GU

A client has been prescribed allopurinol (Zyloprim) for renal calculi that are caused by high uric acid levels. Which of the following indicate the client is experiencing adverse effect( s) of this drug? Select all that apply. 1. Nausea. 2. Rash. 3. Constipation. 4. Flushed skin. 5. Bone marrow depression.

1, 2, 5. Common adverse effects of allopurinol (Zyloprim) include gastrointestinal distress, such as anorexia, nausea, vomiting, and diarrhea. A rash is another potential adverse effect. A potentially life-threatening adverse effect is bone marrow depression. Constipation and flushed skin are not associated with this drug.

To prevent recurrence of cystitis, the nurse should plan to encourage the female client to include which of the following measures in her daily routine? 1. Wearing cotton underpants. 2. Increasing citrus juice intake. 3. Douching regularly with 0.25% acetic acid. 4. Using vaginal sprays.

1. A woman can adopt several health-promotion measures to prevent the recurrence of cystitis, including avoiding too-tight pants, noncotton underpants, and irritating substances, such as bubble baths and vaginal soaps and sprays. Increasing citrus juice intake can be a bladder irritant. Regular douching is not recommended; it can alter the pH of the vagina, increasing the risk of infection.

A client has urge incontinence. When obtaining the health history, the nurse should ask if the client has: 1. Inability to empty the bladder. 2. Loss of urine when coughing. 3. Involuntary urination with minimal warning. 4. Frequent dribbling of urine.

3. A characteristic of urge incontinence is involuntary urination with little or no warning. The inability to empty the bladder is urine retention. Loss of urine when coughing occurs with stress incontinence. Frequent dribbling of urine is common in male clients after some types of prostate surgery or may occur in women after the development of a vesicovaginal or urethrovaginal fistula.

The client is scheduled for an intravenous pyelogram (IVP) to determine the location of the renal calculi. Which of the following measures would be most important for the nurse to include in pretest preparation? 1. Ensuring adequate fluid intake on the day of the test. 2. Preparing the client for the possibility of bladder spasms during the test. 3. Checking the client's history for allergy to iodine. 4. Determining when the client last had a bowel movement.

3. A client scheduled for an IVP should be assessed for allergies to iodine and shellfish. Clients with such allergies may be allergic to the IVP dye and be at risk for an anaphylactic reaction. Adequate fluid intake is important after the examination. Bladder spasms are not common during an IVP. Bowel preparation is important before an IVP to allow visualization of the ureters and bladder, but checking for allergies is most important.

Which of the following interventions would be the most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery? 1. Encourage the client to ambulate every 2 to 4 hours. 2. Offer 3 to 4 oz of a carbonated beverage periodically. 3. Encourage use of a stool softener. 4. Continue I.V. fluid therapy.

1. Ambulation stimulates peristalsis. A client with paralytic ileus is kept on nothing-by-mouth status until peristalsis returns. Carbonated beverages will increase gas and distention but will not stimulate peristalsis. A stool softener will not stimulate peristalsis. I.V. fluid infusion is a routine postoperative order that does not have any effect on preventing paralytic ileus.

The client with cystitis is given a prescription for phenazopyridine hydrochloride (Pyridium). The nurse should teach the client that this drug is used to treat urinary tract infections by: 1. Releasing formaldehyde and providing bacteriostatic action. 2. Potentiating the action of the antibiotic. 3. Providing an analgesic effect on the bladder mucosa. 4. Preventing the crystallization that can occur with sulfa drugs.

3. Phenazopyridine hydrochloride (Pyridium) is a urinary analgesic that works directly on the bladder mucosa to relieve the distressing symptoms of dysuria. Phenazopyridine does not have a bacteriostatic effect. It does not potentiate antibiotics or prevent crystallization.

A client is admitted to the hospital with a diagnosis of renal calculi. The client is experiencing severe flank pain and nausea; the temperature is 100.6 ° F (38.1 ° C). Which of the following would be a priority outcome for this client? 1. Prevention of urinary tract complications. 2. Alleviation of nausea. 3. Alleviation of pain. 4. Maintenance of fluid and electrolyte balance.

3. The priority nursing goal for this client is to alleviate the pain, which can be excruciating. Prevention of urinary tract complications and alleviation of nausea are appropriate throughout the client's hospitalization, but relief of the severe pain is a priority. The client is at little risk for fluid and electrolyte imbalance.

A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter would be to: 1. Irrigate the catheter with 30 mL of normal saline every 8 hours. 2. Ensure that the catheter is draining freely. 3. Clamp the catheter every 2 hours for 30 minutes. 4. Ensure that the catheter drains at least 30 mL/ hour.

2. The ureteral catheter should drain freely without bleeding at the site. The catheter is rarely irrigated, and any irrigation would be done by the physician. The catheter is never clamped. The client's total urine output (ureteral catheter plus voiding or indwelling urinary catheter output) should be 30 mL/ hour.

Which of the following statements by the client would indicate that she is at high risk for a recurrence of cystitis? 1. "I can usually go 8 to 10 hours without needing to empty my bladder." 2. "I take a tub bath every evening." 3. "I wipe from front to back after voiding." 4. "I drink a lot of water during the day."

1. Stasis of urine in the bladder is one of the chief causes of bladder infection, and a client who voids infrequently is at greater risk for reinfection. A tub bath does not promote urinary tract infections as long as the client avoids harsh soaps and bubble baths. Scrupulous hygiene and liberal fluid intake (unless contraindicated) are excellent preventive measures, but the client also should be taught to void every 2 to 3 hours during the day.

What should the nurse teach the client to do to prevent stress incontinence? Select all that apply. 1. Use techniques that strengthen the sphincter and structural supports of the bladder, such as Kegel exercises. 2. Avoid dietary irritants (e.g., caffeine, alcoholic beverages). 3. Not to laugh when in social gatherings. 4. Carry an extra incontinence pad when away from home. 5. Obtain a fluid intake of 500 mL/ day.

1, 2. Laughing may be a part of one's socialization, so it should not be discouraged. In non-restricted clients, a fluid intake of at least 2 to 3 L/ day is encouraged; clients with stress incontinence may reduce their fluid intake to avoid incontinence at the risk of developing dehydration and urinary tract infections. Establishing a voiding schedule would be more effective in the prevention of stress incontinence rather than carrying incontinence pads. Dietary irritants and natural diuretics, such as caffeine and alcoholic beverages, may increase stress incontinence. Kegel exercises strengthen the sphincter and structural supports of the bladder.

A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client's discharge teaching plan? 1. Increase daily fluid intake to at least 2 to 3 L. 2. Strain urine at home regularly. 3. Eliminate dairy products from the diet. 4. Follow measures to alkalinize the urine.

1. A high daily fluid intake is essential for all clients who are at risk for calculi formation because it prevents urinary stasis and concentration, which can cause crystallization. Depending on the composition of the stone, the client also may be instructed to institute specific dietary measures aimed at preventing stone formation. Clients may need to limit purine, calcium, or oxalate. Urine may need to be either alkaline or acid. There is no need to strain urine regularly.

A client has nephropathy. The physician orders that a 24-hour urine collection be done for creatinine clearance. Which of the following actions is necessary to ensure proper collection of the specimen? 1. Collect the urine in a preservative-free container and keep it on ice. 2. Inform the client to discard the last voided specimen at the conclusion of urine collection. 3. Ask the client what his weight is before beginning the collection of urine. 4. Request an order for insertion of an indwelling urinary catheter.

1. All urine for creatinine clearance determination must be saved in a container with no preservatives and refrigerated or kept on ice. The first urine voided at the beginning of the collection is discarded, not the last. A self-report of weight may not be accurate. It is not necessary to have an indwelling urinary catheter inserted for urine collection.

Which of the following interventions would be most appropriate for a client who has urge incontinence? 1. Have the client urinate on a timed schedule. 2. Provide a bedside commode. 3. Administer prophylactic antibiotics. 4. Teach the client intermittent self-catheterization technique.

1. Instructing the client to void at regularly scheduled intervals can help decrease the frequency of incontinence episodes. Providing a bedside commode does not decrease the number of incontinence episodes and does not help the client who leads an active lifestyle. Infections are not a common cause of urge incontinence, so antibiotics are not an appropriate treatment. Intermittent self-catheterization is appropriate for overflow or reflux incontinence, but not urge incontinence, because it does not treat the underlying cause.

When teaching the client with a urinary tract infection about taking phenazopyridine hydrochloride (Pyridium), the nurse should tell the client to expect: 1. Bright orange-red urine. 2. Incontinence. 3. Constipation. 4. Slight drowsiness.

1. The client should be told that phenazopyridine hydrochloride (Pyridium) turns the urine a bright orange-red, which may stain underwear. It can be frightening for a client to see orange-red urine without having been forewarned. Other common adverse effects associated with phenazopyridine include headaches, gastrointestinal disturbances, and rash. Phenazopyridine does not cause incontinence, constipation, or drowsiness.

A nurse is assessing a client with a urinary tract infection who takes an antihypertensive drug. The nurse reviews the client's urinalysis results pH 6.8, RBC 3 per high power field, color-yellow, specific gravity-1.030 . The nurse should: 1. Encourage the client to increase fluid intake. 2. Withhold the next dose of antihypertensive medication. 3. Restrict the client's sodium intake. 4. Encourage the client to eat at least half of a banana per day.

1. The client's urine specific gravity is elevated. Specific gravity is a reflection of the concentrating ability of the kidneys. This level indicates that the urine is concentrated. By increasing fluid intake, the urine will become more dilute. Antihypertensives do not make urine more concentrated unless there is a diuretic component within them. The nurse should not hold a dose of antihypertensive medication. Sodium tends to pull water with it; by restricting sodium, less water, not more, will be present. Bananas do not aid in the dilution of urine.

A client has been prescribed nitrofurantoin (Macrodantin) for treatment of a lower urinary tract infection. Which of the following instructions should the nurse include when teaching the client how to take this medication? Select all that apply. 1. "Take the medication on an empty stomach." 2. "Your urine may become brown in color." 3. "Increase your fluid intake." 4. "Take the medication until your symptoms subside." 5. "Take the medication with an antacid to decrease gastrointestinal distress."

2, 3. Clients who are taking nitrofurantoin (Macrodantin) should be instructed to take the medication with meals and to increase their fluid intake to minimize gastrointestinal distress. The urine may become brown in color. Although this change is harmless, clients need to be prepared for this color change. The client should be instructed to take the full prescription and not to stop taking the drug because symptoms have subsided. The medication should not be taken with antacids as this may interfere with the drug's absorption.

Allopurinol (Zyloprim), 200 mg/ day, is prescribed for the client with renal calculi to take at home. The nurse should teach the client about which of the following adverse effects of this medication? 1. Retinopathy. 2. Maculopapular rash. 3. Nasal congestion. 4. Dizziness.

2. Allopurinol (Zyloprim) is used to treat renal calculi composed of uric acid. Adverse effects of allopurinol include drowsiness, maculopapular rash, anemia, abdominal pain, nausea, vomiting, and bone marrow depression. Clients should be instructed to report rashes and unusual bleeding or bruising. Retinopathy, nasal congestion, and dizziness are not adverse effects of allopurinol.

The nurse is developing a teaching plan for a client with stress incontinence. Which of the following instructions should be included? 1. Avoid activities that are stressful and upsetting. 2. Avoid caffeine and alcohol. 3. Do not wear a girdle. 4. Limit physical exertion.

2. Clients with stress incontinence are encouraged to avoid substances, such as caffeine and alcohol, that are bladder irritants. Emotional stressors do not cause stress incontinence. It is most commonly caused by relaxed pelvic musculature. Wearing girdles is not contraindicated. Although clients may want to limit physical exertion to avoid incontinence episodes, they should be encouraged to seek treatment instead of limiting their activities.

Which of the following nursing interventions is likely to provide the most relief from the pain associated with renal colic? 1. Applying moist heat to the flank area. 2. Administering meperidine (Demerol). 3. Encouraging high fluid intake. 4. Maintaining complete bed rest.

2. During episodes of renal colic, the pain is excruciating. It is necessary to administer opioid analgesics to control the pain. Application of heat, encouraging high fluid intake, and limitation of activity are important interventions, but they will not relieve the renal colic pain.

The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. Which of the following findings would be most important for the nurse to report to the physician? 1. Temperature, 99.8 ° F (37.7 ° C). 2. Urine output, 20 mL/ hour. 3. Absence of bowel sounds. 4. A 2″ × 2″ area of serosanguineous drainage on the flank dressing.

2. The decrease in urine output may reflect inadequate renal perfusion and should be reported immediately. Urine output of 30 mL/ hour or greater is considered acceptable. A slight elevation in temperature is expected after surgery. Peristalsis returns gradually, usually the second or third day after surgery. Bowel sounds will be absent until then. A small amount of serosanguineous drainage is to be expected.

A client has stress incontinence. Which of the following data from the client's history contributes to the client's incontinence? 1. The client's intake of 2 to 3 L of fluid per day. 2. The client's history of three full-term pregnancies. 3. The client's age of 45 years. 4. The client's history of competitive swimming.

2. The history of three pregnancies is most likely the cause of the client's current episodes of stress incontinence. The client's fluid intake, age, or history of swimming would not create an increase in intra-abdominal pressure.

In addition to nausea and severe flank pain, a female client with renal calculi has pain in the groin and bladder. The nurse should assess the client further for signs of: 1. Nephritis. 2. Referred pain. 3. Urine retention. 4. Additional stone formation.

2. The pain associated with renal colic due to calculi is commonly referred to the groin and bladder in female clients and to the testicles in male clients. Nausea, vomiting, abdominal cramping, and diarrhea may also be present. Nephritis or urine retention is an unlikely cause of the referred pain. The type of pain described in this situation is unlikely to be caused by additional stone formation.

A client with a urinary tract infection is to take nitrofurantoin (Macrodantin) four times each day. The client asks the nurse, "What should I do if I forget a dose?" What should the nurse tell the client? 1. "You can wait and take the next dose when it is due." 2. "Double the amount prescribed with your next dose." 3. "Take the prescribed dose as soon as you remember it, and if it is very close to the time for the next dose, delay that next dose." 4. "Take a lot of water with a double amount of your prescribed dose."

3. Antibiotics have the maximum effect when a blood level of the medication is maintained. However, because nitrofurantoin (Macrodantin) is readily absorbed from the gastrointestinal tract and is primarily excreted in urine, toxicity may develop by doubling the dose. The client should not skip a dose if she realizes that she has missed one. Additional fluids, especially water, should be encouraged, but not forced to promote elimination of the antibiotic from the body. Adequate fluid intake aids in the prevention of urinary tract infections, in addition to an acidic urine.

The client asks the nurse, "How did I get this urinary tract infection?" The nurse should explain that in most instances, cystitis is caused by: 1. Congenital strictures in the urethra. 2. An infection elsewhere in the body. 3. Urinary stasis in the urinary bladder. 4. An ascending infection from the urethra.

4. Although various conditions may result in cystitis, the most common cause is an ascending infection from the urethra. Strictures and urine retention can lead to infections, but these are not the most common cause. Systemic infections are rarely causes of cystitis.

The client, who is a newlywed, is afraid to discuss her diagnosis of cystitis with her husband. Which would be the nurse's best approach? 1. Arrange a meeting with the client, her husband, the physician, and the nurse. 2. Insist that the client talk with her husband because good communication is necessary for a successful marriage. 3. Talk first with the husband alone and then with both of them together to share the husband's reactions. 4. Spend time with the client addressing her concerns and then stay with her while she talks with her husband.

4. As newlyweds, the client and her husband need to develop a strong communication base. The nurse can facilitate communication by preparing and supporting the client. Given the situation, an interdisciplinary conference is inappropriate and would not promote intimacy for the client and her husband. Insisting that the client talk with her husband is not addressing her fears. Being present allows the nurse to facilitate the discussion of a difficult topic. Having the nurse speak first with the husband alone shifts responsibility away from the couple.

The nurse is reviewing laboratory reports for a client who is taking allopurinol (Zyloprim). Which of the following indicate that the drug has had a therapeutic effect? 1. Decreased urine alkaline phosphatase level. 2. Increased urine calcium excretion. 3. Increased serum calcium level. 4. Decreased serum uric acid level.

4. By inhibiting uric acid synthesis, allopurinol (Zyloprim) decreases its excretion. The drug's effectiveness is assessed by evaluating for a decreased serum uric acid concentration. Allopurinol does not alter the level of alkaline phosphatase, nor does it affect urine calcium excretion or the serum calcium level.

A client has renal colic due to renal lithiasis. What is the nurse's first priority in managing care for this client? 1. Do not allow the client to ingest fluids. 2. Encourage the client to drink at least 500 mL of water each hour. 3. Request the central supply department to send supplies for straining urine. 4. Administer an opioid analgesic as prescribed.

4. If infection or blockage caused by calculi is present, a client can experience sudden severe pain in the flank area, known as renal colic. Pain from a kidney stone is considered an emergency situation and requires analgesic intervention. Withholding fluids will make urine more concentrated and stones more difficult to pass naturally. Forcing large quantities of fluid may cause hydronephrosis if urine is prevented from flowing past calculi. Straining urine for small stones is important, but does not take priority over pain management.

The nurse explains to the client the importance of drinking large quantities of fluid to prevent cystitis. The nurse should tell the client to drink: 1. Twice as much fluid as usual. 2. At least 1 quart more than usual. 3. A lot of water, juice, and other fluids throughout the day. 4. At least 3,000 mL of fluids daily.

4. Instructions should be as specific as possible, and the nurse should avoid general statements such as "a lot." A specific goal is most useful. A mix of fluids will increase the likelihood of client compliance. It may not be sufficient to tell the client to drink twice as much as or 1 quart more than she usually drinks if her intake was inadequate to begin with.

The primary goal of nursing care for a client with stress incontinence is to: 1. Help the client adjust to the frequent episodes of incontinence. 2. Eliminate all episodes of incontinence. 3. Prevent the development of urinary tract infections. 4. Decrease the number of incontinence episodes.

4. The primary goal of nursing care is to decrease the number of incontinence episodes and the amount of urine expressed in an episode. Behavioral interventions (e.g., diet and exercise) and medications are the nonsurgical management methods used to treat stress incontinence. Without surgical intervention, it may not be possible to eliminate all episodes of incontinence. Helping the client adjust to the incontinence is not treating the problem. Clients with stress incontinence are not prone to the development of urinary tract infection.

The nurse is teaching an 80-year-old client with a urinary tract infection about the importance of increasing fluids in the diet. Which of the following puts this client at a risk for not obtaining sufficient fluids? 1. Diminished liver function. 2. Increased production of antidiuretic hormone. 3. Decreased production of aldosterone. 4. Decreased ability to detect thirst.

4. The sensation of thirst diminishes in those greater than 60 years of age; hence, fluid intake is decreased and dissolved particles in the extracellular fluid compartment become more concentrated. There is no change in liver function in older adults, nor is there a reduction of ADH and aldosterone as a normal part of aging.

A client who weighs 207 lb is to receive 1.5 mg/ kg of gentamicin sulfate (Garamycin) I.V. three times each day. How many milligrams of medication should the nurse administer for each dose? Round to the nearest whole number. __________________ mg.

141 mg

Because a client's renal stone was found to be composed of uric acid, a low-purine, alkaline-ash diet was ordered. Incorporation of which of the following food items into the home diet would indicate that the client understands the necessary diet modifications? 1. Milk, apples, tomatoes, and corn. 2. Eggs, spinach, dried peas, and gravy. 3. Salmon, chicken, caviar, and asparagus. 4. Grapes, corn, cereals, and liver.

1. Because a high-purine diet contributes to the formation of uric acid, a low-purine diet is advocated. An alkaline-ash diet is also advocated because uric acid crystals are more likely to develop in acid urine. Foods that may be eaten as desired in a low-purine diet include milk, all fruits, tomatoes, cereals, and corn. Foods allowed on an alkaline-ash diet include milk, fruits (except cranberries, plums, and prunes), and vegetables (especially legumes and green vegetables). Gravy, chicken, and liver are high in purine.

Nitrofurantoin (Macrodantin), 75 mg four times per day, has been prescribed for a client with a lower urinary tract infection. The medication comes in an oral suspension of 25 mg/ 5 mL. How many milliliters should the nurse administer for each dose? ________________________ mL.

15 mL

After an intravenous pyelogram (IVP), the nurse should anticipate incorporating which of the following measures into the client's plan of care? 1. Maintaining bed rest. 2. Encouraging adequate fluid intake. 3. Assessing for hematuria. 4. Administering a laxative.

2. After an IVP, the nurse should encourage fluids to decrease the risk of renal complications caused by the contrast agent. There is no need to place the client on bed rest or administer a laxative. An IVP would not cause hematuria.

The nurse teaches a female client who has cystitis methods to relieve her discomfort until the antibiotic takes effect. Which of the following responses by the client would indicate that she understands the nurse's instructions? 1. "I will place ice packs on my perineum." 2. "I will take hot tub baths." 3. "I will drink a cup of warm tea every hour." 4. "I will void every 5 to 6 hours."

2. Hot tub baths promote relaxation and help relieve urgency, discomfort, and spasm. Applying heat to the perineum is more helpful than cold because heat reduces inflammation. Although liberal fluid intake should be encouraged, caffeinated beverages, such as tea, coffee, and cola, can be irritating to the bladder and should be avoided. Voiding at least every 2 to 3 hours should be encouraged because it reduces urinary stasis.

A client who has been diagnosed with renal calculi reports that the pain is intermittent and less colicky. Which of the following nursing actions is most important at this time? 1. Report hematuria to the physician. 2. Strain the urine carefully. 3. Administer meperidine (Demerol) every 3 hours. 4. Apply warm compresses to the flank area.

2. Intermittent pain that is less colicky indicates that the calculi may be moving along the urinary tract. Fluids should be encouraged to promote movement, and the urine should be strained to detect passage of the stone. Hematuria is to be expected from the irritation of the stone. Analgesics should be administered when the client needs them, not routinely. Moist heat to the flank area is helpful when renal colic occurs, but it is less necessary as pain is lessened.

A 24-year-old female client comes to an ambulatory care clinic in moderate distress with a probable diagnosis of acute cystitis. When obtaining the client's history, the nurse should ask the client if she has had: 1. Fever and chills. 2. Frequency and burning on urination. 3. Flank pain and nausea. 4. Hematuria.

2. The classic symptoms of cystitis are severe burning on urination, urgency, and frequent urination. Systemic symptoms, such as fever and nausea and vomiting, are more likely to accompany pyelonephritis than cystitis. Hematuria may occur, but it is not as common as frequency and burning.

The client is scheduled to have a kidney, ureter, and bladder (KUB) radiograph. To prepare the client for this procedure, the nurse should explain to the client that: 1. Fluid and food will be withheld the morning of the examination. 2. A tranquilizer will be given before the examination. 3. An enema will be given before the examination. 4. No special preparation is required for the examination.

4. A KUB radiographic examination ordinarily requires no preparation. It is usually done while the client lies supine and does not involve the use of radiopaque substances.