NCLEX 10000 GENITOURINARY
A couple is inquiring about vasectomy as a permanent method of contraception. Which teaching statement would the nurse include in the teaching plan?
"Another method of contraception is needed until the sperm count is 0."
An 18-year-old female is to have a pelvic exam. Which response by the nurse would be best when the client says that she is nervous about the upcoming pelvic examination?
"Can you tell me more about how you are feeling?"
A middle-aged male client comes to the clinic for an evaluation of difficulty urinating and nocturia. His father died from prostate cancer. He asks the nurse what he can do to ensure early detection of this disease. Which of the following questions should the nurse ask next?
"Do you have a digital rectal examination and prostate-specific antigen (PSA) tests yearly?"
A client who is recovering from transurethral resection of the prostate (TURP) experiences urinary incontinence and has decreased the fluid intake because of the incontinence. What would be the nurse's best response to the client?
"Drink eight glasses of water a day and urinate every 2 hours."
The nurse gives a pamphlet that describes Kegel exercises to a client with stress incontinence. Which statement indicates that the client has understood the instructions contained in the pamphlet?
"I can do these exercises sitting up, lying down, or standing."
Which statements by a female client would indicate that she is at high risk for a recurrence of cystitis?
"I can usually go 8 to 10 hours without needing to empty my bladder."
The nurse is teaching a 17-year-old girl who has a severe gonorrheal infection. The nurse realizes that the girl understands the implications of her disease when she tells the nurse:
"I could have trouble getting pregnant."
The nurse is collecting data on a client with a urinary tract infection (UTI). Which statements should the nurse expect the client to make? Select all that apply.
"I need to urinate frequently." "It burns when I urinate." "I need to urinate urgently."
A nurse is teaching a client with genital herpes. Which of the following would indicate to the nurse that the client's teaching was successful?
"I should inform my partners about the disease."
A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which of the following statements, if made by a group member, would indicate understanding of the teaching?
"I should notify the physician if urinary urgency, burning, frequency, or difficulty urinating occurs."
A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs?
"I should take at least 1,000 mg of vitamin C each day."
The nurse is instructing the unlicensed assistive personnel (UAP) about the correct technique for obtaining a clean-catch urine culture from a female client. Which statement indicates
"I will ask the client to clean her labia, void into the toilet, and then into the specimen cup."
The nurse is evaluating a female client's understanding of how to prevent sexually transmitted infections (STIs). Which statement indicates that the client understands how to protect herself?
"I will be sure my partner uses a condom."
The nurse is instructing an unlicensed assistive personnel (UAP) to collect a urine specimen from an indwelling catheter. Which statement indicates that the UAP understands the instructions?
"I will get a sterile syringe and remove urine from the catheter through the collection port to place in the specimen container."
A client is to take sulfamethoxazole-trimethoprim for a urinary tract infection. Which statement indicates that the client knows how to correctly take the medication?
"I will need to get a urine culture when I am finished taking the pills."
The client with a urinary tract infection is given a prescription for trimethoprim. Which statement indicates that the client understands how to take the medication?
"I will take all the pills and then return to my doctor."
The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel. Which statement indicates that the client understands the teaching?
"I will take it with meals and bedtime snacks."
A nurse is caring for a client who also works in the hospital. The client has recently received a diagnosis of genital herpes and is being treated for a urinary tract infection (UTI). While on lunch break in the cafeteria, the nurse sees the client's coworkers, who voice concern over his condition. The nurse's best response would be:
"I'll be sure to tell him you're thinking of him."
A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address?
"I'm allergic to shellfish."
After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which client statement indicates a need for further teaching?
"If I gain or lose 20 lb (9 kg), I can still use the same diaphragm."
During a clinic visit, the mother of an infant with hydrocele states that the infant's scrotum is smaller now than when he was born. After teaching the mother about the infant's condition, which statement by the mother indicates that the teaching has been effective?
"It seems like the fluid is being reabsorbed."
The client with benign prostatic hypertrophy is being transferred from the emergency department to a surgery unit. Which information should be included in the report from the nurse in the emergency department to the nurse responsible for admitting the client?
"The client was catheterized, and 1,100 mL of urine was obtained. The urine appeared cloudy, and a specimen was sent to the laboratory."
A couple has completed testing and is a candidate for in vitro fertilization. The nurse is reviewing the procedure with them and realizes that further instruction is needed when the woman states:
"The fertilization procedure can be done anytime during my cycle."
When providing client teaching about continuous bladder irrigation following prostate surgery, the nurse should tell the client:
"The purpose of the irrigation is to keep bladder drainage clear and to prevent the formation of blood clots in the bladder."
An unlicensed assistive personnel (UAP) tells the nurse, "I think the client is confused. He keeps telling me he has to void, but that is not possible because he has a catheter in place that is draining well." The nurse should tell the UAP:
"The urge to void is usually created by the large catheter, and he may be having some bladder
An unlicensed assistive personnel (UAP) tells the nurse, "I think the client is confused. He keeps telling me he has to void, but that is not possible because he has a catheter in place that is draining well." The nurse should tell the UAP:
"The urge to void is usually created by the large catheter, and he may be having some bladder spasms."
A client scheduled for a vasectomy asks the nurse how soon after the procedure he can have sexual intercourse without using an alternative birth control method. How should the nurse respond?
"You can safely have unprotected intercourse when your sperm count indicates sterilization."
A client with a new ileal conduit asks the nurse when he needs to wear his appliance. What should the nurse tell the client?
"You need to wear your appliance all the time."
The client with pyelonephritis asks the nurse, "How will I know whether the antibiotics are effectively treating my infection?" What should the nurse tell the client?
"Your health care provider will take a urine culture."
A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in:
1 min
A client with marked oliguria is ordered a test dose of 0.2 g/kg of 15% mannitol solution intravenously over 5 minutes. The client weighs 132 lb. How many grams would the nurse administer? Record your answer as a whole number.
12
A client who weighs 207 lb (94.1 kg) is to receive 1.5 mg/kg of gentamicin sulfate IV three times each day. How many milligrams of medication should the nurse administer for each dose? Round to the nearest whole number.
141
Nitrofurantoin, 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? Record your answer using a whole number.
15
A nurse is teaching a client about peritoneal dialysis. The nurse should tell the client the dwell time is
20
A woman is using progestin injections for contraception. The nurse instructs the client to return for an appointment in:
3 months.
A male client is diagnosed with a chlamydial infection. Azithromycin 1 g is prescribed. The supply of azithromycin is in 250-mg tablets. How many tablets should the nurse administer? Record your answer using a whole number.
4
Sulfamethoxazole has been prescribed to treat a client's urinary tract infection. The initial dosage is 2 g orally. The nurse has 500-mg tablets available. How many tablets should the nurse give? Record your answer using a whole number.
4
The nurse is completing an intake and output record for a client who is receiving continuous bladder irrigation after transurethral resection of the prostate. How many milliliters of urine should the nurse record as output for her shift if the client received 1,800 ml of normal saline irrigating solution and the output in the urine drainage bag is 2,400 ml? Record your answer using a whole number.
600
A nurse receives the assignment of the following clients for the shift. Following the report, which client should the nurse see first?
A client 3 days after kidney transplant with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L after dialysis
A registered nurse and a nursing assistant are caring for a group of clients. Which client's care may safely be delegated to the nursing assistant?
A client diagnosed with renal calculi who must ambulate four times daily and drink plenty of fluids
Which client is at highest risk for developing a hospital-acquired infection?
A client with an indwelling urinary catheter
A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution?
Acidic
Which of the following is a priority nursing diagnosis for the client presenting with pelvic inflammatory disease?
Acute pain.
A client has renal colic due to renal lithiasis. What is the nurse's first priority in managing care for this client?
Administer an opioid analgesic as prescribed.
The client asks the nurse, "Is it really possible to lead a normal life with an ileostomy?" Which action by the nurse would be the most effective to address this question?
Arrange for a person with an ostomy to visit the client preoperatively.
A nurse is admitting an older female client to the gynecology surgical unit. When the nurse asks the client what medication she is taking at home, the client responds that she is taking a little red pill in the morning and a white capsule at night for her blood pressure. What action by the nurse is focused on safe, effective care of this client?
Ask a family member to bring the medications from home in the original vials for proper identification and administration times.
The unlicensed assistive personnel (UAP) reports to the nurse that the client with an abdominal hysterectomy who returned from the recovery room 1 hour earlier has saturated the blue pad with bright red blood. What should the nurse do?
Ask the UAP to obtain vital signs while the nurse calls the surgeon.
A client returned to the recovery room after a dilatation and curettage has the postoperative medication prescriptions shown in the medical record. What should the nurse do next?
Ask the client to rate the intensity of her pain on a scale of 1 to 10, and administer the analgesia according to the intensity of the pain.
A client reports left calf pain after undergoing renal arteriogram, in which the left groin was accessed. Which intervention should the nurse perform first?
Assess peripheral pulses in the left leg.
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?
Assess the AV fistula for a bruit and thrill.
A client with chronic renal failure is experiencing central nervous system (CNS) changes caused by uremic toxins. Which nursing approach would be most appropriate for addressing the changes?
Assess the client's mental status regularly.
After undergoing transurethral resection of the prostate to treat benign prostatic hyperplasia, a client returns to the room with continuous bladder irrigation. On the first day after surgery, the client reports bladder pain. What should the nurse do first?
Assess the irrigation catheter for patency and drainage.
A client undergoes cystoscopy with bladder biopsy. After the procedure, which assessment is most appropriate for the nurse to make?
Assess urine for excessive bleeding.
A client with end-stage renal failure has an internal arteriovenous fistula in the left arm for vascular access during hemodialysis. What should the nurse instruct the client to do? Select all that apply.
Avoid sleeping on the left arm. Wear wrist watch on the right arm. Assess fingers on the left arm for warmth.
A client with acute pyelonephritis receives a prescription for co-trimoxazole P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the ordered regimen?
Bacteria are absent on urine culture.
A client with renal insufficiency is admitted to the hospital with pneumonia. He's being treated with gentamicin. Which laboratory value should be closely monitored?
Blood urea nitrogen (BUN)
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?
Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl
A client with chronic kidney disease (CKD) has a blood urea nitrogen (BUN), 100 mg/dL, serum creatinine 6.5 mg/dL, potassium 6.1 mEq/L, and lethargy. Which of the following is the priority nursing assessment?
Cardiac rhythm
The client is scheduled for an intravenous pyelogram (IVP) to determine the location of the renal calculi. Which action would be most important for the nurse to include in pretest preparation?
Check the client's history for allergy to iodine.
A client presents with severe diarrhea and a history of chronic renal failure to the emergency department. Arterial blood gas results are as follows: pH 7.30 PaO2 97 PaCO2 37 HCO3 18 The nurse would expect what sets of assessment findings?
Clammy skin, blood pressure 86/46 mm Hg, headache
A client has nephropathy. The health care provider (HCP) prescribes a 24-hour urine collection for creatinine clearance. Which action is necessary to ensure proper collection of the specimen?
Collect the urine in a preservative-free container and keep it on ice.
During a routine physical examination, a male client informs the nurse that he frequently participates in anal intercourse with his girlfriend. The nurse informs the client that:
Condoms are recommended for anal intercourse.
A nurse is conducting a healthy-living workshop with a group of female college students. Which of the following methods of contraception should the nurse recommend as a means of preventing both pregnancy and sexually transmitted infections?
Condoms.
The nurse should inform a young female client that the barrier method providing the best protection against sexually transmitted infections (STIs) is:
Condoms.
A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans?
Cottage cheese-like discharge
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?
Creatinine clearance
The nurse is caring for a client with polydipsia and large amounts of urine with a specific gravity of 1.003. Which disorder is anticipated?
Diabetes insipidus
A postmenopausal woman is worried about pain in the upper outer quadrant of her left breast. The nurse's best course of action is to:
Do a breast examination and report the results to the physician.
A client is scheduled for an intravenous pyelogram (IVP). In preparation for the procedure, what should the nurse ask the client?
Do you have any allergies?"
A 30-year-old female client asks the nurse about douching. What information should the nurse include in the teaching plan?
Douching removes natural mucus and changes the balance of normal vaginal flora.
A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs." How should the nurse proceed?
Educate the client about why it's important to inform sexual contacts so they can receive treatment.
After an intravenous pyelogram (IVP), the nurse should include which measure in the client's plan of care?
Encourage adequate fluid intake.
A client is diagnosed with pyelonephritis. Which nursing action is a priority for care now?
Ensure sufficient hydration.
A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged I.V. pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow?
Evaluating patency of the drainage lumen
The nurse is providing preoperative instructions to a client who is having a transurethral resection of the prostate. The nurse should tell the client:
Expect blood in your urine in the first couple of days following the procedure."
A nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way?
Fluid intake should be about equal to the urine output.
The nurse teaches a client scheduled for an I.V. pyelogram what to expect when the dye is injected. The client has correctly understood what was taught when the client states that there may be which of the following sensations when the dye is injected?
Flushing of the face.
The nurse is developing an educational program about prostate cancer. The nurse should provide information about which topic?
For all men, age 50 and older, the American and Canadian Cancer Societies recommend an annual rectal examination.
A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention? You Selected:
Foul-smelling discharge from the penis
A client admitted to the unit with a diagnosis of end-stage renal disease is scheduled to undergo hemodialysis. He voices anxiety over shunt placement and management of care at home. A nurse initiates a referral to which members of the interdisciplinary team?
Home health nurse, nutritionist, and social worker
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?
Increase daily fluid intake to at least 2 to 3 L.
A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?
Increase your fluid intake to 2 to 3 L per day."
A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important?
Increasing fluid intake to 3 L/day
The nurse is caring for a client with acute renal failure. Rank in chronological order the phases of acute renal failure. Use all the options.
Initial insult Oliguric phase Diuretic phase Recovery phase
A client is scheduled for a creatinine clearance test. What should the nurse do?
Instruct the client about the need to collect urine for 24 hours.
A client undergoes extracorporeal shock wave lithotripsy (ESWL) to break up and remove renal calculi. Which nursing measure is appropriate for the postoperative care of this client?
Instruct the client to anticipate hematuria for about 24 hours after the procedure. Explanation:
After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an I.V. infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output?
It's an abnormal finding that requires further assessment.
After a radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. The client then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first?
Kegel exercises
A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site?
Kidney
The nurse is teaching the client with an ileal conduit how to prevent a urinary tract infection. Which measure would be most effective?
Maintain a daily fluid intake of 2,000 to 3,000 mL.
Which should be included in the client's plan of care during dialysis therapy?
Monitor the client's blood pressure.
A client with suspected renal dysfunction is scheduled for excretory urography. The nurse reviews his history for conditions that may warrant changes in client preparation. Normally, the client should be mildly hypovolemic (fluid depleted) before excretory urography. Which history finding calls for the client to be well hydrated?
Multiple myeloma
A 39-year-old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which client statement indicates effective teaching?
My fallopian tubes will be tied off through a small abdominal incision."
A client is voiding small amounts of urine every 30 to 60 minutes. What should the nurse do first?
Palpate for a distended bladder.
When instructing a client about the proper use of condoms for pregnancy prevention, the nurse should include which instructions to ensure maximum effectiveness?
Place the condom over the erect penis before coitus.
A male client informs the urology nurse that he is embarrassed because his wife rarely has time to reach sexual satisfaction during their encounters. He says he experiences orgasm as soon as he enters the wife's vagina. What is this condition best known as?
Premature ejaculation.
Which is the correct order, from first to last, for proper placement of a urinary catheter? All options must be used
Prepare a sterile field. Lubricate the catheter adequately with a water-soluble lubricant. Insert the catheter far enough into the bladder to prevent trauma to the urethral tissue. Ensure free flow of urine.
Which steps should a nurse follow to insert a straight urinary catheter?
Prepare the client and equipment, create a sterile field, put on gloves, clean the urinary meatus, and insert the catheter until urine flows.
A nurse is caring for an elderly male client who complains that he can't pass urine. A bladder scan reveals 600 ml of urine present in the bladder. The nurse attempts to place the indwelling catheter the physician ordered, but resistance prevents her from placing it. A serum prostate-specific antigen (PSA) test indicates a level of 29 g/L. The physician places an indwelling catheter and the urine specimen returns positive for nitrites, leukocytes, and bacteriuria. Which conditions should the nurse suspect? Select all that apply.
Prostate problems Urinary tract infection (UTI)
During rounds, a client admitted with gross hematuria asks the nurse about the physician's diagnosis. To facilitate effective communication, what should the nurse do?
Provide privacy for the conversation.
A client is scheduled for a renal arteriogram. No allergies are recorded in the client's medical record, and the client is unable to provide allergy information. During the arteriogram, the nurse should be alert for which assessment finding that may indicate an allergic reaction to the dye used?
Pruritus
A nurse is caring for a client who had an ileal conduit 3 days earlier. Which assessment finding, if made by the nurse, would indicate a need for a further consultation with the enterostomal nurse?
Red, sensitive skin around the stoma site
Assessment of a 36-year-old woman who has malaise and dysuria reveals a temperature of 100° F (37.4° C) and painful blisters on the outside of her vagina. The client tells the nurse she had intercourse with a new partner 5 days ago. What should the nurse do?
Refer the client to a health care provider (HCP).
What are important nursing care measures for a client with diabetes who is admitted with end-stage renal failure?
Restrict sodium and potassium and restrict fluids as ordered.
A client is prescribed alfuzosin for benign prostatic hyperplasia (BPH). What should the nurse teach the client?
Rise slowly from a supine position.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
Risk for infection
Which nursing diagnosis is appropriate for a client with renal calculi?
Risk for infection
A school nurse is teaching a class about sexually transmitted infections (STIs). Which statement is correct regarding STIs?
STIs are most prevalent among teenagers and young adults.
A client was treated for a streptococcal throat infection 2 weeks ago. The client now has been diagnosed with acute poststreptococcal glomerulonephritis. The client asks the nurse how he could have prevented this condition. What should the nurse tell the client?
See your health care provider (HCP) for an early diagnosis and treatment of a sore throat."
The nurse collects a urine specimen from a client for a culture and sensitivity analysis. What should the nurse do next?
Send the specimen to the laboratory immediately.
A client is receiving hemodialysis for chronic kidney failure. The nurse understands the client is at an increased risk for which of the following?
Serum hepatitis
The client, who is a newlywed, is afraid to discuss her diagnosis of cystitis with her husband. Which approach would be best?
Spend time with the client addressing her concerns and then stay with her while she talks with her husband.
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?
Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.
A client who has been diagnosed with renal calculi reports that the pain is intermittent and less colicky. Which nursing action is most important at this time?
Strain the urine carefully.
When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?
The client keeps the drainage bag below the bladder at all times.
After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?
The client reports bladder spasms and the urge to void.
The client is taking sildenafil orally for erectile dysfunction. What instruction should the nurse give the client?
The health care provider (HCP) should be notified promptly if the client experiences sudden or diminished vision.
A nurse is explaining self-catheterization to a female client who has been diagnosed with neurogenic bladder. Which instructions would the nurse include in the teaching? Select all that apply.
The meatus would be cleaned with a towelette or soapy washcloth and then rinsed. Sterile technique is not required.
A nurse preceptor is observing a new graduate during care of a client in contact isolation. Which action by the new graduate indicates a need for further teaching about handling infectious materials?
The nurse uses alcohol gel to clean her hands after changing linen soiled with urine and feces.
A client who is to have a vaginal radium implant tells the nurse she is concerned about being radioactive. The nurse should tell the client:
The radioactive material is controlled and stays with the source; once the material is removed, no radioactivity will remain."
An unlicensed assistive personnel (UAP) tells the nurse, "I think the client is confused. He keeps telling me he has to void, but that is not possible because he has a catheter in place that is draining well." The nurse should tell the UAP:
The urge to void is usually created by the large catheter, and he may be having some bladder spasms."
A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?
This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.
A client who had a transurethral resection of the prostate (TURP) 1 day earlier has a three-way Foley catheter inserted for continuous bladder irrigation. Which of the following statements best explains why continuous irrigation is used after TURP?
To keep the catheter free from clot obstruction.
A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal?
Transurethral resection of the prostate (TURP)
Which clinical finding should a nurse look for in a client with chronic renal failure?
Uremia
A client is diagnosed with acute pyelonephritis. What should the nurse instruct the client to do?
Urinate frequently.
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
Urine output of 250 ml/24 hours
A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation?
Urine pH of 3.0
What is most important for the nurse to teach a client newly diagnosed with genital herpes?
Use condoms at all times during sexual intercourse.
A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis?
Use of corticosteroids
A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?
Use sterile technique when irrigating the catheter.
The client in acute renal failure has an external cannula inserted in the forearm for hemodialysis. Which nursing measure is appropriate for the care of this client?
Use the unaffected arm for blood pressure measurements.
A 20-year-old female client says, "I feel that my vaginal opening constricts whenever I am about to have intercourse. I seem to have no control over it." Which of the following terms should the nurse use to document the client's condition?
Vaginismus.
Which teaching approach for the client with chronic renal failure who has difficulty concentrating due to high uremia levels would be most appropriate?
Validate the client's understanding of the material frequently.
A client is at risk for acute pyelonephritis. The nurse should instruct the client about which health promotion behaviors that will be most effective in preventing pyelonephritis?
Wash the perineum with warm water and soap, cleaning from front to back.
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?
White blood cell (WBC) count of 20,000/mm3 (0.02 L)
On the second day following an abdominal hysterectomy, a client reports she has had three brown, loose stools in moderate amount. The morning medications include an order for 100 mg of docusate sodium daily or as needed. What should the nurse do next?
Withhold the medication, and document the client's report of loose stools.
The nurse is developing a community health education program about sexually transmitted infections. Which information about women who acquire gonorrhea should be included?
Women with gonorrhea are usually asymptomatic.
The client with acute renal failure asks the nurse for a snack. Because the client's potassium level is elevated, which snack is most appropriate?
a gelatin dessert
The nurse is performing a digital rectal examination. Which finding is a key sign for prostate cancer?
a hard prostate, localized or diffuse
Which client is at highest risk for developing a urinary tract infection?
a man with an indwelling urinary catheter
The typical chancre of syphilis appears as:
a painless, moist ulcer.
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 outcome would be a priority for this client?
alleviation of pain
A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it:
allows the client to be more independent.
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:
an ascending infection from the urethra.
A charge nurse is completing day-shift client care assignments on the genitourinary floor. A new graduate is present for her first day on the unit. An agency nurse and an experienced nurse are also present on the unit. The charge nurse should assign the new graduate to the care of:
an elderly client with bladder cancer awaiting surgery, an elderly client who had a prostatectomy and bladder irrigation 2 days ago, and an elderly client with renal insufficiency.
A male client reports having impotence. The nurse examines the client's medication regimen and determines that a contributing factor to impotence could be:
antihypertensives.
A 45-year-old client had a complete abdominal hysterectomy with bilateral salpingo-oophorectomy 2 days ago. The client's abdominal dressing is dry and intact. While sitting up in the chair, the client has severe pain and numbness in her left leg. The nurse should first:
assess color and temperature of the left leg.
A client who had transurethral resection of the prostate has dribbling urine after his Foley catheter is removed on the second postoperative day. The nurse notes that the client had 200 mL of urine output in the last 8 hours with a 1,000 mL intake. The nurse should first:
assess for bladder distention.
Eight hours after an abdominal hysterectomy, the client has not voided and says to the nurse, "I do not think I can urinate." The nurse should first:
assess the client's bladder.
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:
at least 3,000 mL of fluids daily.
A client with stress incontinence asks the nurse what kind of diet she should follow at home. The nurse should recommend that the client:
avoid alcohol and caffeine.
A client has nephrotic syndrome. To aid in the resolution of the client's edema, the health care provider (HCP) prescribes 25% albumin. In addition to an absence of edema, the nurse should evaluate the client for which expected outcome?
blood pressure elevation
A nurse is inserting a urinary catheter into a client who is extremely anxious about the procedure. The nurse can facilitate the insertion by asking the client to:
breathe deeply.
A client is scheduled for an intravenous pyelogram (IVP). The evening before the procedure, the nurse learns that the client is allergic to shellfish. The nurse should:
cancel the IVP and notify the health care provider (HCP).
A client with acute renal failure has an increase in the serum potassium level. The nurse should monitor the client for:
cardiac arrest.
A client with human papillomavirus (HPV) infection is being treated by a colposcopy. The client asks the nurse if this procedure is really necessary. The nurse explains that the procedure to treat the warts is important because HPV can lead to: You Selected:
cervical cancer.
Women who have human papillomavirus (HPV) are at risk for development of:
cervical cancer.
A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should:
check the client's pedal pulses frequently.
A client on the genitourinary floor has refused all medications for 3 days. A nurse caring for this client asks why he isn't complying with his medication. The client states, "I don't want to take those pills anymore." The nurse informs the client that he must take all the medication the physician orders. With this statement, the nurse has violated the:
client's right to refuse medication.
When teaching a client with chronic renal failure who is taking antibiotics about signs and symptoms of potential nephrotoxicity to report, the nurse should encourage the client to promptly report which changes in the color of the urine? Select all that apply.
cloudy smoky pink
After teaching the mother of a young child with a peritoneal catheter about the signs and symptoms of peritonitis, the nurse determines that the mother has understood the teaching when she identifies which finding as an important sign?
cloudy dialysate drainage return
A female client is experiencing bladder control problems. Which outcome indicates the success of nursing interventions to promote urinary continence for this client?
continence for 24 hours a day
The client with acute renal failure is recovering and asks the nurse, "Will my kidneys ever function normally again?" The nurse's response is based on knowledge that the client's renal status will most likely:
continue to improve over a period of weeks.
A client with chronic renal failure is undergoing hemodialysis. Postdialysis, the client weighs 59 kg. The nurse should teach the client to:
control the amount of protein intake to 59 to 70 g/day.
A client with a history of cystitis is admitted to the hospital with a diagnosis of pyelonephritis. The nurse should assess the client for:
costovertebral tenderness.
The nurse receives the preoperative blood work report for a client who is scheduled to undergo surgery. Which laboratory finding should be reported to the surgeon and anesthesiologist?
creatinine, 2.6 mg/dL (230 µmol/L)
The nurse determines that interventions for decreasing fluid retention have been effective when the nurse makes which assessment in child with nephrotic syndrome?
decreased abdominal girth
The nurse is teaching an older adult with a urinary tract infection about the importance of increasing fluids in the diet. What puts this client at a risk for not obtaining sufficient fluids?
decreased ability to detect thirst
Which abnormal blood value would not be improved by dialysis treatment?
decreased hemoglobin concentration
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should assess the client for which alteration in fluid and electrolyte balance?
decreased serum sodium level
The most significant sign of acute renal failure is:
decreased urine output.
A nulliparous client says that she and her husband plan to use a diaphragm with spermicide to prevent conception. Which should the nurse include as the action of spermicides when teaching the client?
destruction of spermatozoa before they enter the cervix
A nulliparous client tells the nurse that during her last pelvic examination, the health care provider (HCP) said that her uterus was in a severe retroverted position. The nurse determines that the client may experience:
difficulty conceiving a child.
The nurse should specifically assess a client with prostatic hypertrophy for:
difficulty starting the flow of urine.
The nurse is assessing a client who has benign prostatic hypertrophy (BPH). The nurse should ask the client if he has:
difficulty starting the urinary stream.
The nurse finds a container with the client's urine specimen sitting on a counter in the bathroom. The client states that the specimen has been sitting in the bathroom for at least 2 hours. The nurse should:
discard the urine and obtain a new specimen.
A client is scheduled to undergo weekly intravesical chemotherapy for bladder cancer for the next 8 weeks. Which statement indicates that the client understands how to manage the urine as a biohazard? The client will:
disinfect the urine and toilet with bleach for 6 hours following a treatment.
A nurse is teaching a client how to prevent a vaginal infection. Which activity puts the client at risk for altering the normal pH of her vagina?
douching unless instructed to do so by the health care provider (HCP)
Urinary tract infection (UTI) is a potential problem after spinal cord injury. To prevent an UTI, the nurse should encourage the client to:
drink at least 2,000 mL of fluid daily.
A female client with gonorrhea informs the nurse that she has had sexual intercourse with her boyfriend and asks the nurse, "Would he have any symptoms?" The nurse responds that in men the symptoms of gonorrhea include:
dysuria.
Two days after a herniorrhaphy, the client reports that his scrotum is swollen and painful. To promote comfort, the nurse should instruct the client to:
elevate the scrotum and place ice bags on the area intermittently.
The nurse is assessing the urine of a client who has had an ileal conduit and notes that there is a moderate amount of mucus. The nurse should:
encourage a high fluid intake.
A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl (70mmol/L). The most therapeutic pharmacologic intervention would be to administer:
epoetin alfa.
A female client who has a urinary diversion tells the nurse, "This urinary pouch is embarrassing. Everyone will know that I am not normal. I do not see how I can go out in public anymore." The most appropriate nursing goal for this client is to:
express fears about the urinary diversion.
A client has cystitis. The nurse should further assess the client for:
foul-smelling urine.
The primary reason for lubricating the urinary catheter generously before inserting it into a male client is that this technique helps reduce:
friction along the urethra when the catheter is being inserted.
A 39-year-old female client has been experiencing intermittent vaginal bleeding for several months. Her health care provider (HCP) tells her that she has uterine fibroids and recommends an abdominal hysterectomy. When the client expresses fear about the surgery, the nurse should:
give the client opportunities to express her fears.
The client is on a fluid restriction of 500 mL/day plus replacement for urine output. Because the client's 24-hour urine output yesterday was 150 mL, the total fluid allotment for the next 24 hours is 650 mL. How should the nurses distribute this fluid over the next 24 hours?
given in small amounts throughout each shift
A client is admitted to the recovery room after cystoscopy with biopsy. Before the nurse can discharge the client, the nurse should be sure the client:
has voided.
An elderly client with a diagnosis of chronic renal failure is being discharged to home with his wife. The home health nurse visits the hospital before discharge to discuss home safety with the client, who reports decreased mobility and a need for greater assistance with activities of daily living. The nurse focuses her home-safety teaching on:
having adequate lighting, removing cluttered paths, and using nonskid bathroom surfa
A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to:
help the client cope with the anxiety associated with changes in body image.
Which nursing measure would most likely relieve postoperative gas pains after abdominal hysterectomy?
helping the client walk
Which factor would put the client at increased risk for pyelonephritis?
history of diabetes mellitus
A physician enters a computer order for a nurse to irrigate a client's nephrostomy tube every 4 hours to maintain patency. The nurse irrigates the tube using sterile technique. After irrigating the tube, the nurse decides that she can safely use the same irrigation set for her 8-hour shift if she covers the set with a paper, sterile drape. This action by the nurse is:
inappropriate because irrigation requires strict sterile technique.
To reduce urethral irritation, where should the nurse tape the female client's Foley catheter?
inner thigh
The nurse should teach the client with an ileal conduit to prevent urine leakage when changing the appliance by:
inserting a gauze wick into the stoma.
A menopausal woman is taking hormone replacement therapy. The nurse teaches the client that a warning sign for endometrial cancer that needs to be reported is:
irregular vaginal bleeding.
The client has a continuous bladder irrigation after a transurethral resection. A major goal related to the irrigation is to:
maintain catheter patency.
A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 ml. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of:
microorganism transfer.
A client diagnosed with cancer of the cervix in situ is scheduled to have a conization. Which is a priority during the first 24 postoperative hours?
monitoring vaginal bleeding
A 65-year-old male client with erectile dysfunction (ED) asks the nurse, "Is all this just in my head? Am I crazy?" The best response by the nurse is based on the knowledge that:
more than 50% of the cases are attributed to organic causes.
A client with chronic renal failure is experiencing metabolic acidosis. The client most likely requires:
no treatment
When explaining the preparation for a Papanicolaou (Pap) test, the nurse should tell the woman:
not to douche on the morning before the examination.
A nurse is caring for an 8-year-old girl with multiple chronic urinary tract infections. The child's parents appear protective, never leaving their daughter's side. While the nurse helps the child's mother provide morning care, the child states, "My uncle doesn't clean me that way." Her mother becomes visibly upset and gives the girl a stern warning not to discuss the matter. She states, "Don't tell anyone about that again." The nurse has a legal responsibility to:
notify the nursing supervisor and the authorities of the possibility of abuse.
A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:
notify the physician about cloudy or foul-smelling urine.
A client is receiving peritoneal dialysis. While the dialysis solution is dwelling the client's abdomen, the nurse should:
observe respiratory status.
Which initial manifestation of acute renal failure is the most common?
oliguria
The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate?
ow-protein, low-sodium, low-potassium
A client is to receive belladonna and opium suppositories, as needed, postoperatively after transurethral resection of the prostate (TURP). The nurse should give the client these drugs when he demonstrates signs of:
pain from bladder spasms.
A client who is 70 years of age and lives alone has stress incontinence. To prevent incontinence, the nurse advises the client to:
perform perineal muscle exercises (i.e., Kegel exercises).
Which laboratory value supports a diagnosis of pyelonephritis?
pyuria
The client who is in acute renal failure has an elevated blood urea nitrogen (BUN). What is the likely cause of this finding?
reduced renal blood flow
A client is diagnosed with genital herpes, (herpes simplex virus type 2, or HSV-2). The nurse should instruct the client that:
reducing stressful life events may decrease the incidence of herpetic outbreaks.
The correct procedure for collecting a urine specimen from an indwelling catheter is to:
remove urine from the drainage tube with a sterile needle and syringe and place urine from the syringe into the specimen container.
A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is:
renal calculi.
A client tells the nurse that she has had sexual contact with someone whom she suspects has genital herpes. The nurse should instruct the client to:
report any difficulty urinating.
A nurse is planning to administer a sodium polystyrene sulfonate enema to a client with a potassium level of 6.2 mEq/L. Correct administration and the effects of this enema should include having the client:
retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.
A couple is visiting the clinic because they have been unable to conceive a baby after 3 years of frequent coitus. The nurse determines that the couple needs further instruction when they identify which factor as a cause of male infertility?
seminal fluid with an alkaline pH
A 28-year-old male is diagnosed with acute epididymitis. The nurse should assess the client for:
severe tenderness and swelling in the scrotum.
An 18-year-old female client who is sexually active with her boyfriend has a purulent vaginal discharge that is sometimes frothy. The nurse interprets this as suggesting a:
sexually transmitted infection.
During dialysis, the client has disequilibrium syndrome. The nurse should first?
slow the rate of dialysis.
A female client reports to a nurse that she experiences a loss of urine when she jogs. The nurse's assessment reveals no nocturia, burning, discomfort when voiding, or urine leakage before reaching the bathroom. The nurse explains to the client that this type of problem is called:
stress incontinence.
The nurse teaches the client how to recognize an infection in the shunt by telling the client to assess the shunt each day for:
swelling at the shunt site.
An elderly male client has been taking doxazosin 2 mg daily for 4 weeks for treatment of benign prostatic hypertrophy. The client reports feeling dizzy. The nurse should first:
take his blood pressure lying, standing, and sitting.
The client with first-time bacterial cystitis is being treated with an antibiotic to be taken for 7 days. The nurse should instruct the client to:
take the entire prescription as ordered.
A client has stress incontinence. Which data from the client's history contributes to the client's incontinence?
the client's history of three full-term pregnancies
Following an incisional approach to an abdominal hysterectomy, the nurse should assess the client for:
thrombophlebitis.
A female client with which condition would be at risk for increased severity of vulvovaginal candidiasis? Select all that apply.
uncontrolled diabetes immunosuppression due to cancer human immunodeficiency virus (HIV) infection
Whichis an initial clinical manifestation of gonorrhea in men?
urethral discharge
The nurse is assessing the client's urinary stoma. Which sign indicates stomal edema?
urine output below 30 mL/hour
The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. The nurse should report which finding to the health care provider (HCP)?
urine output, 20 mL/h
The nurse teaches the client with a urinary diversion to attach the appliance to a standard urine collection bag at night. The most important reason for doing this is to prevent:
urine reflux into the stoma.
The nurse should tell a client who is to obtain a midstream urine specimen to:
void directly into the sterile specimen container after voiding a small amount into the toilet.
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
A 36-year-old female has increased vaginal dryness during sexual intercourse. She has received chemotherapy in the past and has menopausal symptoms due to ovarian suppression. The nurse should instruct the client on the use of:
water-soluble vaginal lubricants.
A nurse is caring for a male client with gonorrhea. The client asks how he can reduce his risk of contracting another sexually transmitted disease (STD). The nurse should instruct the client to:
wear a condom every time he has intercourse.
The client will have an abdominal hysterectomy tomorrow. Which information will be most important for the nurse to give to the client prior to admission to the hospital?
what she can eat and drink before admission
