exam 5 urinary

The nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? Select all that apply. A. Dysuria B. Enuresis C. Frequency D. Nocturia E. Urgency F. Polyuria

A, C, D, E, The signs and symptoms of UTI include: dysuria (pain or burning with urination), frequency, nocturia (frequent urinating at night), and urgency (having the urge to urinate quickly).Enuresis (bed-wetting) and polyuria (increased amounts of urine production) are not signs of a UTI.

Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? A. Functional B. Overflow C. Stress D. Urge

C Stress incontinence benefits the most from pelvic floor (Kegel) exercise therapy. For women with stress incontinence, Kegel therapy strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence.Functional incontinence is not caused by a weakened pelvic floor. It is due to structural problems often resulting from injury or trauma. Overflow incontinence is caused by too much urine being stored in the bladder. Urge incontinence is caused by a problem (i.e., neurologic) with the client's urge to urinate.

A cognitively impaired client has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan? A. Bladder training B. Credé method C. Habit training D. Kegel exercises

C Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis.Bladder training, the Credé method, and learning Kegel exercises require that the client be alert, cooperative, and able to assist with his or her own training.

For which hospitalized client does the nurse recommend the ongoing use of a urinary catheter? A. 35-year-old woman who was admitted with a splenic laceration and femur fracture (closed repair completed) following a car crash B. 48-year-old man who has established paraplegia and is admitted for pneumonia C. 61-year-old woman who is admitted following a fall at home and has new-onset dysrhythmia D. 74-year-old man who has lung cancer with brain metastasis and is being transitioned to hospice for end-of-life care

D

A newly admitted client who is diabetic and has pyelonephritis and prescriptions for intravenous antibiotics, blood glucose monitoring every 2 hours, and insulin administration would be cared for by which staff member? A. RN whose other assignments include a client receiving chemotherapy for renal cell carcinoma B. RN who is caring for a client who just returned after having renal artery balloon angioplasty C. RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy D. RN who is currently admitting a client with acute hypertension and possible renal artery stenosis

c The client scheduled for nephrectomy is the most stable client. The RN caring for this client will have time to perform the frequent monitoring and interventions that are needed for the newly admitted client.The client receiving chemotherapy will require frequent monitoring by the RN. The client after angioplasty will require frequent vital sign assessment and observation for hemorrhage and arterial occlusion. The client with acute hypertension will need frequent monitoring and medication administration.

When caring for a client with nephrotic syndrome, which intervention would be included in the plan of care? A. Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss B. Administering heparin to prevent deep vein thrombosis (DVT) C. Providing antibiotics to decrease infection D. Providing transfusion of clotting factors

A ACE inhibitors need to be included in a plan of care for a client with nephrotic syndrome. ACE inhibitors can decrease protein loss in the urine.Heparin is administered for DVT, but in nephrotic syndrome it may reduce vascular defects and improve kidney function. Glomerulonephritis may occur secondary to an infection, but it is an inflammatory process. Antibiotics are not indicated for nephrotic syndrome. Clotting factors are not indicated unless bleeding and coagulopathy are present.

A client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the nurse's best response? A. "Because the kidneys cannot get rid of fluid, blood pressure goes up." B. "The damaged kidneys no longer release a hormone that prevents high blood pressure." C. "The waste products in the blood interfere with other mechanisms that control blood pressure." D. "This is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products."The nurse's best response to a client with chronic kidney disease and high blood pressure is, "

A Because the kidneys cannot get rid of fluid, blood pressure goes up." In chronic kidney disease, fluid levels increase in the circulatory system.The statements asserting that damaged kidneys no longer release a hormone to prevent high blood pressure, waste products in the blood interfere with other mechanisms controlling blood pressure, and high blood pressure is a compensatory mechanism that increases blood flow through the kidneys in attempt excrete waste products are not accurate regarding the relationship between chronic kidney disease and high blood pressure.

The nurse is questioning a female client with a urinary tract infection (UTI) about her antibiotic drug regimen. Which statement by the client indicates a need for further instruction? A. "I take my medication only when I have symptoms." B. "I always wipe front to back." C. "I don't use bubble baths and other scented bath products." D. "I try to drink 3 liters of fluid a day."

A Further teaching is need for a female client with a UTI taking an antibiotic drug regimen when the client says, "I take my medication only when I have symptoms." clients with UTIs must complete all prescribed antibiotic therapy, even when symptoms of infection are absent.Wiping front to back helps prevent UTIs because it prevents infection-causing microorganisms in the stool from getting near the urethra. Limiting bubble baths and drinking 3 liters of fluid a day help prevent UTIs.

Which urinary assessment information for a client indicates the potential need for increased fluids? A. Increased blood urea nitrogen B. Increased creatinine C. Pale-colored urine D. Decreased sodium

A Potential for increased fluids are needed for a client with increased blood urea nitrogen. Increased blood urea nitrogen can indicate dehydration.Increased creatinine indicates kidney impairment. Pale-colored urine signifies diluted urine, which indicates adequate fluid intake. Increased, not decreased, sodium indicates dehydration.

The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows a correct understanding of what the nurse has taught? A. "I need to be drinking at least 1.5 to 2.5 liters of fluids every day." B. "It is a good idea for me to reduce germs by taking a tub bath daily." C. "Trying to get to the bathroom to urinate every 6 hours is important for me." D. "Urinating 1000 mL on a daily basis is a good amount for me."

A The client who shows a correct understanding of avoiding UTIs says, "I need to be drinking at least 1.5 to 2.5 liters of fluids every day." To reduce the number of UTIs, clients need to be drinking a minimum of 1.5 to 2.5 liters of fluid (mostly water) each day.Showers, rather than tub baths, are recommended for women who have recurrent UTIs. Urinating every 3 to 4 hours is ideal for reducing the occurrence of UTI. This is advisable rather than waiting until the bladder is full to urinate. Urinary output needs to be at least 1.5 liters daily. Ensuring this amount "out" is a good indicator that the client is drinking an adequate amount of fluid.

A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? A. Administer morphine sulfate 4 mg IV. B. Begin an infusion of metoclopramide (Reglan) 10 mg IV. C. Obtain a urine specimen for urinalysis. D. Start an infusion of 0.9% normal saline at 100 mL/hr.

A The intervention the nurse implements first for a client admitted with urolithiasis who reports "spasms of intense flank pain, nausea, and severe dizziness" is to administer morphine sulfate 4 mg IV. Morphine administered intravenously will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension.An infusion of metoclopramide (Reglan) 10 mg IV would be begun after the client's pain is controlled. A urine specimen for urinalysis would be obtained and an infusion of 0.9% normal saline at 100 mL/hr would be started after the client's pain is controlled.

A client who was previously diagnosed with a urinary tract infection (UTI) and started on antibiotics returns to the clinic 3 days later with the same symptoms. When asked about the previous UTI and medication regimen, the client states, "I only took the first dose because after that, I felt better." How does the nurse respond? A. "Not completing your medication can lead to return of your infection." B. "That means your treatment will be prolonged with this new infection." C. "This means you will now have to take two drugs instead of one." D. "What you did was okay; however, let's get you started on something else."

A The nurse tells the client with a UTI who only took the first dose of a 3-day prescription that, "not completing your medication can lead to return of your infection." Not completing the drug regimen can lead to recurrence of an infection and bacterial drug resistance.Needing to be retreated does not mean that the client will have a prolonged treatment regimen. Some treatment modalities are given over a 3-day period. Given this client's history, larger doses for a shorter time span may be a wise plan. The client does not need to take two drugs, and this response is punitive rather than instructive. Saying that the client's actions were okay does not inform the client with respect to nonadherence. The client needed to take all the prescribed medication to make certain that the infection was properly treated.

An older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the nurse's best response? A. "Have you tried using the toilet at least every couple of hours?" B. "How does that make you feel?" C. "We can fix that." D. "That happens when we get older."

A The nurse's best response to a client who states, "I feel like a child who sometimes pees her pants," is to ask the client if she uses the toilet at least every couple of hours. By emptying the bladder on a regular basis, urinary incontinence from overflow may be avoided, which may give the client some sense of control.The client has already stated how she feels. Asking her again does not address her concern, nor does it allow for nursing education. The nurse cannot assert that the problem can be fixed because this may be untrue. Suggesting that the problem occurs as we get older does not address the client's concern and does not provide for any client teaching.

A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug? Select all that apply. A. "Be certain to wear sunscreen and protective clothing." B. "Drink at least 3 liters of fluids every day." C. "Take this drug with 8 ounces (236 ml) of water." D. "Try to urinate frequently to keep your bladder empty." E. "You will need to take all of this drug to get the benefits."

A, B, C, E The nurse tells the client with a UTI who is taking trimethoprim/sulfamethoxazole to be certain to wear sunscreen protection clothing, drink at least 3 liters of fluid every day, take the drug with 8 ounces (236 mL) of water, and take all of the drug to get the benefits. Wearing sunscreen and protective clothing is important while taking trimethoprim/sulfamethoxazole, because increased sensitivity to the sun can lead to severe sunburn. Sulfamethoxazole can form crystals that precipitate in the kidney tubules, so fluid intake prevents this complication. clients must be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon, to prevent bacterial resistance and infection recurrence.Emptying the bladder is important, but not keeping it empty. The client would be advised to urinate every 3 to 4 hours or more often if he or she feels the urge.

What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy? Select all that apply. A. "Your urine will be strained after the procedure." B. "Be sure to finish all of your antibiotics." C. "Immediately call the primary health care provider if you notice bruising." D. "Remember to drink at least 3 liters of fluid a day to promote urine flow." E. "You will need to change the incisional dressing once a day."

A, B, D The nurse tells the client scheduled for an extracorporeal shock wave, "Your urine will be strained after the procedure," "Be sure to finish all of your antibiotics," and "Remember to drink at least 3 liters of fluid a day to promote urine flow." After lithotripsy, urine is strained to monitor the passage of stone fragments. clients must finish the entire antibiotic prescription to decrease the risk of developing a urinary tract infection. Drinking at least 3 L of fluid a day dilutes potential stone-forming crystals, prevents dehydration, and promotes urine flow.Bruising on the flank of the affected side is expected after lithotripsy as a result of the shock waves that break the stone into small fragments. The client must notify the primary health care provider if he or she develops pain, fever, chills, or difficulty with urination because these signs and symptoms may signal the beginning of an infection or the formation of another stone. There is no incision with extracorporeal shock wave lithotripsy. There may be a small incision when intracorporeal lithotripsy is performed.

Which clients with an indwelling urinary catheter does the nurse reassess to determine whether the catheterization needs to be continued or can be discontinued? Select all that apply. A. Three-day postoperative client B. client in the step-down unit C. Comatose client with careful monitoring of intake and output (I&O) D. Incontinent client with perineal skin breakdown E. Incontinent older adult in long-term care

A, B, E To decide whether the catheterization needs to be continued or discontinued, the nurse reassesses the 3-day postoperative client, the client in the step-down unit, and the incontinent older adult in long-term care. Three days after surgery, the postoperative client probably would be able to urinate on his or her own. This may be influenced by the type of surgery, but most clients do not need long-term catheterization after they have surgery. The incidence of complications (colonization of bacteria) begins to increase after 48 hours post-insertion. The client in the step-down unit is definitely one who would be considered for catheter discontinuation. He or she would be somewhat ambulatory and able to get to a bedside commode. Incontinence in older adults does not necessarily mean that they have to be catheterized. The introduction of a catheter invites the possibility of infection. These clients can often be managed with adult incontinence pads with less risk for developing a urinary tract infection. These infections in the older adult population are serious and would be avoided.The comatose client who is on strict I&O must have a urinary catheter in place to keep an accurate account of fluid balance. A client who is incontinent with no breakdown areas would be considered, but perineal skin problems in this situation make a catheter necessary for this client's skin to have a clean, dry environment for healing.

An older adult client diagnosed with urge incontinence is prescribed the medication oxybutynin (Ditropan). Which side effects does the nurse tell the client to expect? Select all that apply. A. Dry mouth B. Increased blood pressure C. Constipation D. Increased intraocular pressure E. Reddish-orange urine color

A, C, D Urge incontinence is the loss of urine for no apparent reason after suddenly feeling the need or urge to urinate. Side effects of oxybutynin prescribed for urge incontinence include: dry mouth, constipation, and increased intraocular pressure with the potential to make glaucoma worse. Oxybutynin is an anticholinergic/antispasmodic medication.Alpha-adrenergic agonists and beta blockers, which may be prescribed for urinary incontinence, may cause an increase in blood pressure. Phenazopyridine, a bladder analgesic used to decrease urinary pain, causes the urine to be a reddish-orange color.

A client has undergone transurethral resection of the prostate (TURP). Which interventions does the nurse incorporate in this client's postoperative care? Select all that apply. A. Administer antispasmodic medications. B. Encourage the client to urinate around the catheter if pressure is felt. C. Perform intermittent urinary catheterization every 4 to 6 hours. D. Place the client in a supine position with his knees flexed. E. Assist the client to mobilize as soon as permitted.

A, E Antispasmodic drugs can be administered to decrease the bladder spasms that may occur due to catheter use. Assisting the client to a chair as soon as permitted postoperatively will help to decrease the risk of complications from immobility. An indwelling catheter and continuous bladder irrigation are in place for about 24 hours after TURP.The client would not try to void around the catheter. This would cause the bladder muscles to contract and may result in painful spasms. Intermittent urinary catheterization is not necessary and increases the risk for infection. Typically, the catheter is taped to the client's thigh, so he needs to keep his leg straight.

Which factor is an indicator for a diagnosis of hydronephrosis? A. History of nocturia B. History of urinary stones C. Recent weight loss D. Urinary incontinence

B A history of urinary stones is an indicator of hydronephrosis. Other causes of hydronephrosis or hydroureter include tumors, trauma, structural defects, and fibrosis.Nocturia is a key feature of polycystic kidney disease and pyelonephritis, but it is not associated with hydronephrosis. Recent weight loss and urinary incontinence may be factors in renal cell carcinoma but are not associated with hydronephrosis.

The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? A. A 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4°F (37.4°C) B. A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours C. A 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy D. A 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed

B After change-of-shift report, the nurse decides to first assess a 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours. Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client who has been receiving morphine sulfate may be over sedated and may not be aware of any discomfort caused by bladder distention.The 26-year-old admitted with urosepsis and slight fever, the 32-year-old scheduled for cystoscopy, and the 40-year-old with noninfectious urethritis are not at immediate risk for complications or deterioration.

The charge nurse is making client assignments for the day shift. Which client is best to assign to an LPN/LVN? A. Client who has just returned from having a kidney artery angioplasty B. Client with polycystic kidney disease who is having a kidney ultrasound C. Client who is going for a cystoscopy and cystourethroscopy D. Client with glomerulonephritis who is having a kidney biopsy

B The best client to assign to an LPN/LVN is the client with polycystic kidney disease who is having a kidney ultrasound. Kidney ultrasounds are noninvasive procedures without complications, and the LPN/LVN can provide this care.A kidney artery angioplasty is an invasive procedure that requires post procedure monitoring for complications, especially hemorrhage. A registered nurse is needed for this client. Cystoscopy and cystourethroscopy are procedures that are associated with potentially serious complications such as bleeding and infection. These clients must be assigned to RN staff members. Kidney biopsy is associated with potentially serious complications such as bleeding, and this client would also be assigned to RN staff members.

The nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification? A. "A small-lumen catheter will help prevent injury to my urethra." B. "I will use a new, sterile catheter each time I do the procedure." C. "My family members can be taught to help me if I need it." D. "Proper handwashing before I start the procedure is very important."

B The client with a neurogenic bladder who needs to self-catheterize for bladder emptying requires further clarification when the client says, "I will use a new, sterile catheter each time I do the procedure." Catheters are cleaned and reused. With proper handwashing and cleaning of the catheter, no increase in bacterial complications has been shown. Catheters are replaced when they show signs of deteriorating.The smallest lumen possible and the use of a lubricant help reduce urethral trauma to this sensitive mucous tissue. Research shows that family members in the home can be taught to perform straight catheterizations using a clean (rather than a sterile) catheter with good outcomes. Proper handwashing is extremely important in reducing the risk for infection in clients who use intermittent self-catheterization and is a principle that must be stressed.

Which laboratory test is the best indicator of kidney function? A. Blood urea nitrogen (BUN) B. Creatinine C. Aspartate aminotransferase (AST) D. Alkaline phosphatase

B The laboratory test that is the best indicator of kidney function is creatinine excretion. Creatinine excretion, the end product of muscle metabolism, remains relatively steady and therefore is the best laboratory marker of renal function.BUN may be affected by protein, fluid intake, rapid cell destruction, cancer treatment, steroid therapy, and hepatic damage. AST and alkaline phosphatase are measures of hepatic function.

The RN is caring for a client who has just had a kidney biopsy. Which action does the nurse perform first? A. Obtain blood urea nitrogen (BUN) and creatinine. B. Position the client supine. C. Administer pain medications. D. Check urine for hematuria.

B When caring for a client after a kidney biopsy, the nurse first needs to position the client in a supine position. The client is positioned supine with a back roll for several hours after a kidney biopsy to decrease the risk for hemorrhage.BUN and creatinine would be obtained before the procedure is performed. Only local discomfort would be noted around the procedure site. Severe pain could indicate hematoma. Although pink urine may develop, the nurse would position the client to prevent bleeding first. The other actions are appropriate after this procedure, but do not need to be done immediately after the biopsy.

Which percussion technique does the nurse use to assess a client who reports flank pain? A. Place outstretched fingers over the flank area and percuss with the fingertips. B. Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank. C. Place one hand with the palm up over the flank area and cup the other hand to percuss the hand on the flank. Quickly tap the flank area with cupped hands.

B When performing percussion of a client's flank, the nurse needs to place one hand with the palm down flat over the costovertebral angle (CVA) of the flank area and, with the other fisted hand, thump the hand on the flank.Placing outstretched fingers, one hand palm up, and/or using cupped hands and quickly tapping the flank are incorrect techniques.

The nurse in the urology clinic is providing teaching for a female client with cystitis. Which instructions does the nurse include in the teaching plan? Select all that apply. A. Cleanse the perineum from back to front after using the bathroom. B. Try to take in 64 ounces (2 liters) of fluid each day. C. Be sure to complete the full course of antibiotics. D. If urine remains cloudy, call the clinic. E. Expect some flank discomfort until the antibiotic has worked.

B, C, D In the teaching plan for a female clinic client with cystitis, the nurse tells the client: try to take in 64 ounces (2 liters) of fluid every day, be sure to complete the full course of antibiotics, and call the clinic if the urine remains cloudy. Between 64 and 100 ounces (2 to 3 liters) of fluid would be taken daily to dilute bacteria and prevent infection. Not completing the course of antibiotics could suppress the bacteria but would not destroy all bacteria, causing the infection to resurface. For persistent symptoms of infection, the client would contact the primary health care provider.The perineal area needs to be cleansed from front to back or "clean to dirty" to prevent infection. Cystitis produces suprapubic symptoms. Flank pain occurs with infection or inflammation of the kidney.

When assessing a client with acute pyelonephritis, which findings does the nurse anticipate will be present? A. Suprapubic pain B. Vomiting C. Chills D. Dysuria E. Oliguria

B, C, D The findings the nurse expects to find in a client with acute pyelonephritis include: vomiting, chills, and dysuria. Nausea and vomiting and chills along with fever may occur. Dysuria (burning), urgency, and frequency can also occur.Suprapubic pain is indicative of cystitis, not kidney infection (pyelonephritis). Flank, back, or loin pain are symptoms of acute pyelonephritis. Oliguria is related to kidney impairment from severe or long-standing pyelonephritis.

A client diagnosed with urge incontinence is started on tolterodine (Detrol). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? Select all that apply. A. Take the drug at bedtime. B. Encourage increased fluids. C. Increase fiber intake. D. Limit the intake of dairy products. E. Use hard candy for dry mouth.

B, C, E Interventions the nurse suggests to alleviate the side effects of tolterodine include: encouraging increased fluids, increasing fiber intake, and using hard candy for dry mouth. Anticholinergics cause constipation. Increasing fluids and fiber intake will help with this problem. Anticholinergics also cause extreme dry mouth, which can be alleviated with using hard candy to moisten the mouth.Taking the drug at night and limiting dairy products will not have an effect on the complications encountered with propantheline.

When a client with diabetes returns to the medical unit after a computed tomography (CT) scan with contrast dye, all of these interventions are prescribed. Which intervention does the nurse implement first? A. Give lispro (Humalog) insulin, 12 units subcutaneously. B. Request a breakfast tray for the client. C. Infuse 0.45% normal saline at 125 mL/hr. D. Administer captopril (Capoten).

C After a diabetic client returns to the unit after a CT scan, the first intervention implemented by the nurse is to infuse 0.45% normal saline at 125 mL/hour. Fluids are needed because the iodinated dye used in a CT scan with contrast has an osmotic effect, causing dehydration and potential kidney failure.Lispro is not administered until the breakfast tray arrives. A breakfast tray will be requested, but preventing complications of the procedure is done first. Because the client may be hypovolemic, the nurse needs to monitor blood pressure and administer IV fluids before deciding whether administration of captopril is appropriate.

After receiving change-of-shift report on the urology unit, which client does the nurse assess first? A. Client postradical nephrectomy whose temperature is 99.8°F (37.6°C) B. Client with glomerulonephritis who has cola-colored urine C. Client who was involved in a motor vehicle collision and has hematuria D. Client with nephrotic syndrome who has gained 2 kg since yesterday

C After the change-of-shift report, the nurse first needs to assess the client who was involved in a motor vehicle collision. The nurse would be aware of the risk for kidney trauma after a motor vehicle crash. This client needs further assessment and evaluation to determine the extent of blood loss and the reason for the hematuria because hemorrhage can be life-threatening.Although slightly elevated, the low-grade fever of the client who is postradical nephrectomy is not life-threatening in the same way as a trauma victim with bleeding. Cola-colored urine is an expected finding in glomerulonephritis. Because of loss of albumin, fluid shifts and weight gain can be anticipated in a client with nephrotic syndrome.

Which instruction does the nurse give a client who needs a clean-catch urine specimen? A. "Save all urine for 24 hours." B. "Use the sponges to cleanse the urethra, and then initiate voiding directly into the cup." C. "Do not touch the inside of the container." D. "You will receive an isotope injection, then I will collect your urine."

C Before obtaining a clean-catch urine specimen, the nurse instructs the client not to touch the inside of the container. A clean-catch specimen is used to obtain urine for culture and sensitivity of organisms present. Contamination by any part of the client's anatomy will render the specimen invalid and alter results.Saving urine for 24 hours is not necessary for a midstream clean-catch urine specimen. After cleaning, the client needs to initiate voiding into the commode, then stop and resume voiding into the container. Only 1 ounce (30 mL) is needed. The remainder of the urine may be discarded into the commode. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra. A clean-catch specimen for culture does not require injection of an isotope before urine is collected.

Which nursing activity illustrates proper aseptic technique during catheter care? A. Applying Betadine ointment to the perineal area after catheterization B. Irrigating the catheter daily C. Positioning the collection bag below the height of the bladder D. Sending a urine specimen to the laboratory for testing

C Proper aseptic technique during catheter care involves positioning the collection bag below the height of the bladder. Urine collection bags must be kept below the level of the bladder at all times. Elevating the collection bag above the bladder causes reflux of pathogens from the bag into the urinary tract.Applying antiseptic solutions or antibiotic ointments to the perineal area of catheterized clients has not demonstrated any beneficial effect. A closed system of irrigation must be maintained by ensuring that catheter tubing connections are sealed securely; disconnections can introduce pathogens into the urinary tract, so routine catheter irrigation would be avoided. Sending a urine specimen to the laboratory is not indicated for asepsis.

The nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? A. "I must avoid drinking carbonated beverages." B. "I need to douche vaginally once a week." C. "I need to drink 2½ liters of fluid every day." D. "I will not drink fluids after 8 PM each evening."

C Teaching an older female about interventions to decrease the risk for cystitis is effective when the client says, "I need to drink 2½ liters of fluid every day." Drinking this much fluid each day flushes out the urinary system and helps reduce the risk for cystitis.Avoiding carbonated beverages is not necessary to reduce the risk for cystitis. Douching is not a healthy behavior because it removes beneficial organisms as well as the harmful ones. Avoiding fluids after 8:00 p.m. would help prevent nocturia but not cystitis. It is recommended that clients with incontinence problems limit their late-night fluid intake to 120 mL.

The nurse is teaching a client how to provide a clean-catch urine specimen. Which statement by the client indicates that teaching was effective? A. "I must clean with the wipes and then urinate directly into the cup." B. "I will have to drink 2 liters of fluid before providing the sample." C. "I'll start to urinate in the toilet, stop, and then urinate into the cup." D. "It is best to provide the sample while I am bathing."

C Teaching is demonstrated to be effective when the client says, "I'll start to urinate in the toilet, stop, and then urinate into the cup." A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra.Although cleaning with wipes before providing a clean-catch urine sample is proper procedure, a step is missing. It is not necessary to drink 2 liters of fluid before providing a clean-catch urine sample. Providing a clean-catch urine sample does not involve bathing.

The nurse is reviewing the medical record for a client with polycystic kidney disease who is scheduled for computed tomographic angiography with contrast: History and Physical Assessment Polycystic kidney disease Diabetes Hysterectomy Medications Glyburide Metformin Synthroid Diagnostic BUN 26 mg/dL (9.2 mmol/L) Creatinine 1.0 mg/dL (77 umol/L) HbA1c 6.9% Glucose 132 mg/dL (7.3 mmol/L) Findings Abdomen distended edema Which intervention is essential for the nurse to perform? A. Obtain a thyroid-stimulating hormone (TSH) level. B. Report the blood urea nitrogen (BUN) and creatinine. C. Hold the metformin 24 hours before and on the day of the procedure. D. Notify the provider regarding blood glucose and glycosylated hemoglobin (HbA1c) values.

C The essential intervention for the nurse to perform is to withhold metformin at least 24 hours before the time of a contrast media study and for at least 48 hours after the procedure because metformin may cause lactic acidosis.The focus of this scenario is the client with polycystic kidneys. A TSH level is not essential at this time. BUN and creatinine are normal. The glucose is only mildly elevated (if fasting), and the HbA1c is in an appropriate range.

The nurse is educating a female client about hygiene measures to reduce her risk for urinary tract infection (UTI). What does the nurse instruct the client to do? A. "Douche—but only once a month." B. "Use only white toilet paper." C. "Wipe from front to back." D. "Wipe with the softest toilet paper available."

C The nurse is educating the female client about hygiene measures to reduce the risk of UTIs and tells the client, "Wipe from front to back." Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection.Douching is an unhealthy behavior because it removes beneficial organisms as well as the harmful ones. White toilet paper helps prevent allergies, not infections. Using soft toilet paper does not prevent infection.

Which assessment finding alarms the nurse immediately after a client returns from the operating room for cystoscopy performed under conscious sedation? A. Pink-tinged urine B. Urinary frequency C. Temperature of 100.8°F (38.2°C) D. Lethargy

C The nurse is immediately concerned when a postoperative cystoscopy client who had conscious sedation returns to the unit with a temperature of 100.8°F (38.2°C). Fever, chills, or an elevated white blood cell count after cystoscopy suggest infection after an invasive procedure. The provider must be notified immediately.Pink-tinged urine is expected after a cystoscopy. Frequency may be noted as a result of irritation of the bladder. Gross hematuria would require notification of the surgeon. If sedation or anesthesia was used, lethargy is an expected effect.

A 53-year-old postmenopausal woman reports "leaking urine" when she laughs and is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her stress incontinence? A. "They can relieve your anxiety associated with incontinence." B. "They help your bladder to empty." C. "They may be used to improve urethral resistance." D. "They decrease your bladder's tone."

C The nurse tells the 53-year-old postmenopausal woman with stress incontinence that certain drugs may be used to improve urethral resistance. Bladder pressure is greater than urethral resistance so drugs may be used to improve urethral resistance.Relieving anxiety has not been shown to improve stress incontinence. No drugs have been shown to promote bladder emptying, and this is not usually the problem with stress incontinence. Emptying the bladder is accomplished by the individual or, if that is not possible, by using a catheter. Decreasing bladder tone would not be a desired outcome for a woman with incontinence.

When planning an assessment of the urethra, what does the nurse do first? A. Examine the meatus. B. Note any unusual discharge. C. Record the presence of abnormalities. D. Don gloves.

C The nurse will first put on a pair of gloves. When assessing the urethra, the nurse needs to implement body fluid precautions before any other steps are taken.Examining the meatus, noting unusual discharge, and recording the presence of abnormalities are actions the nurse needs to perform after putting on gloves.

A 32-year-old female with a urinary tract infection (UTI) reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100°F (37.8°C). Which drug does the primary health care provider prescribe? A. Nitrofurantoin (Macrodantin) after intercourse B. Estrogen (Premarin) C. Trimethoprim/sulfamethoxazole (Bactrim) D. Phenazopyridine (Pyridium) with intercourse

C The primary health care provider prescribes trimethoprim/sulfamethoxazole to a 32-year-old woman with a UTI who reports urinary frequency, urgency, and some discomfort upon urination. Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole is effective in treating uncomplicated, community-acquired UTI in women.Drugs from the same class as nitrofurantoin reduce bacteria in the urinary tract by inhibiting bacterial reproduction (bacteriostatic action). This client needs a drug that will kill bacteria. Estrogen cream may help prevent recurrent UTIs in postmenopausal women, which this client is not (at age 32). Use of Premarin is related to problems with incontinence. Phenazopyridine (Pyridium) is not used to treat infection, but symptoms of a UTI.

A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the primary health care provider before the ESWL procedure begins? A. "Blood in my urine has become less noticeable, so maybe I don't need this procedure." B. "I have been taking cephalexin (Keflex) for an infection." C. "I previously had several ESWL procedures performed." D. "I take over-the-counter naproxen (Aleve) twice a day for joint pain."

D For a client admitted for ESWL, it is most critical for the nurse to report to the primary health care provider that the client takes over-the-counter naproxen twice a day for joint pain. Because a high risk for bleeding during ESWL has been noted, clients would not take nonsteroidal antiinflammatory drugs before this procedure. The ESWL will have to be rescheduled for this client.Blood in the client's urine would be reported to the primary health care provider but will not require rescheduling of the procedure because blood is frequently present in the client's urine when kidney stones are present. A diminished amount of blood would not eliminate the need for the procedure. The client's taking cephalexin (Keflex) and the fact that the client has had several previous ESWL procedures would be reported, but will not require rescheduling of the procedure.

The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which statement by the client indicates that teaching was effective? A. "I am so relieved that I can continue eating my fried fish meals every week." B. "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." C. "My wife will be happy to know that I can keep enjoying her liver and onions recipe." D. "I will no longer be able to have red wine with my dinner."

D Teaching about low purine diets to a client with urolithiasis consisting of uric acid is effective when the client says, "I will no longer be able to have red wine with my dinner." Nutrition therapy depends on the type of stone formed. When stones consist of uric acid (urate), the client needs to decrease intake of purine sources such as organ meats, poultry, fish, gravies, red wines, and sardines. Reduction of urinary purine content may help prevent these stones from forming.Avoiding oxalate sources such as spinach, black tea, and rhubarb is appropriate when the stones consist of calcium oxalate.

Which staff member does the charge nurse assign to a client who has benign prostatic hyperplasia (BPH) and hydronephrosis and needs an indwelling catheter inserted? A. RN float nurse who has 10 years of experience with pediatric clients B. LPN/LVN who has worked in the hospital's kidney dialysis unit until recently C. RN without recent experience who has just completed an RN refresher course D. LPN/LVN with 5 years of experience in an outclient urology surgery center

D The charge nurse assigns a LPN/LVN with 5 years' experience in an outclient urology surgery center to insert an indwelling catheter in a client with BPH and hydronephrosis. Catheterization of a client with an enlarged prostate, a skill within the scope of practice of the LPN/LVN, would be performed frequently in a urology center.The pediatric nurse would have little exposure to prostatic obstruction and adult catheterization. Dialysis clients do not typically have catheters inserted, so the LPN/LVN from the kidney dialysis unit would not be the best staff member to assign to the client. The nurse who has been out of practice for several years is not the best candidate to insert a catheter in a client with an enlarged prostate.

A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection. Which nursing action can the home health RN delegate to the home health aide (unlicensed assistive personnel [UAP])? A. Assisting the client in developing a schedule for when to take prescribed antibiotics B. Inserting a straight catheter as necessary if the client is unable to empty the bladder C. Teaching the client how to use the Credé maneuver to empty the bladder more fully D. Using a bladder scanner (with training) to check residual bladder volume after the client voids

D The home health RN delegates the task of using a bladder scanner (with training) to check residual bladder volume after the client voids, to the UAP. Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (UAP) who has been trained and evaluated in this skill.Assisting the client in developing a schedule for when to take prescribed antibiotics, inserting a straight catheter, and teaching the client to use the Credé maneuver all require more education and are in the legal scope of practice of the LPN/LVN or RN.

The nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? A. "For the best effect, perform all of your exercises while you are seated on the toilet." B. "Limit your exercises to 5 minutes twice a day, or you will injure yourself." C. "Results should be visible to you within 72 hours." D. "You know that you are exercising correct muscles if you can stop urine flow in midstream."

D The nurse is telling the client about pelvic muscle exercises and says, "You know that you are exercising correct muscles if you can stop urine flow in midstream." When the client can start and stop the urine stream, the pelvic muscles are being used.Pelvic muscle exercises can be performed anywhere and would be performed at least 10 times daily to improve and maintain pelvic muscle strength. Noticeable results in pelvic muscle strength take several weeks.

A client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the health care provider (HCP) visited the client the day before. What action does the nurse take? A. Asks the client to sign the informed consent B. Cancels the procedure C. Asks the client's spouse to sign the form D. Notifies the department and the HCP

D The nurse notifies both the HCP and the department to ensure effective communication across the continuum of care. This nursing action makes it less likely that essential information will be omitted. The client may be asked to sign the consent form in the department. The HCP gives the client a complete description of and reasons for the procedure and explains complications. The nurse reinforces this information.The procedure would not be cancelled without an attempt to correct the situation. The client has not received sedation, so nothing suggests that the client is not competent to consent and that the spouse needs to sign the form.

Which technique does the nurse use to obtain a sterile urine specimen from a client with a Foley catheter? A. Disconnect the Foley catheter from the drainage tube and collect urine directly from the Foley. B. Remove the existing catheter and obtain a sample during the process of inserting a new Foley. C. Use a sterile syringe to withdraw urine from the urine collection bag. D. Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine.

D The nurse will employ the technique of clamping the tubing, attaching a syringe to the specimen, and withdrawing at least 5 mL of urine when obtaining a sterile urine specimen from a client with a Foley catheter.Disconnecting the Foley catheter from the drainage tube and collecting urine directly from the Foley increases the risk for microbe exposure. A Foley catheter would not be removed to get a urine sample. Microbes may be in the urine collection bag from standing urine, so using a sterile syringe to withdraw urine from the urine collection bag is not the proper technique to obtain a sterile urine specimen.

Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients? A. Encouraging them to drink fluids B. Irrigating all catheters daily with sterile saline C. Recommending that catheters be placed in all clients D. Periodically reevaluating the need for indwelling catheters

D The nursing intervention that is most effective is helping to prevent UTIs in hospitalized clients is periodically reevaluating the need for indwelling catheters. Studies have shown that this intervention is the best way to prevent UTIs in the hospital setting.Encouraging fluids, although it is a valuable practice for clients with catheters, will not necessarily prevent the occurrence of UTIs in the hospital setting. In some clients, their conditions do not permit an increase in fluids, such as those with congestive heart failure and kidney failure. Irrigating catheters daily is contraindicated, because any time a closed system is opened, bacteria may be introduced. Placing catheters in all clients is unnecessary and unrealistic. This practice would place more clients at risk for the development of UTI.

A client had a computed tomography (CT) scan with contrast dye 8 hours ago. Which nursing intervention is the priority for this client? A. Maintaining bedrest B. Medicating for pain C. Monitoring for hematuria D. Promoting fluid intake

D The priority nursing intervention for this client is to promote fluid intake. The nurse must ensure that the client has adequate hydration to dilute and excrete the contrast media. The nurse urges the client to take oral fluid or, if needed, administers IV fluids to the client. Hydration reduces the risk for kidney damage.Bedrest is not indicated for the client who has undergone a CT scan with contrast dye. CT with contrast dye is not a painful procedure, so pain medication is not indicated. The client who has undergone CT with contrast dye is not at risk for hematuria.

What does the nurse teach a client to do to decrease the risk for urinary tract infection (UTI)? A. Limit fluid intake. B. Increase caffeine consumption. C. Limit sugar intake. D. Drink about 3 liters of fluid daily.

D To decrease the risk of UTIs, the nurse tells the client to drink about 3 liters of fluid daily. Drinking about 3 liters of fluid daily, if another medical problem does not require fluid restriction, helps prevent dehydration and UTIs.Fluids flush the system and must not be limited. Increased caffeine intake and limiting sugar intake will not prevent UTIs.

When caring for a client with hemorrhage secondary to kidney trauma, the nurse provides volume expansion. Which element does the nurse anticipate will be used? A. Fresh-frozen plasma B. Platelet infusions C. 5% dextrose in water D. Normal saline solution (NSS)

D To provide volume expansion to a client with hemorrhage secondary to kidney trauma, the nurse expects that normal saline solution will be used. Isotonic solutions and crystalloid solutions are administered for volume expansion. 0.9% sodium chloride (NS) and 5% dextrose in 0.45% sodium chloride may also be given. Lactated Ringer's solution may be used if the client has no liver damage.Clotting factors, contained in fresh-frozen plasma, are given for bleeding, not for volume expansion. Platelet infusions are administered for deficiency of platelets. A solution hypotonic to the client's blood, 5% dextrose, is administered for nutrition or hypernatremia, not for volume expansion.

A client who is 6 months pregnant comes to the prenatal clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this client? A. Discharges the client to her home for strict bedrest for the duration of the pregnancy B. Instructs the client to drink a minimum of 3 liters of fluids, especially water, every day to "flush out" bacteria C. Recommends that the client refrain from having sexual intercourse until after she has delivered her baby D. Refers the client to the clinic nurse practitioner for immediate follow-up

D When a client who is 6 months pregnant comes to the prenatal clinic with a suspected UTI, the nurse needs to refer the client to the clinic nurse practitioner for immediate follow-up. Pregnant women with UTIs require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor with adverse effects for the fetus.It is unsafe for the client to be sent home without analysis of the symptoms that she has. Her problem needs to be investigated without delay. Although drinking increased amounts of fluids is helpful, it will not cure an infection. Having sexual intercourse (or not having it) is not related to the client's problem. The client's symptoms need follow-up with a primary health care provider.

During discharge teaching for a client with kidney disease, what does the nurse teach the client to do? A. "Drink 2 liters of fluid and urinate at the same time every day." B. "Eat breakfast and go to bed at the same time every day." C. "Check your blood sugar and do a urine dipstick test." D. "Weigh yourself and take your blood pressure."

D When discharging a client with kidney disease, the nurse needs to tell the client to "Weigh yourself and take your blood pressure." Regular weight assessment monitors fluid restriction control, while blood pressure control is necessary to reduce cardiovascular complications and slow the progression of kidney dysfunction.Fluid intake and urination, and breakfast time and bedtime, do not need to be at the same time each day. clients with diabetes, not kidney disease, would regularly check their blood sugar and perform a urine dipstick test.

A client with these assessment data is preparing to undergo a computed tomography (CT) scan with contrast: Physical Assessment Flank pain Dysuria Bilateral knee pain Diagnostic Findings BUN 54 mg/dL (19.3 mmol/L) Creatinine 2.4 mg/dL (212 umol/L) Calcium 8.5 mg/dL (2.13 mmol/L) Medications Captopril Metformin Acetylcysteine Which medication does the nurse plan to administer before the procedure? a. Acetylcysteine (Mucomyst) b. Metformin (Glucophage) c. Captopril (Capoten) d. Acetaminophen (Tylenol)

a Before a CT scan with contrast, the nurse needs to administer acetylcysteine to the client. This client has kidney impairment demonstrated by increased creatinine. Acetylcysteine (an antioxidant) would be used to prevent contrast-induced nephrotoxic effects.Metformin is held at least 24 hours before and for at least 48 hours after procedures using contrast. Although captopril and acetaminophen may be administered with a sip of water with permission of the provider, this is not essential before the procedure.

Which age-related change can cause nocturia? a. Decreased ability to concentrate urine b. Decreased production of antidiuretic hormone c. Increased production of erythropoietin d. Increased secretion of aldosterone

a Nocturia may result from decreased kidney-concentrating ability associated with aging.Increased production of antidiuretic hormone, decreased production of erythropoietin, and decreased secretion of aldosterone are age-related changes.

A client has returned from a captopril renal scan. Which teaching does the nurse provide when the client returns to the unit? a. "Arise slowly and call for assistance when ambulating." b. "I must measure your intake and output." c. "We must save your urine because it is radioactive." d. "I must attach you to this cardiac monitor."

a When a client returns to the unit from a captopril retinal scan, the nurse needs to teach the client to rise slowly and call for help when ambulating. Captopril can cause severe hypotension during and after the procedure. The client would be warned to avoid rapid position changes and about the risk for falling as a result of orthostatic (positional) hypotension.Intake and output measurement is not necessary after this procedure, unless it had been requested previously. The urine is not radioactive, because only a small amount of radioisotope is used in a renal scan. Standard Precautions need to be implemented and the nurse must wear gloves. Cardiac monitoring is not needed, although the nurse would monitor for hypotension secondary to captopril.

Which condition may predispose a client to chronic pyelonephritis? A. Spinal cord injury B. Cardiomyopathy C. Hepatic failure D. Glomerulonephritis

a The client with a spinal cord injury may be predisposed to chronic pyelonephritis. Chronic pyelonephritis usually occurs with structural deformities, urinary stasis, obstruction, or reflux. Reduced bladder tone from spinal cord injury contributes to stasis and reflux. Conditions that lead to urinary stasis include prolonged bedrest and paralysis. Obstruction can be caused by stones, kidney cancer, scarring from pelvic radiotherapy or surgery, recurrent infection, or injury.Cardiomyopathy or weakness of the heart muscle may cause kidney impairment, not an infection. Pyelonephritis may damage the kidney, not the liver. Glomerulonephritis may result from infection but may not cause infection of the kidney.

For which clients scheduled for a computed tomography (CT) scan with contrast does the nurse communicate safety concerns to the health care provider (HCP)? Select all that apply. a. Client with an allergy to shrimp b. Client with a history of asthma c. Client who requests morphine sulfate every 3 hours d. Client with a blood urea nitrogen of 62 mg/dL (22.1 mmol/L) and a creatinine of 2.0 mg/dL (177 umol/L) e. Client who took metformin (Glucophage) 4 hours ago

a, b, d, e The nurse would communicate to the HCP CT scan contrast safety concerns about a client with an allergy to shrimp, a client with an asthma history, a client with an elevated BUN and creatinine, and a client who took Metformin 4 hours ago. All clients undergoing a CT scan with contrast would be asked about known hay fever or food or drug allergies, especially to seafood, eggs, milk, or chocolate. Contrast reactions have been reported to be as high as 15% in these clients. Clients with asthma have been shown to be at greater risk for contrast reactions than the general public. When reactions do occur, they are more likely to be severe. The risk for contrast-induced nephropathy is also increased in clients who have pre-existing renal insufficiency (e.g., serum creatinine levels greater than 1.5 mg/dL (133 umol/L) or estimated glomerular filtration rate less than 45 mL/min). Metformin must be discontinued at least 24 hours before and for at least 48 hours after any study using contrast media because the life-threatening complication of lactic acidosis, although rare, could occur.There are no contraindications to undergo CT scan with contrast while taking morphine sulfate. CT with contrast may help to identify the underlying cause of pain.

Which clinical manifestation in a client with pyelonephritis indicates that treatment has been effective? A. Decreased urine output B. Decreased white blood cells in urine C. Increased red blood cell count D. Increased urine specific gravity

b Treatment has been effective when a client with pyelonephritis has a decreased presence of white blood cells in the urine. This indicates the eradication of infection.A decreased urine output, an increased red blood cell count, and increased urine specific gravity are not symptoms of pyelonephritis.

When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which factor? a. Abdominal girth b. Presence of urinary infection c. History of hysterectomy d. Hematuria

c Before performing bladder scanning to detect residual urine in a female client, the nurse must first determine if the client has had a hysterectomy. The scanner must be in the scan mode for female clients in order to ensure the scanner subtracts the volume of the uterus from the measurement.The nurse performs this procedure in response to distention or pressure in the bladder; girth is not a factor. This procedure detects urine retained in the bladder, not infection. The presence of retained urine in the bladder is assessed, regardless of hematuria.

A client is in the emergency department for an inability to void and for bladder distention. What is most important for the nurse to provide to the client? a. Increased oral fluids b. IV fluids c. Privacy d. Health history forms

c It is most important for the nurse to provide privacy for this client. Besides privacy, the nurse also needs to help this client with assistance and voiding stimulants, such as warm water over the perineum, as needed.Increased oral fluids and IV fluids would exacerbate the client's problem. Obtaining a health history is not the priority for this client's care.

The nurse has these client assignments. Which client does the nurse encourage to consume 2 to 3 liters of fluid each day? a. Client with chronic kidney disease b. Client with heart failure c. Client with complete bowel obstruction d. Client with hyperparathyroidism

c The nurse encourages the client with hyperparathyroidism to drink 2 to 3 liters of fluid each day. A major feature of hyperparathyroidism is hypercalcemia, which predisposes a client to kidney stones. This client must remain hydrated.A client with chronic kidney disease would not consume 2 to 3 liters of water because the kidneys are not functioning properly. Consuming that much fluid could lead to fluid retention. People with heart failure typically have fluid volume excess. A client with complete bowel obstruction may experience vomiting and would be NPO.

The nurse visualizes blood clots in a client's urinary catheter after a cystoscopy. What nursing intervention does the nurse perform first? a. Administer heparin intravenously. b. Remove the urinary catheter. c. Notify the health care provider (HCP). d. Irrigate the catheter with sterile saline.

c The nurse first notifies the HCP after visualizing a blood clot in a postoperative cystoscopy client's urinary catheter. Bleeding and/or blood clots are potential complications of cystoscopy and may obstruct the catheter and decrease urine output. In addition, the nurse must monitor urine output and notify the HCP of obvious blood clots or a decreased or absent urine output.Heparin would not be administered due to bleeding. The urinary catheter is allowing close monitoring of the urinary system and would not be removed at this time. The Foley catheter may be irrigated with sterile saline if prescribed by the HCP.

When caring for a client with uremia, the nurse assesses for which symptom? a. Tenderness at the costovertebral angle (CVA) b. Cyanosis of the skin c. Nausea and vomiting d. Insomnia

c The signs and symptoms the nurse needs to assess for are nausea and vomiting. Other manifestations of uremia include anorexia, nausea, vomiting, muscle cramps, pruritus, fatigue, and lethargy.CVA tenderness is a sign of inflammation or infection in the renal pelvis. Cyanosis is related to poor tissue perfusion. Insomnia is nonspecific and may be caused by psychoemotional factors, medications, or other problems.

The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor? A. Hemoglobin and hematocrit (H&H) B. White blood cell (WBC) count C. Blood urea nitrogen (BUN) and creatinine D. Lipid levels

c In the client with hydronephrosis, the nurse monitors the client's BUN and creatinine. BUN and creatinine are kidney function tests. With back-pressure on the kidney, glomerular filtration is reduced or absent, resulting in permanent kidney damage. Hydronephrosis results from the backup of urine secondary to obstruction.H&H monitors for anemia and blood loss, while WBC count indicates infection. Elevated lipid levels are associated with nephrotic syndrome, not with obstruction and hydronephrosis.

One of the nurse's roles is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body areas? a. Children's terms that are easily understood b. Slang words and terms that are heard "socially" c. Technical and medical terminology d. Words that the client uses

d When talking to an adult client about urinary and sexual hygiene, the nurse uses words that the client uses. The nurse would use the terms with which the client is most familiar, so there is no chance for the client to misunderstand information. Using the client's language ensures the comfort level for the client.The use of children's terms is demeaning to adult clients. The use of slang terms is unprofessional. Technical terms would not be used because the client may not know what they mean.