Lesson 8-E: Genitourinary-Renal-Reproductive Systems

A client with benign prostatic hypertrophy has been prescribed tamsulosin. Which statement by the nurse describes how this medication works? A. "This medication will improve the flow of urine." B. "This medication will shrink your enlarged prostate gland." C. "Your libido will increase with this medication." D. "This drug will eliminate your nocturia."

Correct Answer: A Rationale: Tamsulosin is an alpha-adrenergic blocker that is prescribed to promote bladder and prostate gland relaxation for clients with benign prostatic hypertropy or hyperplasia (BPH). Common clinical manifestations of BPH include urine obstruction, urinary retention, decrease urine flow, hesitancy and nocturia. Tamsulosin will relax the smooth muscle of the bladder neck and prostate, allowing urine to flow more easily and decreasing bladder neck contractions that can cause hesitancy. Tamsulosin does not shrink the prostate, nor does it increase libido or sexual desire. Finasteride, an androgen inhibitor also commonly prescribed for BPH, reduces the prostate size, thus helping to alleviate the urinary symptoms of BPH. Although tamsulosin may reduce episodes of having to void during the night (nocturia), it might not eliminate them.

The nurse in the outpatient clinic is assisting in the admission of a client scheduled for a prostatectomy this morning. Which statement by the client should be of greatest concern to the nurse? A. "I have not had to urinate since yesterday evening." B. "I have had an allergic reaction to an antibiotic before." C. "I have not had anything to eat since 9:00 pm last night." D. "I am feeling nervous about the procedure."

Correct Answer: A Rationale: The client's statement about not having urinated in over 12 hours should be the greatest concern to the nurse. Urinary retention is a complication of an enlarged prostate gland and the nurse will need to further evaluate the client. The client may require a bladder ultrasound (bladder scan) to determine the amount of urine retained and the insertion of a catheter to drain the bladder may be indicated. The health care provider should also be notified. The nurse will then follow up on the client's other statements.

A client comes to the community health clinic with symptoms of gonorrhea. Which intervention should the nurse implement first? A. Obtain information about the client's recent sexual encounters. B. Instruct the client to notify past sexual partners. C. Collect a urethral swab from the client. D. Discuss the risk of infertility with the client.

Correct Answer: A Rationale: The nurse should first obtain information from the client about their recent sexual encounters. This will provide further insight and assist other health care providers who are coordinating care. The nurse should prepare for a urethral swab, but this should not be the first intervention. The nurse must provide sensitive care because some people are reluctant to seek health care when problems first arise. Sexually transmitted infections can cause emotional distress and may progress without symptoms. It would be important for the client to speak to any sexual partners that may have a risk of contracting the infection, but this should not be the first thing. Discussing the risk of infertility would not be appropriate at this time.

A nurse is caring for a client with continuous bladder irrigation (CBI), following a transurethral resection of the prostate. Which finding would indicate the need for the nurse to increase the flow of the CBI? A. Blood clots in the catheter tubing B. Temperature of 99.8° F C. Bladder spasms D. Pain at the catheter insertion site

Correct Answer: A Rationale: For benign prostatic hyperplasia, a transurethral resection of the prostate (TURP) may be performed. After this surgical procedure, the nurse should be aware of potential complications, including hemorrhage, urinary retention and/or infection. After a TURP, CBI through a three-way catheter is typically initiated to irrigate the bladder of any obstruction such as blood clots and maintain patency of the urethra. Having pink-tinged urine, bladder spasms, a low-grade fever and discomfort at the catheter site are common after the procedure, but increased bleeding and blood clots indicate that the CBI flow is not sufficient and should be increased. A clogged catheter is a medical emergency and immediate steps must be taken to prevent this from happening.

The nurse is caring for a client receiving chemotherapy for breast cancer. Which client statement indicates that additional teaching is required? A. "I've been careful to drink water in small sips throughout the day." B. "My neighbor is bringing me fresh flowers from her garden." C. "I have been waking up throughout the night, feeling restless." D. "I feel nauseous every day after receiving my medications."

Correct Answer: B Rationale: Clients receiving chemotherapeutic treatment are at-risk for neutropenia and associated infections. Chemotherapy can suppress, or weaken, the immune system, otherwise known as immunosuppression. Fresh flowers and plants introduce the potential for the client to be exposed to fungi or bacteria, and thus should be avoided in immunosuppressed patients on chemotherapeutic agents. Nausea and impaired sleep are common side effects of chemotherapy, and although they should be addressed by the nurse, they are not a priority concern. Clients who drink water throughout the day are likely to stay hydrated despite potential nausea and vomiting, so this is also not a concerning statement.

The nurse is reinforcing teaching with a client who has recurrent kidney stones. Which statement by the client would indicate that further teaching is needed? A. "I will make sure I drink plenty of water throughout the day." B. "I will follow a low-calcium diet and avoid dairy products." C. "I will monitor the color of my urine." D. "I will contact my health care provider if I am having difficulty urinating."

Correct Answer: B Rationale: The client's statement regarding a low-calcium diet and avoiding dairy products would require further teaching from the nurse. Low-calcium diets are not generally recommended as this can lead to osteoporosis. Clients should be drinking fluids, preferably water, at least every 1 to 2 hours throughout the day. This can flush the system and prevent the occurrence of kidney stones. Clinical manifestations of kidney stones include pain, infection and difficulty with urination. Clients should notify their health care providers at the first sign of a urinary tract infection, as this can be caused by a kidney stone obstructing the flow of urine.

A client diagnosed with renal calculi is admitted to the unit. Which intervention should the nurse implement first? A. Increase the client's oral fluid intake. B. Assess the client's pain. C. Review appropriate diet choices with client. D. Monitor the client's urinary output.

Correct Answer: B Rationale: The nurse should use the nursing process to prioritize and plan which intervention to implement first. The first step in the process is assessment/data collection and should be taken before formulating a plan of care and implementing interventions. All of the interventions in the scenario are appropriate for a client with renal calculi, but asking the client about their pain level should be done first. Based on the data obtained (i.e., the client's pain level) the nurse should then decide how to proceed.

A 50-year-old male client with a family history of prostatic hyperplasia asks the nurse how the health care provider will screen him for the disease. Which is the best response by the nurse? A. A history of symptoms B. A prostate biopsy C. A digital rectal exam D. A prostate-specific antigen test

Correct Answer: C Rationale: A digital rectal exam is the most effective way to determine if the prostate gland is enlarged. The prostate-specific antigen (PSA) test is a blood test used primarily to screen for prostate cancer, not benign prostatic hyperplasia (BPH). A history of symptoms will also be completed, however many symptoms of BPH are similar to other conditions. A biopsy is usually done to determine the presence of cancer.

The nurse is assisting in developing as plan of care for a postoperative client following a radical left mastectomy. Which nursing problem should be the priority for this client? A. Impaired left arm circulation (lymphedema) B. Anxiety related to the cancer diagnosis C. Acute pain related to the surgery D. Risk of infection of the surgical site

Correct Answer: C Rationale: A radical mastectomy is performed to treat invasive breast cancer and involves the removal of the breast, the nipple and areola, as well as a portion of the axillary lymph nodes. Using Maslow's Hierarchy of Needs to prioritize nursing care and interventions, the acute post-surgical pain (a basic, physiological need) is the priority problem. Next, the nurse should focus on prevention of lymphedema, alleviating the client's anxiety and monitoring for signs of infection at the surgical site.

The nursing care plan for a client in the diuresis stage of acute kidney injury (AKI) should include monitoring for which complication? A. Urinary retention B. Acute pain C. Electrolyte imbalance D. Excess fluid volume

Correct Answer: C Rationale: During the diuresis stage of AKI, the client will be losing an excessive amount of urine (3 to 6 liters per day) and will be at risk for fluid volume deficiency and electrolyte imbalance. The nurse must monitor the client's electrolyte levels, especially potassium (hypokalemia).

A nurse working in a nursing home is caring for an older adult client who has been diagnosed with a urinary tract infection. Which finding should be of greatest concern to the nurse? A. Confusion B. Cloudy urine C. Low blood pressure D. Suprapubic pain

Correct Answer: C Rationale: Having a low blood pressure should be the greatest concern to the nurse. Clients with a urinary tract infection (UTI) are at risk of developing urosepsis, an infection of the blood, which can quickly lead to septic shock. Low blood pressure can be a sign of urosepsis and the beginning stage of shock. Confusion, suprapubic pain and cloudy urine are expected signs and symptoms of a UTI.

The nurse is reinforcing teaching for a client with genital herpes. Which statement by the client indicates that the teaching was effective? A. "My infection will be cured after I take all antibiotics." B. "I can only get the disease from someone with visible lesions." C. "I need to inform my sexual partner of my infection." D. "My infection must be reported to the health department."

Correct Answer: C Rationale: It is critical for the nurse to make sure the client understands that informing their partners of the disease is important to help stop the spread of the infection. Genital herpes is transmittable even when lesions are not visible. Genital herpes is an incurable, life-long infection. Although not a cure, antiviral medications are often used to shorten healing time of lesions and reduce the frequency of outbreaks. Herpes simplex virus (HSV) is typically not required to be reported. However, gonorrhea and syphilis are required to be reported to public health authorities throughout the U.S. In some states, chlamydia infections must also be reported.

To evaluate the effectiveness of antiretroviral therapy for a client infected with human immunodeficiency virus (HIV), which laboratory test result will the nurse plan to review? A. Nucleic acid amplification test B. Rapid HIV antibody test C. Viral load test D. Western blot test

Correct Answer: C Rationale: Viral load refers to the amount of HIV circulating in the blood. The effectiveness of antiretroviral therapy (ART) is measured by the decrease in the amount of HIV virus, i.e., viral load, detectable in the blood. The goal is for the viral load to be so low that it is deemed undetectable. An undetectable viral load does not mean that the client is cured or can no longer transmit the disease. The other tests are used to detect HIV antibodies, which remain positive even with effective ART. A nucleic acid amplification test (NAAT) is commonly used to diagnose a gonorrhea infection.

The school nurse is teaching a group of teenagers about the prevention of sexually transmitted infections (STIs). Which statement by one of the students indicates an understanding of the teaching? A. "Wearing a condom will eliminate any risk of contracting an STI." B. "There are vaccines available that will prevent the majority of STIs." C. "Having multiple sexual partners puts me at a higher risk for an STI." D. "Being on birth control will prevent getting an STI."

Correct Answer: C Rationale: While educating individuals on sexually transmitted infections (STIs) and prevention, discussing the risk of exposure should be emphasized. Although the use of condoms has been shown to reduce the risk of infection for both men and women, they do not completely eliminate the risk. The nurse should follow up on the other responses as they indicate a lack of understanding of how an STI is transmitted or prevented.

A male client who is diagnosed with gonococcal urethritis tells the nurse he had recent sexual contact with a woman who did not appear to have any disease. What is the best response by the nurse? A. "Gonorrhea in women only affects the ovaries and not the genital organs." B. "Men are at a much greater risk than women for acquiring gonorrhea." C. "Women might not have the disease but can be a carrier and infect others. D. "Women might not realize that they have gonorrhea because they are often asymptomatic."

Correct Answer: D Rationale: Men and women who are sexually active are equally at risk for contracting gonorrhea. Many women with gonorrhea are asymptomatic or have minor symptoms that are easily overlooked. The disease may affect both the genitals and the other reproductive organs and cause complications such as pelvic inflammatory disease. Only persons with an active infection of gonorrhea can transmit the disease. A person does not become a carrier of gonorrhea.

A 68-year-old, postmenopausal, female client has been prescribed tamoxifen for breast cancer with bone metastases. The nurse should reinforce teaching about which potential adverse drug effect? A. Symptoms of hypocalcemia B. Insomnia C. Seizures D. Stroke-like symptoms

Correct Answer: D Rationale: Tamoxifen is an antineoplastic drug, commonly prescribed for clients with breast cancer or for clients who are at high risk for developing breast cancer. The most common adverse drug effects (ADEs) are hot flashes, fluid retention, vaginal discharge, nausea, vomiting and menstrual irregularities. In women with bone metastases, tamoxifen may cause transient hypercalcemia. Because of its estrogen agonist actions, tamoxifen poses a small risk of thromboembolic events, including deep vein thrombosis, pulmonary embolism and stroke. Insomnia and seizures are not known ADEs of tamoxifen.

The nurse is evaluating a client's understanding of appropriate dietary choices with chronic kidney disease. Which food choices by the client indicate an understanding of the teaching? (Select all that apply.) A. Slice of cheese B. Fresh apples C. Orange juice D. Unsalted pretzels E. Baked chicken F. Baked potato

Correct Answers: B, D, E Rationale: A client with chronic kidney disease (CKD) must limit intake of potassium, sodium, phosphorus and protein. In CKD, the kidneys are unable to adequately excrete these components. Foods low in potassium include: apples, grapes, lettuce and cauliflower. Foods high in potassium include: bananas, oranges, potatoes and spinach. Foods low in phosphorus include: chicken, shrimp, crab and rice. Foods high in phosphorus include: organ meats, salmon, scallops, nuts and cheese.

The nurse should monitor which clients who may be at-risk for the development of acute kidney injury? (Select all that apply.) A. A client who received multiple blood transfusions B. A client admitted with an acute myocardial infarction C. A client with a history of cirrhosis D. A client with a history of syndrome of inappropriate diuretic hormone E. A client recovering from septic shock

Correct Answers: A, B, E Rationale: Reduced renal perfusion is a risk factor for acute kidney injury (AKI). A client with significant blood or fluid loss, such as one who was recently in a motor vehicle accident would be at-risk for the development of AKI due to poor perfusion. Myocardial infarction is another risk factor for AKI due to reduced cardiac output and subsequent hypoperfusion. Finally, septic shock is associated with significant hypotension, which can cause poor blood flow and hypoperfusion to the kidneys. All of these factors predispose a client to developing AKI. Clients with a history of syndrome of inappropriate antidiuretic hormone secretion (SIADH) or cirrhosis, on the other hand, may present with volume overload, and thus are not at increased risk for the development of AKI.

The nurse is caring for a client who is taking leuprolide for endometriosis. The nurse should monitor the client for which side effects? (Select all that apply.) A. Vaginal dryness B. Increased fertility C. Hot flashes D. Amenorrhea E. Emotional lability F. Anorexia

Correct Answers: A, C, D, E Rationale: Endometriosis is a benign gynecologic condition in which endometrial tissue grows outside of the uterus. It can be controlled, but not cured, by drug therapy. Drugs commonly used include oral contraceptives and GnRH agonists such leuprolide and nafarelin. GnRH drugs result in amenorrhea (absence of menstruation) and other symptoms that mimic menopause such as hot flashes, vaginal dryness and emotional lability. Anorexia (lack of appetite) is not a side effect usually seen with leuprolide. Leuprolide does not increase fertility.

The nurse is caring for a client with an indwelling urinary catheter. Which of the following statements is true? (Select all that apply.) A. The nurse should not allow the tip of the catheter outflow tube to touch the urine collection container. B. The nurse should utilize a clean technique when inserting the urinary catheter. C. The nurse should perform daily catheter care with soap and water. D. The nurse should apply antibiotic ointment to the perineal area. E. The nurse should assure that the urine collection bag is below the level of the bladder.

Correct Answers: A, C, E Rationale: A major risk of an indwelling urinary catheter is the development of a catheter-associated urinary tract infection (CAUTI). To reduce the risk of a CAUTI, nurses should perform daily catheter care with soap and water and should not allow the tip of the catheter outflow tube to touch the urine collection container, as this can lead to contamination. Additionally, obstruction of the urine flow can also lead to increased risk of infection. Therefore, the nurse should make sure that urine is draining appropriately, and that the urine collection bag is below the level of the bladder so that urine can be eliminated with gravity. The nurse should not apply antibiotic ointment to the perineal area, as this does not reduce the likelihood of developing a CAUTI and can introduce the potential for contamination. The nurse should always utilize sterile technique, as opposed to clean technique, when inserting an indwelling urinary catheter.

A nurse at a community health clinic is speaking to a group of young adults about preventing HIV infection. Which high risk behaviors to avoid should the nurse include? (Select all that apply.) A. Inhaling illegal drugs B. Having unprotected sex C. Donating blood D. Smoking e-cigarettes E. Sharing needles

Correct Answers: B & E Rationale: Risk factors associated with HIV include sharing injection drug equipment, having multiple sexual partners, having sexual relations with infected persons, being born to mothers with HIV infection and not using some form of protection during sex. The nurse should provide preventative education regarding using safer sexual practices to reduce the risk of transmitting HIV and avoid sharing any type of needles, razors, toothbrushes or anything that is potentially contaminated with blood. The other behaviors are not known to increase the risk for contracting HIV.

The nurse is caring for a client with end-stage renal disease (ESRD). Which manifestations would the nurse expect to see with this client? (Select all that apply). A. Blood pressure of 119/78 B. Conjunctivitis C. Pruritus D. HbA1c of 5.9% E. Frequent fractures

Correct Answers: B, C, E Rationale: Clients with chronic kidney disease (CKD) and ESRD will present with calcium and phosphorous imbalance, low calcium levels and high phosphorous levels. Bone mineral loss as a result of low calcium levels can result in frequent fractures. Additionally, excessive phosphorous, called metastatic calcifications, can become deposited in various body tissues and systems, including the optic area, which can result in conjunctivitis. Pruritus is a common side effect of excessive serum phosphate. Both diabetes mellitus and hypertension are risk factors for CKD/ESRD, but a HbA1c of 5.9% shows that the diabetes is well-controlled, so does the blood pressure of 119/78 for hypertension.

The nurse is assisting with developing a plan of care for a client with benign prostatic hyperplasia. Which nursing interventions should the nurse include for this client? (Select all that apply.) A. Void every 1 to 2 hours to empty the bladder. B. Monitor for bladder distention. C. Calculate accurate intake and output. D. Catheterize as needed for post-void residual urine. E. Limit caffeinated and alcoholic beverages.

Correct Answers: B, D, E Rationale: Benign prostatic hyperplasia (BPH) is a benign enlargement of the prostate gland. This is common among aging men and can cause urinary difficulties including obstruction, retention, infection and incontinence. Nursing management includes assessing/monitoring for bladder distention. With urinary retention, this can cause pain and increased risk of an acute kidney injury. If the client is retaining urine, the nurse might need to perform straight catheterization to empty the bladder. The client should attempt to void every 4 to 6 hours to prevent retention. The client should avoid or limit the use of caffeinated and alcoholic beverages as these can cause irritation to the bladder and worsen symptoms. Monitoring intake and output would be appropriate to evaluate a client's fluid balance and kidney function, not BPH.

The nurse in a long-term care facility is reviewing the plan of care for a female client diagnosed with a urinary tract infection. To reduce the risk of recurrence, which interventions should the nurse include in the plan of care? (Select all that apply.) A. Provide the client with at least 1 liter of water a day. B. Bathe the client rather than have her shower. C. Discourage the client from drinking coffee or tea. D. Have the client void every 2 to 3 hours. E. Assist the client with wiping the perineum front to back.

Correct Answers: C, D, E Rationale: Appropriate interventions include having the client void every 2 to 3 hours during the day to prevent retention and ensure frequent emptying of the bladder. Drinking caffeinate beverages can cause irritation to the bladder, increasing the risk for an infection. To help reduce pathogens from entering the urethral opening, the nurse should assist the client in wiping the perineum from front to back. The client should take a shower, rather than bathe, as the bacteria in the tub water may enter the urethra. The client should drink at least 2 to 3 liters of water a day, if not contraindicated, to help flush out bacteria in the urinary tract.

The nurse is reviewing the electronic medical record of a client diagnosed with endometriosis. The nurse should expect which findings with this diagnosis? (Select all that apply.) A. Amenorrhea B. Urinary tract infection C. Infertility D. Dyspareunia E. Dysmenorrhea

Correct Answers: C, D, E Rationale: The following findings that would indicate the client has endometriosis are pain with menstruation (dysmenorrhea), pain with intercourse (dyspareunia), excessive bleeding, and infertility. The client may also complain of pelvic and/or back pain, along with pain during bowel movements. The endometrial tissue that implants outside the uterus may cause mild to severe pain, fluctuations in menstrual cycles and fibroids that can cause infertility. Endometriosis often times is mistaken for pelvic inflammatory disease (PID), which causes inflammation of the pelvis, irritable bowel syndrome (IBS) or ovarian cysts. A urinary tract infection and amenorrhea (absence of menstruation) are not usually seen with endometriosis.

The nurse is reviewing the medical record of a client admitted with acute kidney injury. Which findings would support this diagnosis? (Select all that apply.) A. Hypokalemia B. Decreased blood area nitrogen C. Proteinuria D. Hematuria E. Elevated creatinine level F. Decreased glomerular filtration rate

Correct Answers: C, D, E, F Rationale: Acute kidney injury (AKI) is the rapid loss of kidney function due to some form of damage. A clinical manifestation of AKI includes an elevated blood urea nitrogen level due to the breakdown of protein. Protein is then released into the bloodstream and is filtered through the kidneys. Through a urine analysis protein can be found, which is not typically present. Increased levels of protein can damage the kidney, causing an elevated creatinine level, a decreased glomerular filtration rate and hematuria and can cause the release of cellular potassium into body fluids. This can cause hyperkalemia, not hypokalemia.