PrepU: Genitourinary Disorders

PEDS: A client's mother asks the nurse, "When should my daughter have a pelvic examination?" Which response by the nurse is most appropriate?

- "A pelvic exam is necessary at 18 to 20 years of age."

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."

A nurse is caring for a client in renal failure who fell and sustained a head injury. The nurse is educating the client on the upcoming computed tomography (CT) scan of the brain requiring radiopaque dye. Which statement by the nurse is correct?

- "Blood will be drawn and analyzed before the test to ensure your kidneys can remove the dye."

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. What question will the nurse ask next?

- "Do you have a digital rectal examination and prostate-specific antigen tests yearly?"

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 client with a urinary tract infection is ordered co-trimoxazole. The nurse should provide which medication instruction?

- "Drink at least eight 8-oz (240 mL) glasses of fluid daily."

The nurse is providing preoperative instructions to a client who is having a transurethral resection of the prostate. What should the nurse tell the client?

- "Expect blood in your urine in the first couple of days following the procedure." Rationale: The surgery commonly results in blood from the surgery in the urine for the first few days, and the client should not be concerned; the urine will become clear within 2 to 3 days.

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."

PEDS: The nurse is conducting a follow-up visit for a 13-year-old girl who has been treated for pelvic inflammatory disease. Which remark indicates a need for further teaching?

- "I cannot have unprotected sex again until my partner is treated."

A nurse is teaching a client about prevention of genital herpes. What statement indicates the teaching was successful?

- "I'll ask any future partners if they have ever been diagnosed with genital herpes."

A nurse is caring for a male client who has gonorrhea. Which statement indicates that the client needs additional instruction?

- "It is not possible to be contagious as long as I take all of my antibiotics as prescribed."

The nurse is explaining hemodialysis to a student nurse. What statement leads the nurse to determine that additional teaching is needed?

- "It will extract the client's red blood cells." Rationale: HEMO = BLOOD CELLS

PEDS: The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents?

- "Let's meet with the dietitian and plan some meals."

A 65-year-old male client with erectile dysfunction (ED) asks the nurse, "Is all this just in my head? Am I crazy?" What should the nurse tell the client?

- "More than 50% of the cases are attributed to organic causes."

A client with a urinary tract infection is to take nitrofurantoin 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?

- "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."

PEDS: The caregiver of a 1-year-old boy calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which statement regarding the son's treatment?

- "The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place."

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's not possible because he has a catheter in place that is draining well." What should the nurse tell the UAP?

- "The urge to void is usually created by the large catheter, and he may be having some bladder spasms."

After trying for a year to conceive, a couple consults a fertility specialist. When obtaining a history from the husband, which question should the nurse ask?

- "What childhood immunizations and illnesses did you have?"

PEDS: The nurse is conducting a routine wellness examination of a 13-year-old client. Which question would be best to ask first, when opening a discussion on sexual behavior?

- "What do you like to do on weekends?"

A nurse is attending a seminar at the local senior center. The nurse knows the presenter has a good understanding of genitourinary changes in the elderly when the presenter makes which statement?

- "You should leave a light on in your bathroom at night."

A client is admitted for a transurethral resection of the prostate (TURP). Preoperative teaching will include which information?

- "You will return from surgery with a catheter in your bladder and fluid flowing into and out of it continuously."

The client with pyelonephritis asks the nurse, "How will I know whether the antibiotics are treating my infection?" What should the nurse tell the client?

- "Your health care provider will take a urine culture."

A woman is using progestin injections for contraception. When does the nurse instruct the client to return for her next injection?

- 3 months

PEDS: The nurse is conducting a presentation for a group of nurses who work with adolescents. The group discusses dysmenorrhea. Which statement is most accurately related to dysmenorrhea?

- A contributing factor in dysmenorrhea is the increased secretion of prostaglandins. Rationale: The increased secretion of prostaglandins, which occurs in the last few days of the menstrual cycle, is thought to be a contributing factor in primary dysmenorrhea.

**The nurse is performing a digital rectal examination. Which finding is a key sign for prostate cancer?

- A hard prostate, localized or diffuse

PEdS: The nurse is caring for an infant boy with grade IV vesicoureteral reflux. Which finding would lead the nurse to suspect that hydronephrosis is present?

- Abdominal mass Rationale:

A nurse is caring for a client diagnosed with ovarian cancer. Diagnostic testing reveals that the cancer has spread outside the pelvis. The client has previously undergone a right oophorectomy and received chemotherapy. The client now wants palliative care instead of aggressive therapy. The nurse determines that the care plan's priority nursing diagnosis should be:

- 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.

Which measures are helpful in reducing discomfort in a client with acute epididymitis? Select all that apply.

- Apply ice packs intermittently. - Elevate the scrotum. - Maintain bed rest.

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 should the nurse do next?

- 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 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.

- Assess fingers on the left arm for warmth. - Wear wrist watch on the right arm. - Avoid sleeping on the left arm.

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. What should the nurse do first?

- Assess for bladder distention.

A nurse is concerned that an unlicensed assistive worker stated that a client has a discrepancy of > 350 mL in liquid intake and output for the shift. Which action is the most appropriate for the nurse to take?

- Assess the client's daily weight patterns.

A client who had transurethral resection of the prostate (TURP) 2 days earlier has lower abdominal pain. What should the nurse do first?

- Assess the patency of the urethral catheter. Rationale: The lower abdominal pain is most likely caused by bladder spasms. A common cause of bladder spasms after TURP is blood clots obstructing the catheter; therefore, the nurse's first action should be to assess the patency of the catheter.

PEDS: A nurse has admitted a 3-year-old female diagnosed with a urinary tract infection. When developing the plan of care, what should the nurse do first?

- Assess usual voiding patterns

**A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?

- Assessing present voiding patterns

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 (The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl.)

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 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.

A client diagnosed with chronic renal failure is undergoing hemodialysis. Post dialysis, the client weighs 59 kg. The nurse should teach the client to make which dietary changes?

- Control the amount of protein intake to 59 to 70 g/day. Rationale: The protein requirement is 1.0 to 1.2 g/kg body weight per day

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 receives the preoperative blood work report for a client who is scheduled to undergo surgery. Which laboratory finding should the nurse report to the surgeon and anesthesiologist?

- Creatinine, 2.6 mg/dL (230 µmol/L)

PEDS: A 7-year-old boy has experienced repeated urinary tract infections (UTIs). His older sister also experienced repeated UTIs and was diagnosed with vesicoureteral reflux, a condition that tends to appear in families. Therefore, the nurse suspects this same condition in this client. Which diagnostic tests would confirm this suspicion?

- Cystoscopy

The nurse is planning care for a client with stress incontinence. What goal is realistic for the nurse to establish with the client?

- Decrease the number of incontinence episodes.

The most significant sign of acute renal failure is:

- Decreased urine output.

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

To treat a urinary tract infection, a client is ordered trimethoprim-sulfamethoxazole. The nurse should teach the client that trimethoprim-sulfamethoxazole is most likely to cause which adverse effect?

- Diarrhea

A client has prostatic hypertrophy. What should the nurse assess when conducting a focused assessment of the client's ability to urinate?

- Difficulty starting the flow of urine

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.

**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 with a rolled towel and place ice bags on the area intermittently.

**A client is admitted to the recovery room after cystoscopy with biopsy. Before the nurse can discharge the client, what should the nurse assess?

- Emptied the bladder.

PEDS: A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms?

- Encourage high fluid intake.

A client is diagnosed with pyelonephritis. Which nursing action is a priority for care now?

- Ensure sufficient hydration

A client with acute renal failure has the following laboratory results. Based on these findings, which of the following should the nurse administer? hemoglobin 9.2 g/dL blood urea nitrogen 22 mg/dL creatinine 0.7 mg/dL potassium 4.8 mEq/L

- Erythropoietin

PEDS: A symptom often seen in acute glomerulonephritis is edema. The most common site the edema is first noted is in which area of the body?

- Eyes

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 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

PEDS: The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which characteristics of this condition should the nurse expect to assess or glean from chart review?

- Hemolytic anemia, thrombocytopenia, and acute renal failure

When providing discharge teaching for a client with uric acid calculi, the nurse would include an instruction to avoid which type of diet?

- High purine

When providing discharge teaching for a client with uric acid calculi, the nurse would include an instruction to avoid which type of diet?

- High purine Rationale: To control uric acid calculi, the client would follow a low-purine diet, which excludes high-purine foods such as organ meats.

Which factor would put the client at increased risk for pyelonephritis?

- History of diabetes mellitus

PEDS: A nurse is reviewing the medical record of an infant with hydronephrosis. Which finding(s) will the nurse anticipate in the history and physical examination? Select all that apply.

- History of repeated urinary tract infections - Abdominal mass on palpation - Crying on voiding

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 is scheduled for a creatinine clearance test. What should the nurse do to prepare the client?

- Instruct the client about the need to collect urine for 24 hours.

PEDS: Most urinary tract infections seen in children are caused by:

- Intestinal bacteria

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.

The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate?

- Low-protein, low-sodium, low-potassium

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.

The client has a continuous bladder irrigation after a transurethral resection. A major goal related to the irrigation is to:

- Maintain catheter patency.

A nurse is assessing a client with nephrotic syndrome. The nurse should assess the client for which condition?

- Massive proteinuria

The nurse determines that interventions for decreasing fluid retention have been effective when the nurse makes which assessment in a child with nephrotic syndrome?

- Measure abdominal girth

PEDS: An adolescent is diagnosed with a trichomonal infection. Which medication would the nurse include when teaching the adolescent about treatment for this infection?

- Metronidazole

**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. The physician 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.

PEDS: The nurse is most accurate to instruct the client that which occurs during a female's mid-cycle?

- Mittelschmerz

PED: A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage tube patency?

- Monitor output

Two weeks after being diagnosed with a streptococcal infection, a client develops fatigue, a low-grade fever, and shortness of breath. The nurse auscultates bilateral crackles and observes jugular vein distention. Urinalysis reveals red and white blood cells and protein. After the physician diagnoses poststreptococcal glomerulonephritis, the client is admitted to the medical-surgical unit. Which immediate action should the nurse take?

- Monitor pt blood pressure

A nurse is caring for an 8-year-old female with multiple, chronic urinary tract infections. While the nurse helps the child's parent provide morning care, the child states, "My uncle doesn't clean me that way." The parent becomes visibly upset and gives the girl a stern warning not to discuss the matter. What is the priority action for the nurse?

- Notify the nursing supervisor and the authorities of the possibility of abuse.

A client is receiving peritoneal dialysis. What should the nurse assess while the dialysis solution is dwelling in the client's abdomen?

- Observe respiratory status Rationale: Nurse should monitor the client's respiratory status because the pressure of the dialysis solution on the diaphragm can create respiratory distress

Prior to administering continuous renal replacement therapy (CRRT) on November 7, the nurse notes that the dialysate is clear and the expiration date is November 6. What is the appropriate action by the nurse?

- Obtain a new dialysate

PEDS: A teacher sends a child to see the school nurse for irritability and bruising. Which symptom would be indicative of hemolytic uremic syndrome?

- Oliguria and jaundice

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 which symptom?

- Pain from bladder spasms

A client is voiding small amounts of urine every 30 to 60 minutes. What should the nurse do first?

- Palpate for distended bladder

PEDS: When developing the preoperative plan of care for an infant with bladder exstrophy, which intervention would the nurse least likely include?

- Placing infant side lying

PEDS: The nurse is caring for a 6-year-old child with acute glomerulonephritis. When reviewing the client's laboratory results, which result is most important to review with the health care provider?

- Positive culture for group A streptococcus

PEDS: Which is a priority for the nurse caring for a client with bladder exstrophy?

- Prevent skin breakdown

What should the nurse do to prevent catheter-associated urinary tract infection? Select all that apply.

- Provide perineal care at least once a day. - Maintain a closed drainage system. - Encourage the client to drink 3,000 mL of fluids a day.

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first?

- Pulse

PEDS: The nurse is providing care to a child with acute renal failure. What assessment would be a priority for the nurse to determine if this child is developing hyperkalemia?

- Pulse and rhythm

PEDS: A 3-month-old boy is found to have undescended testes. The parents are concerned. What should the nurse anticipate as the next step for this client?

- Reassess the client's testes at 6 months of age.

The nurse is caring for a client with acute renal failure and edema. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? Select all that apply.

- Remind the client that all urine is to be saved for intake and output measurement. - Make sure the urinal is within the client's reach. - Weigh the client every morning using the standing scale. - Measure and record vital signs.

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.

Trimethoprim has been prescribed for a client with a urinary tract infection. The nurse should instruct the client to:

- Report any unusual bleeding or bruising.

The nurse notes that the dialysate drainage of a client receiving peritoneal dialysis is cloudy. Which action should the nurse take?

- Report the finding to the healthcare provider.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?

- Risk for infection

PEDS: When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority?

- Risk for infection

The nurse is caring for a client with urinary calculi of unknown origin. Which interventions would be appropriate for this client? Select all that apply.

- Strain urine. - Medicate for pain.

PEDS: The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion?

- Sudden onset of severe scrotal pain with significant hemorrhagic swelling

PEDS: The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to take which action?

- Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone.

PEDS: A voiding cystourethrogram (VCUG) is prescribed for a child. What education should be provided to the parents?

- The VCUG will rule out vesicoureteral reflux.

A client asks the nurse to explain the meaning of her abnormal Papanicolaou (Pap) smear result of atypical squamous cells. The nurse should tell the client that an atypical Pap smear means that what has occurred?

- The cells could cause various conditions and help identify a problem early.

PEDS: The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history?

- The child recently had an ear infection.

**Which finding in a client's history would be the most likely to increase the client's risk for renal calculi?

- The client drinks one to two glasses of fluid daily.

PEDS: A nurse is discussing with a family the various causes of their child's vulvovaginitis. What would be included in the education?

- The use of cleansing towelettes may have caused the vulvovaginitis.

**Which statement best describes the therapeutic action of loop diuretics?

- They block sodium reabsorption in the ascending loop and dilate renal vessels.

A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?

- This condition puts the client at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. Rationale: Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection.

Which clinical finding should a nurse look for in a client with chronic renal failure?

- Uremia Rationale: Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure.

PEDS: The nurse is caring for a 10-year-old girl presenting with fever, dysuria, flank pain, urgency, and hematuria. The nurse would expect to help obtain which test first?

- Urinalysis

The nurse is teaching the caregiver of an older adult client about urinary incontinence. What statement should the nurse make to the caregiver about urinary incontinence in the older adult?

- Urinary incontinence has many causes and can often be improved with intervention.

The nurse teaches the client with a urinary diversion to attach the appliance to a standard urine collection bag at night. The intended outcome of the instruction is to prevent what occurrence?

- Urine reflux into the stoma

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 client underwent a transurethral resection of the prostate gland 24 hours ago and is prescribed continuous bladder irrigation. What nursing intervention is appropriate?

- Use sterile technique if manual irrigation of the catheter is required.

What should the nurse teach the client to do to prevent stress incontinence? Select all that apply.

- Use techniques that strengthen the sphincter and structural supports of the bladder, such as Kegel exercises. - Avoid natural diuretics such as caffeine or alcoholic beverages.

PEDS: The nurse is caring for a child who is undergoing peritoneal dialysis. Immediately after draining the dialysate, which action should the nurse should take immediately?

- Weigh the old dialysate

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:

- Weight loss

PEDS: A nurse is caring for a 13-year-old boy with end-stage renal disease who is preparing to have his hemodialysis treatment in the dialysis unit. Which nursing action is appropriate?

- Withhold his routine medication until after dialysis is completed

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.

Which client is at highest risk for developing a hospital-acquired infection?

- a client with an indwelling urinary catheter

A client comes to the emergency department reporting severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis?

- acute pain

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 renal insufficiency is admitted to the hospital with pneumonia. The client is being treated with gentamicin. Which laboratory value should be closely monitored?

- blood urea nitrogen (BUN) Rationale: BUN and creatinine levels should be closely monitored to detect elevations caused by nephrotoxicity

A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis?

- corticosteroid use

A client with a history of cystitis is admitted to the hospital with a diagnosis of pyelonephritis. The nurse should assess the client for which symptom?

- costovertebral tenderness Rationale: Costovertebral tenderness occurs on the side of the affected kidney in pyelonephritis.

Which abnormal blood value would not be improved by dialysis treatment?

- decreased hemoglobin concentration

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 said that her uterus was in a severe retroverted position. The nurse determines that the client may experience which complication?

- difficulty conceiving a child

A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence?

- encouraging intake of at least 2 L of fluid daily Rationale: Encouraging a daily fluid intake of at least 2 L helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void

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. Rationale: Chronic renal failure diminishes the production of erythropoietin by the kidneys and leads to a subnormal Hb level. (Normal Hb level is 13 to 18 g/dl in men and 12 to 16 g/dl in women.) An effective pharmacologic treatment for this is epoetin alfa, a recombinant erythropoietin.

**Nurse is to irrigate a client's nephrostomy tube q 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

PEDS: When assessing a child with hydronephrosis, what would the nurse expect to find? Select all that apply.

- intermittent hematuria - abdominal mass

A menopausal woman is taking hormone replacement therapy. What warning sign of endometrial cancer should the nurse instruct the client to report to her health care provider?

- irregular vaginal bleeding

Renal calculi can form anywhere in the urinary tract. What is their most common formation site?

- kidney

PEDS: Which cause of pediatric enuresis must be ruled out before psychological causes are investigated? Select all that apply.

- lack of awareness - urinary tract infection - small bladder capacity

PEDS: What is a clinical manifestation of pelvic inflammatory disease (PID)? Select all that apply.

- lower severe abdominal pain - purulent vaginal discharge - fever

When educating a female client with gonorrhea, what should the nurse emphasize? In women, gonorrhea:

- may not cause symptoms until serious complications occur.

PEDS: The parents of an 8-year-old child with nocturnal enuresis bring the child to the clinic for a follow-up. History reveals that the parents have tried numerous behavioral and motivational therapies without success. The nurse anticipates medication therapy. Which agents would the nurse identify as being used? Select all that apply.

- oxybutynin - imipramine - desmopressin

PEDS: Which clinical manifestation should the nurse recognize as most significant when assessing a client suspected of having nephrotic syndrome?

- periorbital edema

A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. What should the nurse tell the client to expect when following this diet?

- prevent the development of ketosis.

PEDS: The nurse is providing care to a child with acute renal failure. What assessment would be a priority for the nurse to determine if this child is developing hyperkalemia?

- pulse rate and rhythm

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 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 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.

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. Rationale: Doxazosin is also used as an antihypertensive agent; the client may be experiencing orthostatic hypotension

PEDS: A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema?

- weight, daily

**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)

A client with an indwelling urinary catheter is suspected of having a urinary tract infection. The nurse should collect a urine specimen for culture and sensitivity by:

- wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle.

A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important?

increasing fluid intake to 3 L/day