Evolve Urinary/Reproductive Systems

A client is injured in a motor vehicle accident and admitted for observation. Damage to the bladder is evident. The nurse takes the client's history and concludes that the client is at increased risk of bladder rupture based on the history of:

Not having voided for six hours

A client who is dehydrated is to receive an intravenous (IV) solution of normal saline to be infused at 175 mL/hr. The drop factor of the IV set is 15 gtts/mL. At what drop rate should the nurse adjust the flow to provide the prescribed solution? Record your answer using a whole number. __________ gtts/min

44

A client with chronic kidney disease has been on hemodialysis for two years. The client relates to a nurse in the dialysis unit in an angry, critical manner and frequently does not follow the prescribed diet or take prescribed medications. What does the nurse identify as the most likely underlying cause of this behavior?

A defense against underlying depression and fear

A client with acute kidney failure becomes confused and irritable. Which does the nurse determine is the most likely cause of this behavior?

An increased blood urea nitrogen level

A client reports to a health clinic because a sexual partner recently was diagnosed as having gonorrhea. The health history reveals that the client has engaged in receptive anal intercourse. The nurse should assess the client for:

Anal itching

A client with end-stage renal disease is hospitalized. For what signs and symptoms of complications should the nurse monitor the client? (Select all that apply.)

Anemia Dyspnea Anasarca

A client who had a transurethral resection of the prostate is transferred to the post-anesthesia care unit with an IV and a urinary retention catheter. For which major complication is it most important for the nurse to assess during the immediate postoperative period?

Hemorrhage

A nurse is caring for a client who is being treated with continuous ambulatory peritoneal dialysis (CAPD) for chronic glomerulonephritis. What dietary need should the nurse discuss with the client?

High-quality protein

A nurse is assessing a client who is scheduled for a liver biopsy. What assessment finding needs to be reported immediately because it warrants a postponement of the liver biopsy?

International normalized ratio (INR) of 4.0

A client experiences difficulty in voiding after an indwelling urinary catheter is removed. The nurse determines that this difficulty most likely is related to:

Interruption in previous voiding habits

A health care provider prescribes furosemide (Lasix) for a client with hypervolemia. The nurse recalls that furosemide exerts its effects in what part of the renal system?

Loop of Henle

A nurse is caring for a client with a diagnosis of renal calculi secondary to hyperparathyroidism. Which type of diet should the nurse explore with the client when providing discharge information?

Low calcium

A nurse is caring for a client with an undescended testicle. The nurse teaches the client that the main reason why the testicles are suspended in the scrotum is to:

Protect the sperm from high abdominal temperatures.

What is the most basic method the nurse can use when encouraging hospitalized clients to void?

Providing privacy

A sexually active client presents with a sore throat and a generalized rash. The client states that a chancre that had been present healed approximately three months ago. The physical assessment and the serologic test findings indicate a diagnosis of syphilis. The nurse recognizes that the client is experiencing what stage of syphilis?

Secondary

A nurse is providing postoperative care to a client who had a kidney transplant. What assessment is the best indicator of the functioning of the newly transplanted kidney?

Serum creatinine

A client is diagnosed as having invasive cancer of the bladder, and radiation therapy is scheduled. What should the nurse expect the client to demonstrate that indicates success of radiation therapy?

Shrinkage of the tumor on scanning

A female client has a history of recurrent urinary tract infections. What should the nurse include in the teaching plan when teaching the client about health practices that may help decrease future urinary tract infections?

Wear cotton underpants

A nurse administers trimethoprim-sulfamethoxazole (Bactrim) to a client diagnosed with a urinary tract infection. What should the nurse monitor to determine the therapeutic effectiveness of the drug?

White blood cell (WBC) count

A client with tuberculosis is started on a chemotherapy protocol that includes rifampin (RIF). The nurse evaluates that the teaching about rifampin is effective when the client states:

"I can expect my urine to turn orange from this medication.

A client who has had a transurethral prostatectomy (TURP) experiences dribbling after the indwelling catheter is removed. To address this problem, an appropriate nursing response is:

"Increase your fluid intake and urinate at regular intervals.

A client has a permanent colostomy. During the first 24 hours, there is no drainage from the colostomy. The nurse concludes that this is a result of the:

Absence of intestinal peristalsis

After a transurethral vaporization of the prostate, the client returns to the unit with an indwelling urinary catheter and a continuous bladder irrigation. The client puts the call light on to report the need to urinate. What should the nurse do first?

Assess that the tubing attached to the collection bag is patent

To facilitate micturition in a male client, the nurse should instruct him to

Assume the standing position for voiding

A nurse instructs a client with a history of frequent urinary tract infections to drink cranberry juice to:

Decrease the urinary pH

When admitting a client with benign prostatic hyperplasia, the most relevant assessment made by the nurse is:

Distention of the suprapubic area

A nurse evaluates that a client understands the side effects of hydrochlorothiazide (HCTZ) therapy when the client states, "I should call my health care provider if I develop:

Generalized weakness.

A client with acute glomerulonephritis reports feeling thirsty. What should the nurse offer the client?

Hard candy

A client is admitted to a medical unit with the diagnosis of acute kidney failure. The nurse reviews the client's laboratory data, performs a physical assessment, and obtains the client's vital signs. What should the nurse conclude the client is most likely experiencing?

Hyperkalemia

A client is diagnosed as having kidney failure. During the oliguric phase the nurse should assess the client for:

Hyperkalemia

The nurse is caring for a client with ureteral colic. To prevent the development of renal calculi in the future, the client's plan of care should include:

Instructing the client to drink 8 to 10 glasses of water daily

A pathology report states that a client's urinary calculus is composed of uric acid. Which should the nurse instruct the client to avoid?

Liver

A client who had a suprapubic prostatectomy returns from the post-anesthesia care unit and accidentally pulls out the urethral catheter. What should the nurse do first?

Notify the health care provider

A male client has discharge from his penis. Gonorrhea is suspected. To obtain a specimen for a culture, the nurse should:

Swab the drainage directly from the urethra to obtain a specimen

A client is scheduled for an intravenous pyelogram (IVP). The nurse explains that on the day before the IVP the client must:

Take a laxative before going to bed

A nurse is planning to administer a prescribed intravenous solution that contains potassium chloride. What assessment should be brought to the health care provider's attention before administration of the intravenous (IV) line?

Urinary output of 200 mL during the previous 8 hours

The nurse determines that which genitourinary factor contributes to urinary incontinence in older adults?

Urinary tract infection

After prostate surgery a client's indwelling catheter and continuous bladder irrigation (CBI) are to be removed. The nurse discusses the procedure with the client. The nurse evaluates that the teaching is understood when the client states, "After the catheter is removed I probably will:

Experience some burning on urination."

A nurse concludes that the anemia that accompanies chronic kidney disease should be treated because it contributes to:

Chronic fatigue

The nurse provides education to a client about the side effects of furosemide (Lasix). Which client statements indicate that the teaching is understood? (Select all that apply.)

"I should change my position slowly." "I must eat a food that contains potassium every day."

The nurse provides education to a client about the side effects of furosemide (Lasix). Which client statements indicate that the teaching is understood? (Select all that apply.)

"I should change my position slowly." "I must eat a food that contains potassium every day.

A 40-year-old client scheduled for a hemi-colectomy because of ulcerative colitis asks if having a hemi-colectomy means wearing a pouch and having bowel movements in an abnormal way. Which is the best response by the nurse?

"No, only part of the colon is removed and the rest reattached.

A client has undergone surgery with general anesthesia. Within how many hours after surgery should the nurse notify the health care provider if the client does not void?

8 hours

A client is admitted to the hospital with severe flank pain, nausea, and hematuria caused by a ureteral calculus. A lithotripsy is scheduled. What should be the nurse's initial intervention?

Administer the prescribed analgesic

A nurse is reviewing the clinical record of a client with a diagnosis of benign prostatic hyperplasia (BPH). Which test result confirmed the diagnosis?

Biopsy of prostatic tissue

The nurse reviews the medical records of four male clients and concludes that the client that is at highest risk of developing prostate cancer is the:

Black 55-year-old

A nurse is caring for a client who reports urinary problems, and the health care provider prescribes a cholinergic medication. Which response is prevented that helps the nurse determine that the medication is effective?

Bladder flaccidity

A client with the diagnosis of chronic kidney disease develops hypocalcemia. Which clinical manifestations should the nurse expect the client with hypocalcemia to exhibit? (Select all that apply.)

Chvostek sign Muscle cramps

A nurse is assessing the urine of a client with a urinary tract infection. For which characteristic should the nurse assess each specimen of urine?

Clarity

Which nursing action can best prevent infection from a urinary retention catheter?

Cleansing around the meatus routinely

A client arrives at a health clinic reporting hematuria, frequency, urgency, and pain on urination. What does the nurse suspect is the cause of these signs and symptoms?

Correct2 Cystitis

After a successful kidney transplant for a client with end-stage kidney disease, the nurse anticipates that laboratory studies will demonstrate:

Decreasing serum creatinine

A nurse is caring for a client who had a kidney transplant. What sign indicates that the client may be rejecting the transplanted kidney?

Fever

A nurse assesses a newly admitted client with renal colic to determine the signs and symptoms that are present. The nurse assesses the client for which primary subjective symptom?

Flank discomfort

The nurse is caring for a client who has been diagnosed with glomerulonephritis. What initial urinary finding supports this diagnosis?

Hematuria

A client is admitted to the hospital with a ureteral calculus. The nurse expects what urinary clinical findings?

Hematuria with sharp pain when voiding

Which is the most serious complication for which the nurse must monitor a client with kidney failure?

Hyperkalemia

A nurse is caring for an older bedridden male client who is incontinent of urine. What nursing intervention is the most satisfactory initial approach to managing urinary incontinence?

Offering the urinal regularly

A nurse is monitoring a client with renal failure for signs of fluid excess. Which finding does the nurse identify as inconsistent with fluid excess?

Orthostatic hypotension

A client who is 5 feet, 8 inches tall and weighs 220 pounds is admitted to the hospital with ureteral colic, blood in the urine, and a blood pressure of 150/90. The immediate objective of nursing care for this client is to decrease:

Pain

A postmenopausal woman who has cancer of the breast decides to have a lumpectomy followed by chemotherapy. After receiving chemotherapy for several weeks, she says to a nurse at the clinic, "I don't feel well." The nurse reviews the medical record. Based on this information, what does the nurse conclude is the client's priority need?

Preventing infection

A 40-year-old client scheduled for a hemi-colectomy because of ulcerative colitis asks if having a hemi-colectomy means wearing a pouch and having bowel movements in an abnormal way. Which is the best response by the nurse?

"No, only part of the colon is removed and the rest reattached."

A client who is diagnosed with sexual dysfunction makes a comment to the nurse, "Well, I guess my sex life is over." What is the most appropriate response by the nurse?

"You are concerned about your sex life?"

A client with renal colic is scheduled for extracorporeal shock-wave lithotripsy. The night before the procedure, the client puts the call light on frequently and has many demands. Which would be an appropriate statement for the nurse to make?

"You are facing a new experience tomorrow; tell me what concerns you have."

An older client who is living in a nursing home is admitted to the hospital to be treated with intravenous antibiotics for sepsis resulting from a urinary tract infection. The client becomes agitated and attempts to pull out the IV. The health care provider prescribes a stat dose of haloperidol (Haldol) 0.5 mg IM. The haloperidol is available in a vial that states there are 2 mg/mL. How much solution should the nurse administer? Include a leading zero if applicable. Record your answer using two decimal places. __________ mL

0.25

For which clinical indicator should a nurse monitor a client with end-stage renal disease?

Azotemia

A nurse is caring for a client with an indwelling urinary catheter. What is the most important action for the nurse to implement when irrigating the bladder?

Use sterile equipment

A female client who has recurrent urinary tract infections (UTIs) is inquiring about the prevention of future UTIs. What information should the nurse include when teaching the client? (Select all that apply.)

Drink 8 to 10 glasses of water each day Urinate immediately after sexual intercourse

The nurse is providing postoperative care eight hours after a client had a total cystectomy and the formation of an ileal conduit. What assessment finding should be reported immediately?

Dusky-colored stoma

Twenty-four hours after a penile implant the client's scrotum is edematous and painful. The nurse should:

Elevate the scrotum using a soft support

A nurse plans to teach the signs of rejection to a client who just had a transplanted kidney. What sign of rejection should the nurse include?

Elevated blood pressure

A nurse obtains a health history from a client with the diagnosis of renal calculi. The nurse concludes that the factor that most likely contributed to the calculi development is the client's:

Excess ingestion of antacids

A client is receiving furosemide (Lasix) to relieve edema. The nurse should monitor the client for which response to the medication?

Excessive loss of potassium ions

A nurse is developing a discharge plan for a client who was hospitalized with severe cirrhosis of the liver. The plan should include the:

Importance of reporting personality changes to the health care provider

A nurse is caring for a client who is scheduled for cystoscopy. What should the nurse include in the client's postprocedure teaching plan?

Increase fluid intake for three to four days postoperatively

A client with a history of benign prostatic hypertrophy asks whether cranberry juice prevents bladder infections. The nurse replies that cranberry juice may be helpful because it:

Increases acidity of the urine

A client's urine specific gravity is being measured. For what condition should the nurse conduct a focused assessment when a client's specific gravity is increased?

Low-grade fever

A client with an ileal conduit is being prepared for discharge. As part of the discharge teaching, the nurse instructs the client to:

Maintain fluid intake of at least 2 L daily

A client is admitted to the hospital with urinary retention, and an indwelling urinary catheter is prescribed by the health care provider. What should the nurse do to help prevent the client from developing a urinary tract infection?

Maintain the prescribed hydration

The nurse is caring for a client four days after the client had a cystectomy and formation of a continent diversion. After observing mucous threads in the client's urine, the nurse should:

Recognize that this is an expected response

A nurse is caring for a client who has a radium implant for cancer of the cervix. What is the priority nursing intervention?

Restrict visitors to a 10-minute stay

A client with cancer of the prostate requests the urinal at frequent intervals but either does not void or voids in very small amounts. What does the nurse conclude is most likely the causative factor?

Retention

A nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet because:

Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats.

A nurse is caring for a client who had a kidney transplant. Which test is most important for determining whether a client's newly transplanted kidney is working effectively?

Serum creatinine

A client who has repeated episodes of cystitis is scheduled for a cystoscopy to determine the possibility of urinary tract abnormalities. The client asks the nurse to describe the procedure. The nurse's most appropriate response is, "This procedure is:

The visualization of the inside of the bladder with an instrument connected to a source of light."

Before a transurethral resection of the prostate (TURP), a client asks about what to expect postoperatively. The most appropriate response by the nurse is:

There will be an indwelling urinary catheter and a continuous bladder irrigation in place."

A nurse is caring for a client with acute kidney failure who is receiving a protein-restricted diet. The client asks why this diet is necessary. What information should the nurse include in a response to the client's questions?

This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys.

The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis results. The nurse concludes that the presence of what substance in the urine needs to be reported to the health care provider?

Urea nitrogen

The nurse provides discharge instructions to a male client that had a ureterolithotomy. The client has a history of recurrent urinary tract infections (UTIs). The teaching should include that indicators of a UTI are:

Urgency or frequency of urination

The laboratory values of a client with renal calculi reveal a serum calcium within expected limits and an elevated serum purine. The nurse concludes that the stone probably is composed of:

Uric acid

A nurse is evaluating a client's response to fluid replacement therapy. Which clinical finding indicates adequate tissue perfusion to vital organs?

Urinary output of 30 mL in an hour

A lithotripsy to break up renal calculi is unsuccessful, and a nephrolithotomy is performed. Which postoperative clinical indicator should the nurse report to the health care provider?

Urine output of 20 to 30 mL/hr

A client with a history of chronic kidney disease is hospitalized. The nurse assesses the client for signs of related kidney insufficiency, which include:

Edema and pruritus

A client with acute kidney failure is to receive peritoneal dialysis and asks why the procedure is necessary. The nurse's best response is, "It:

Helps perform some of the work usually done by the kidneys."