequate blood flow. A dusky or cyanotic stoma indicates insufficient blood supply and is an emergency needing prompt intervention. Urine output less than 30ml/hr or no urine output for more than 15 min should be reported. Slight bleeding from the stoma when changing the appliance may occur because the intestinal mucosa is fragile.

72. For definitive diagnosis of cirrhosis, the nurse will assist with which diagnostic tests? 1. Albumin level 2. Bromsulfophthalein dye excretion 3. Liver biopsy 4. Liver enzyme levels

Answer 3 A liver biopsy can reveal the exact cause of the hepatomegaly. The albumin level will be low, but that can be caused by poor nutritional states. Bromsulfophthalein dye excretion may be reduced, but other hepatocirculatory disorders could also cause this. Liver enzymes may be elevated, but other liver conditions may cause these elevations.

70. Which factor causes biliary cirrhosis? 1. Acute viral hepatitis 2. Alcohol hepatotoxicity 3. Chronic biliary inflammation or obstruction 4. Heart failure with prolonged venous hepatic congestion

Answer 3 Chronic biliary inflammation or obstruction causes biliary cirrhosis. Acute viral hepatitis can cause postnecrotic cirrhosis. Alcohol hepatotoxicity is Laennec's cirrhosis. Heart failure with prolonged venous hepatic congestion will cause cardiac cirrhosis.

65. When admitting a client to the hospital with suspected acute pancreatitis, which electrolyte disorder would be expected? 1. Hypoglycemia 2. Hypernatremia 3. Hypocalcemia 4. Hyperkalemia

Answer 3 The client with acute pancreatitis may exhibit hypocalcemia due to the deposit of calcium in areas of fat necrosis. Hyperglycemia, not hypoglycemia, may occur due to reduced insulin production caused by islet of langerhans involvement. Hypokalemia and hyponatremia may occur because potassium is lost in emesis, but hypernatremia is unlikely.

67. A client presents to the emergency department with abdominal pain, weight loss, steatorrhea, and a random glucose of 417 mg/dl. The nurse should expect which diagnostic test to be ordered? 1. Upper GI series 2. Lower GI series 3. Ultrasound of the abdomen 4. Colonoscopy

Answer 3 The symptoms described correlate with chronic pancreatitis. An abdominal ultrasound could reveal pancreatic changes. The other tests are of no value in evaluating the pancreas.

57. Which instruction about skin care at the stoma site should be given to a client with an ileal conduit? 1. change the appliance at bedtime. 2. Leave the stoma open to air while changing the appliance. 3. Clean the skin around the stoma with mild soap and water, and dry it thoroughly. 4. Cut the faceplate or wafer of the appliance no more than 4mm larger than the stoma.

Answer 3 Cleaning the skin around the stoma with mild soap and water and drying it thoroughly helps keep the area clean from urine, which can irritate the skin. Change the appliance in the early morning when urine output is less to decrease the amount of urine in contact with the skin. The stoma should be covered with a gauze pad when changing the appliance to prevent seepage of urine onto the sin. The faceplate or wafer of the appliance shouldn't be more than 3mm larger than the stoma to reduce the skin area in contact with urine.

73. Which of the following assessment findings would be consistent with a client's diagnosis of cirrhosis? 1. Increased carbon dioxide level 2. Increased pH level 3. Increased prothrombin time 4. Increased white blood cell (WBC) Count

Answer 3 Clotting factors may not be produced normally when a client has cirrhosis, increasing the potential for bleeding. There's no associated change in carbon dioxide level or pH unless the client is developing other comorbidities, such as metabolic alkalosis. The WBC count can be elevated in acute cirrhosis but isn't always altered.

60. Which method should be used to collect a specimen for urine culture? 1. Have the client void in a clean container. 2. Clean the foreskin of the penis of uncircumcised men before specimen collection. 3. Have the client void into a urinal, and then pour the urine into the specimen container. 4. Have the client begin to the stream of urine in the toilet and catch the urine in a sterile container midstream.

Answer 4 Catching urine midstream reduces the amount of contamination by microorganisms at the meatus. Voiding in a clean container is done for a random specimen, not a clean-catch specimen for urine culture. When cleaning an uncircumcised male, the foreskin should be retracted and the glans penis should be cleaned to prevent specimen contamination. Voiding in a urnial doesn't allow for an uncontaminated specimen because the urinal isn't sterile.

63. A client with pancreatitis may exhibit cullen's sign on physical examination. Which symptom best describes cullen's sign? 1. Jaundiced sclera 2. Pain that occurs with movement 3. Bluish discoloration of the left flank area 4. Bluish discoloration of the periumbilical area

Answer 4 Cullen's sign is bluish discoloration of the periumbilical area from subcutaneous intraperitoneal hemorrhagic pancreatitis. Jaundiced sclera occurs with hepatitis. Pain with movement is a common finding with peritonitis. Turner's sign is the bluish discoloration of the left flank area, which can be present in peritonitis.

64. Which factor should be the initial focus of nursing management in a client with acute pancreatitis? 1. Dietary management 2. Prevention of skin breakdown 3. Management of hypoglycemia 4. Pain control

Answer 4 The priority is to provide adequate pain control, Tghius is essential to minimize discomfort and restlessness, which may stimulate pancreatic secreation further. Initially, the clien with acute pancreatitis isn't permitted food and oral intake. Although prevention of skin breakdown is important, it isn't the initial focus. Clients are at risk for hyperglycemia, not hypoglycemia.

68. In alcohol-related pancreatitis, which intervention is the best way to reduce the exacerbation of pain? 1. Lying in a supine position 2. taking aspirin 3. Eating a low-fat diet 4 Abstaining from alcohol

Answer 4 Abstaining from alcohol is imperative to reduce the injury to the pancreas; in fact, it may be enough to completely control pain. Lying in a supine position usually aggravates the pain because it stretches the abdominal muscles. Taking aspirin can cause bleeding in hemorrhagic pancreatitis. During an attack of acute pancreatitis, the client usually isn't allowed to ingest anything orally.

55. A client is receiving a radiation implant for the treatment of bladder cancer. Which intervention is appropriate? 1. Flush all urine down the toilet. 2. Restrict the client's fluid intake. 3. Place the client in a semiprivate room 4. Monitor the client for signs and symptoms of cystitis.

Answer 4 Cystitis is the most common adverse reaction of clients undergoing radiation therapy; symptoms include dysuria, frequency, urgency, and nocturia. Urine of clients with radiation implants for bladder cancer should be sent to the radioisotopes laboratory for monitoring. It's recommended that fluid intake be increased. Clients with radiation implants require a private room.

34. Which interventions is appropriate for a client having hysterosalpingography? 1. Give the client a perineal pad to wear after the procedure. 2. Give the client nothing by mouth after midnight the night before the procedure. 3. Position the client in the knee-chest position during the procedure. 4. Keep the client in a dorsal recumbent position for 4 hours after the procedure.

Answer: 1 A perineal pad is needed after hysterosalpingography because the contrast medium may leak from the vagina for several hours and stain the clothing. The bowel needs to be cleaned before the procedure, but the client doesn't have to refrain from having anything by mouth after midnight. The procedure is performed with the client in the lithotomy position, and no special positioning is required after the procedure.

37. Which statement by a client scheduled for a vasectomy indicates the needs the further teaching about the procedure? 1. "I'm glad I won't have to worry about contraception as soon as this procedure is done." 2. "I'll need to place an ice pack over the incision several times a day when I first go home." 3. "I know this procedure can be reversed, but the success rate is low." 4. "I'll have to limit my usual activities for about 1 week."

Answer: 1 After vasectomy, the client remains fertile for several weeks until sperm stored distal to the severed vas are evacuated. After this occurs, sperm are still produced but they don't enter the ejaculate and are absorbed by the body. The other statements are accurate.

Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a patient with benign prostatic hyperplasia (BPH)? 1. Voiding pattern 2. Size of the prostate 3. Creatinine clearance 4. Serum testosterone level

Answer: 1 Alpha-adrenergic blockers relax the smooth muscle of the bladder neck and prostate, so the urinary voiding symptoms (frequency, urgency, hesitancy) of BPH are reduced in many clients. These drugs don't affect the size of the prostate, renal function or production or metabolism of testosterone.

On a follow-up visit after having a vaginal hysterectomy, a 32-year-old client has an elevated temperature and decreased hematocrit. Which complication does this suggest? 1.Hematoma 2. Hypovolemia 3. Infection 4. Thromboembolism

Answer: 1 An elevated temperature and decreased hematocrit are signs of hematoma, a delayed complication of abdominal and vaginal hysterrectomy. Symptoms of hypovolemia include increased hematocrit and hemoglobin levels. Temperature is a classic sign of infection, but a decreased hematocrit isnt. Abrupt onset of fever is a symptom of thromboembolism, but other symptoms include dyspnea, chest pain, cough, hemoptysis, restlessness, and signs of shock.

28. Which assessment finding would be a cause for alarm in a client taking finasteride (Proscar)? 1. Azotemia 2. Breast enlargement 3. Decreased prostate size 4. Flushing

Answer: 1 Azotemia, a buildup of nitrogenous waste products in the blood, indicates impaired renal function. Finasteride, an antiandrogenic agent, is prescribed for chronic urinary retention with large residual volumes secondary to benign prostatic hypertrophy. Azotemia in a client on finasteride therapy can indicate the drug isn't effective in relieving the urinary symptoms associated with benign prostatic hypertrophy or that an unrelated renal problem has occurred. Breast enlargement, decrease in prostate size, and flushing are expected effects on finasteride.

26. Which comment made by a client being treated for chronic prostatitis indicates that self-care instructions need to be clarified? 1. "I miss not being able to have sex." 2. "I enjoy frequent soaking in a hot tub of water." 3. "Cutting down on coffee hasn't been as hard as I expected." 4. "I'm used to getting up and moving, not just sitting for long periods.

Answer: 1 Ejaculation can aid in the treatment of chronic prostatitis by decreasing the retention of prostatic fluid. Coffee should be eliminated from the diet because it can increase prostate secretion. Warm sitz baths and not sitting for too long as a time promote comfort.

Which nursing intervention is appropriate for a client who had breast reconstruction surgery? 1. Prevent hypothermia 2. Maintain even pressure on the wound 3. Position client on the operative side 4. Raise the client's arms over her hear four times a day

Answer: 1 Hypothermia causes a decrease in suface circulation. This can lead to ischemia of the skin or muscle graft and ultimately to tissue necrosis. Because of the importance of maintaining good circulation, pressure on the breast wound must be avoided, so the client is positioned on the back or nonoperative side. Arms shouldn't be lifted above the shoulder level for 4-6 weeks.

38. Which are of client teaching should be stressed when the goal is preventing the development of phimosis in a 20-year old uncircumcised client? 1. Proper cleaning of the prepuce 2. Importance of regular ejaculation 3. Technique of testicular self-examination 4. Proper hand washing before touching the genitals.

Answer: 1 Proper cleaning of the preputial area to remove secretions is critical to the preventions of noncongenital phimosis. Regular ejaculation can decrease the symptoms of chronic prostatitis, but it has no effect on the development of phimosis. Testicular self-examination is important in the early detection and treatment of testicular cancer. Hand washing is important in preventing the spread of infection.

Which client is a GREATEST risk for dehydration? 1. A 48-year-old having intracavitary radiation for cancer of the cervix 2. A 59-year-old 1 week after radical vulvectomy 3. A 67-year-old receiving adjuvant tamoxifen therapy for breast cancer 4. A 72-year-old with a vesicovaginal fistula

Answer: 1 Regardless of age, dehydration is a risk caused by fluid loss secondary to tissure destruction at the site of irradiation. After radical vulvectomy, wound drains are generally removed post-op day 4 or 5 and don't create significatn risk of dehydration. Tamoxifen therapy is unrelated to dehydration. Although urine may escape through the vagina as a result of a vesicovaginal fistula, it doesn't cause an abnormal amount of fluid to be lost.

42. Which discharge instruction should be given to a client after a prostatectomy? 1. Avoid straining at strool. 2. Report clots in the urine right away. 3. Soak in a warm tub daily for comfort. 4. Return to your usual activities in 3 weeks.

Answer: 1 Straining at stool after prostatectomy can cause bleeding. Small blood clots or pieces of tissue commonly are passed in the urine for up to 2 weeks postoperatively. Tub baths are prohibited because they cause dilation of pelvic blood vessels. Other activities are resumed based on the guidance of the physician. Sexual intercourse and driving are usually prohibited for about 3 weeks. Exercising and returning to work are usually prohibited for about 6 weeks.

Which comfort measure can be recommended to a client with genital herpes? 1. Wear loose cotton underwear 2. Apply a water-based lubricant to the lesions 3. Rub rather than scratch in response to an itch 4. Pour hydrogen peroxide and water over the lesions

Answer: 1 Wearing loose cotton underwear promotes drying and helps avoid irritation of the lesions. Use of lubricants is contraindicated because they can prolong healing time and increase the risk of secondary infection. Lesions shouldn't be rubbed or scratched because of the risk of tissue damage and additional infection. Cool, wet compresses can be used to soothe the itch. The use of hydrogen peroxide and water on lesions isn't recommended.

Which instruction should be given to a client with prostatitis who's receiving co-trimoxazole double strength (Bactrim DS)? 1. Don't expect improvement of symptoms for 7-10 days 2. Drink 6-8 glasses of fluid daily while taking the medication 3. If a sore mouth or throat develops, take the medication with milk or antacid 4. Use sunscreen of at least SPF-15 with para-aminobenzoic acid (PABA) to protect against drug-induced photosensitivity

Answer: 2 6-8 glasses of fluid daily are needed to prevent renal problems, such as crystalluria and stone formation. The symptoms should improve in a few days if the drug is effective. Sore throat and sore mouth are adverse effects that should be reported right away. The drug causes photosensitivity, but a PABA-free sunscreen should be used because PABA can interfere with the drug's action

40. Which instruction should be given when teaching penile hygiene? 1. Use warm water without soap. 2. Dry all areas of the penis thoroughly. 3. Wash from the base of the shaft to the tip. 5. Avoid retracting the foreskin if not circumcised.

Answer: 2 Careful drying is essential to avoid maceration of the penis. To decrease the risk of genitourinary infection, wash the penis from the tip to the base to reduce the risk for introducing pathogens into the urethral meatus. Effective cleaning requires soap and thorough rinsing. It's also essential to remove secretions that accumulate under the foreskin because they can lead to inflammation and are associated with the development of penile cancer. The foreskin in uncircumcised men must be retractable for cleaning, then replaced to prevent paraphimosis.

A nurse enters the room of a client who had a left modified mastectomy 8 hours earlier. Which observation indicates that the nursing assistant assigned to the client needs further instruction? 1. The client is squeezing a ball in her left hand 2. The client is wearing a robe with elastic cuffs 3. The client's affected arm is elevated on a pillow 4. A blood pressure cuff is on the client's right arm

Answer: 2 Elastic cuffs can contribute to the development of lymphedema and should be avoided. Simple exercises, such as squeezing a ball, help promote circulation and should be started as soon as possible after surgery. Elevation of the affected arm promotes venous and lymphatic return from the extremity. Blood pressure measurements in affected arm also should be avoided.

Which finding indicates that oxycodone given to a client with breast cancer metastisized to the bone is exerting the desired effect? 1. Bone density is increased 2. pain is 0-2 on 10 point scale 3. Alpha-fetoprotein level is increased 4. Serum calcium level is within normal range

Answer: 2 Oxycodone is an opiod analgesic used for alleviating severe pain, especially in terminal illness. If a client's pain has decreased to 0-2 on a 10 point scale, the medication is working as desired. The drug doesn't directly affect bone density, alpha-fetoprotein level, or serum calcium level.

Which response is the most appropriate when a client asks what activity limitations are necessary after a dilation and curettage procedure? 1. Tampons may be used during exercise 2. Avoid strenuous work and sexual intercourse for at least 2 weeks 3. Stay on bed rest for 3 days; then gradually resume normal activity 4. Take a soaking tub bath each day to promote relaxation

Answer: 2 Strenuous work, which can result in increased bleeding, should be avoided for 2 weeks to allow time for healing. Sexual inercourse should be avoided for 2 weeks to allow healing and thus decrease the risk of infection. Tampons and tub baths should be avoided for 1 week. Overall activity should be gradually resumed, reaching preoperative levels in the 2-week period, but bed rest isn't necessary. No other restrictions are routinely necessary.

Which client is at GREATEST risk for having a false-positive Venereal Disease Research Laboratory (VDRL) result? 1. An alcoholic 2. A narcotics addict 3. A transfusion recipient 4. A breast-feeding monther

Answer: 2 The VDRL is a nontreponemal test used to check for the presence of reagins in the clients serum. It isn't specific for syphilis, so false-positive results occur for a variety of reasons, most commonly in clients with chronic infection, autoimmune disease, and narcotics addiction. History of alcoholism, transfusion, or breast-feeding alone doesn't constitute a risk of false-positive VDRL.

35. The nurse is instructing a client with vulvovaginal candidiasis on the use of the prescribed Nystatin vaginal tablets. Which of the following statements indicates the client needs additional teaching? 1. "I will need to refrigerate the Nystatin tablets." 2. "I can get up to do other activities after inserting the medicine." 3. "I will finish all the tablets even if I am feeling better." 4. "I should report any increased skin irritation to my doctor."

Answer: 2 The client needs to continue lying down for at least 30 minutes after insertion of the vaginal tablets. Refrigerating Nystatin tablets, finishing all the tablets, and reporting any increased skin irritation to the doctor are all important interventions concerning this medication.

39. Which statement should be included when teaching a client newly diagnosed with testicular cancer? 1. Testicular cancer isn't responsive to chemotherapy, but it's highly curative with surgery. 2. Radiation therapy is never used, so the unaffected testicle remains healthy. 3. Testicular self-examination is still important because there's increased risk for a second tumor. 4. Taking testosterone after orchiectomy prevents changes in appearance and sexual function.

Answer: 3 A history of a testicular malignancy puts the client at increased risk for a second tumor. Testicular self-examination allows for early detection and treatment and is critical. Chemotherapy is added for clients who have evidence of metastasis after irradiation. Radiation therapy is used on the retroperinoteal lymph nodes. Testosterone usually isn't needed because the unaffected testis usually produces sufficient hormone.

A client who had intracavitary radiation treatment for cancer of the cervix 1 month earlier reports small amounts of vaginal bleeding. This most likely represents which condition? 1. Recurrence of the carcinoma 2. Development of a rectovaginal fistula 3. Expected effect of radiation therapy 4. Infection secondary to a change in vaginal flora

Answer: 3 After intracavitary radiation, some vaginal bleeding occurs for 1-3 months. Intermittent painless vaginal bleeding is a classic symptom of cervical cancer, but given the clients history, bleeding is more liekly a result of the radiation than recurrent cancer. The passage of feces through the vagina, not vaginal bleeding, is a sign of rectovaginal fistula. Vaginal infections show various types of vaginal discharge but not vaginal bleeding.

41. Which statement shows the significance of a persistent elevation in alpha-fetoprotein level after orchiectomy for testicular cancer? 1. Fertility is maintained. 2. The cancer has recurred. 3. There's metastatic disease. 4. Testosterone levels are low.

Answer: 3 Alpha-fetoprotein is a tumor marker elevated in nonseminomatous malignancies of the testicle. After the tumor is removed, the level should decrease. A persistent elevation after orchiectomy indicates a tumor is present someplace outside the testicle that was removed. The level alpha-fetoprotein isn't related to fertility or testosterone level. A recurrence of the cancer is indicated by a postsurgical decrease in alpha-fetoprotein level followed by an elevation as a new tumor starts to grow.

31. Which condition of the female reproductive system generally requires the identification and treatment of sexual partners? 1. Bartholinitis 2. Candidiasis 3. Chlamydia 4. Endometriosis

Answer: 3 Chlamydia is a common sexually transmitted disease requiring the treatment of all current sexual partners to prevent reinfection. Bartholinitis results from obstruction of a duct. Sexual partners may become infected, although men can usually be treated with over-the-counter products. Candidiasis a yeast infection that typically occurs as a result of antibiotic use. Endometriosis occurs when endometrial cells are seeded throughout the pelvis and isn't a sexually transmitted disease.

43. After a biopsy of the prostate, which symptom should a nurse instruct a client to report? 1. Pain on the following day. 2. Discolored semen 3. Difficulty urinating 4. Temperature greater than 99 F (37.2 C)

Answer: 3 Difficulty urinating suggests urethral obstruction. Mild pain is expected for 1 to 3 days after the biopsy. Semen may be discolored for up to a month after the biopsy. Temperature higher than 101 F should be reported because if suggests infection.

A physician tells a client to return 1 week after treatment to have a repeat culture done to verify the cure. This would be appropriate for a woman with which condition? 1. Genital warts 2. Genital herpes 3. Gonorrhea 4. Syphilis

Answer: 3 Gonococcal infections can be completely eliminated by drug therapy, which is documented 4-7 days after therapy is finished. Genital warts aren't curable and are identified by appearance, not culture. Genital herpes isn't curable and is identified by the appearance of the lesions or by cytologic studies. The diagnosis of syphilis is by darkfield microscopy or serologic tests.

In which group is it MOST IMPORTANT for a client to understand the imporatance of an annual papanicolaou test? 1. Clients with a history of reccurent cadidiasis 2. Clients with pregnancy before age 20 3. Clients infected with human papillomavirus (HPV) 4. Clients witha long history of oral contraceptive

Answer: 3 HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before 20, and use of oral contraceptives don't increase the risk of cervical cancer.

29. Which treatment is appropriate for a client with cervical polyps who has been treated with cryosurgery? 1. Daily douche 2. Oral antiobiotics 3. Intravaginal antibiotic cream 4. Use of tampons for 72 hours.

Answer: 3 Intravaginal antibiotic cream is commonly used to aid healing and prevent infections. Oral antibiotics are used for clients with acute cerviticitis or perimetritis. Douching is generally avoided for 2 weeks, as is the use of tampons.

A 27-year old man arrives at the clinic with priapism. The nurse arranges for a immediate urologic consult because of the risk of which condition? 1. Disseminated intravascular coagulation 2. Hydronephrosis 3. Penile gangrene 4. Testicular atrophy

Answer: 3 Priapism is a condition in which the penis is persistently erect and painful. It's a urologic emergency because gangrene secondary to ischemia can result if venous drainage of the corpora cavernosa doesn't occur. Priapism doesn't cause DIC, hydronephrosis, or testicular atrophy.

27. Perineal pain in the absence of any observable cause is suggestive of which condition? 1. Endometriosis 2. Internal hemorrhoids 3. Prostatitis 4. Renal calculus

Answer: 3 Prostatitis can cause prostate pain, which is felt as perineal discomfort. Endometriosis can cause pain low in the abdomen, deep in the pelvis, or in the rectal or sacrococcygeal area, depending on the location of the ectopic tissue. Hemorrhoids cause rectal pain and pressure. Renal calculi typically produce flank pain.

Which factor in a client's history indicates she's at risk for candidiasis? 1. Nulliparity 2. Menopause 3. Use of corticosteroids 4. Use of spermicidal jelly

Answer: 3 Small numbers of the fungus Candida albicans commonly are ofund in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Pregnancy, not nulliparity, increases the risk of candidiasis. It is rare before menarche and after menopause. The use of oral contraceptives, not spermicidal jelly, increases the risk of candidiasis.

Which instruction is the most important to give women to decrease the risk of toxic shock syndrome? 1. Avoid douching 2. Wear loose cotton underwear 3. Use pads, not tampons, overnight 4. Avoid sexual intercourse during menses

Answer: 3 The cause of toxic shock syndrome is a toxin produced by staphylococcus aureus bacteria. It occurs most commonly in menstrating women using tampons. Tampons, particularly when left in place for more than 8 hours, are believed to provide a good environment for growth of the bacteria, which then enter the bloodstream through breaks in the vaginal mucousa. Douching, use of loose cotton underwear, and sexual intercourse during menstruation have no direct association with toxic shock syndrome.

A 19-year-old woman reports an intermitent milky vaginal discharge. She isn't sexually active and denies itching or burning. Which factor is the most liekly cause of the discharge? 1. Inadequate cleaning of perineal area 2. Sensitivity to feminine hygiene product 3. Normal fluctuation in estrogen and progesterone levels 4. Reaction to heat and moisture from wearing tight clothing

Answer: 3 Vaginal fluid is clear, milky, or cloudy depending on the fluctuating levels of estrogen and progesterone. A milky-appearing vaginal discharge is normal and isn't associated with inadequate cleaning, sensitivity, or reaction to heat or moisture.

32. Which information should be given to a client taking metronidazole (Flagyl)? 1. Breathlessness and cough are common adverse effects. 2. Urine may develop a greenish tinge while the client is taking this drug. 3. Mixing this drug while alcohol causes severe nausea and vomiting 4. Heart palpitations may occur and should be immediately reported.

Answer: 3 When mixed with alcohol, metronidazole causes a disulfram-like effect involving nausea, vomiting, and other unpleasant symptoms. Urine may turn reddish brown, not greenish, from the drug. Cardiovascular or respiratory effects aren't associated with use of this drug.

Which statement best explains why it's important to empty the bowel before treatment with intracavitary radiation for cancer of the cervix? 1. Feces int he bowel increase risk for ileus 2. An empty bowel allows the applicator to be positioned with little or no discomfort 3. Bowel movements increase the risk of inadvertent contamination of the vagina urethra 4. Pressure changes in the pelvis associated with bowel movements can alter the position of the applicator and radiation source

Answer: 4 A position change of the radioactive implant could deliver more radiation to healthy tissues and less to the malignant lesion. This increases the risk of injury to healthy tissue and decreases effectiveness of treatment on the cancer. Feces in the bowel increase the likelihood of a BM, which can change the position of the applicator and radiation source. Feces in the bowel don't increase the risk of ileus or inadvertent contamination of the vagina and urethra from a BM. Applicators are usually inserted under anesthesia in the OR.

Which assessment finding is expected in a client receiving bicalutamide (Casodex) and leuprolide (Lupron) for advanced prostate cancer? 1. Abdominal distention 2. Acromegaly 3. Colicky pain 4. Hot flashes

Answer: 4 Bicalutamide, a nonsteroidal antiandrogen, and leuprolide, a gonadotropin-releasing hormone agonist, decrease the production of testosterone. This helps to decrease the production of cancer cells involved in the prostate cancer. Because androgens are responsible for the development of the male genitalia and secondary male sec characteristics, low androgen levels can cause genital atrophy, breast elargement, and hot flashes.

Which statement made by a client with a chlamydial infection indicates an understanding of the potential complications? 1. "I'm glad I'm not pregnant; I'd hate to have a malformed baby from this disease." 2. "I hope this medicine works before this disease gets into my urine and destroys my kidneys." 3. "If I had known a diaphram would put me at risk for this, I would've taken birth control." 4. "I need to treat this infection so it doesn't spread intomy pelvis because I want to have children some day."

Answer: 4 Chlamydia is a common cause of pelvic inflammatory disease and infertility. It doesn't cause birth defects or affect the kidneys. It can cause conjuntivitis and respiratory infection in neonates exposed to infected cervicovaginal secretions during delivery. Use of diaphragm isn't a factor.

30. Which interventions would be correct for a woman having intracavity radiation for cancer of the cervix? 1. High-residue diet 2. Fowler's position when in bed 3. Intermittent urinary catheterization 4. Bed rest

Answer: 4 Clients having intracavitary radiation therapy are on strict bed rest, with the head of the bed elevated no more than 10 to 15 degrees to avoid displacing the radiation source. A low-residue diet is used to prevent diarrhea during treatment. An order for Fowler's position when in bed is incorrect. An indwelling urinary catheter, not intermittent urinary catheterization, is used to prevent urine from distending the bladder and changing the position of tissues relative to the radiation source.

36. A 36-year old client who has never had mumps reports that he was just notified that an 8-year old child of a family with whom he stayed recently has been diagnosed with mumps. Which treatment should the client receive? 1. I.V. antibiotics 2. Ice packs to the scrotum 3. Application of a scrotal support 4. Administration of gamma globulin

Answer: 4 Gamma globulin provides passive immunity to mumps. Antibiotic therapy is used in the treatment of bacterial orchitis. Ice and the use of a scrotal support are used as comfort measures in the treatment of orchitis.

A nursing diagnosis addressing Risk for Impaired Tissue Integrity would be MOST APPROPRIATE for which client? 1. A client with endometriosis 2. A client taking oral contraceptives 3. A client with vaginal packing in place 4. A client having reconstructive breast surgery

Answer: 4 Reconstructive breast surgery places the client at risk for insufficient blood supply to the muscle graft and skin, which can lead to tissue necrosis. Endometriosis or oral contraceptives aren't generally associated with altered tissue perfursion. Pressure from vaginal packing can sometimes put pressure on the bladder neck and interfere with voiding.

For which symptoms should a client at risk for evisceration be monitored after an abdominal hysterectomy? 1. Tachycardia accompanied by a weak, thready pulse 2. Hypotension with a decreased level of consciousness (LOC) 3. Shallow, rapid respirations and increasing vaginal drainage 4. Low-grade fever with increasing serosanguineous incisional fluid

Answer: 4 Signs of impending evisceration are low-grade fever and increasing serosanguineous drainage. Tachycardia; weak, thready pulse; hypotension; decreased LOC; shallow, rapid respirations; and vaginal drainage after abdominal hysterectomy are all unrelated to impending evisceration, although they may be associated with other serious problems such as shock.

Copious amounts of frothy, greenish vaginal discharge would be a symptom with which infection? 1. Candidiasis 2. Gardnerella vaginallis vaginitis 3. Gonorrhea 4. Trichamoniasis

Answer: 4 The discharge associated with Trichomonas are homogenous, greenish gray, watery, and frothy or purulent. The discharge associated with candidiasis is this and white and resembles cottage cheese in appearance, while that associated with infection due to Gardnerella vaginalis is thin and grayish white, with a marked fishy odor. With gonorrhea, vaginal discharge is purulent when present but, in many women, it's asymptomatic.

53. Discharge instructions for a client treated for acute pyelonephritis should include which statement? 1. avoid taking any dairy products. 2. Return for follow-up urine cultures. 3. Stop taking the prescribed antibiotics when the symptoms subside. Recurrence is unlikely because you've been treated with antibiotic's

answer 2 The client needs to return for follow up urine cultures because bacteriuria may be present but asymptomatic, Intake of dairy products won't contribute to pyelonephritis. Antibiotics need to be taken for the full course of therapy regardless of symptoms. Pyelonephriti typically recurs as a relapse or new infection and frequently recurs within 2 weeks of completing therapy.