CHAPTER 11 - THE GENITOURINARY SYSTEM

A client asks the nurse if he will be able to ejaculate after the vasectomy is done. What is the best response for the nurse to make? 1. "Yes. This procedure does not affect the ejaculate." 2. "No. The purpose of a vasectomy is to prevent ejaculation." 3. "Are you concerned about your sexual identity?" 4. "My husband had a vasectomy and it doesn't bother us."

1. A vasectomy does not prevent ejaculation. The ejaculate does not contain sperm. The man's sexual functioning is not affected. The client asks for information. The most appropriate response is to give the information. There is no evidence in the question that the man is concerned about his sexual identity. The nurse should answer the client's question, not interject her own experience in answering this question.

An 18-year-old female is seen in the clinic for a bladder infection. Which of the following signs and symptoms would the nurse expect her to manifest? 1. Burning upon urination 2. Flank pain 3. Nausea and vomiting 4. Elevated potassium

1. Burning upon urination is usually seen in clients with a bladder infection. Flank pain and nausea and vomiting are seen more frequently in persons with kidney infection or stones. Elevated potassium is seen in renal failure.

An adult client has returned to his room following a cystoscopy. When he voids, his urine is pink- tinged. What is the most appropriate action for the nurse to take? 1. Continue to observe him 2. Report it immediately to the physician 3. Irrigate the catheter with normal saline 4. Take his blood pressure every 15 minutes

1. Pink-tinged urine is normal following a cystoscopy. Bright-red bleeding would need to be reported.

The nurse is straining the urine of a client admitted with possible renal calculi. A small stone is discovered. What should the nurse do? 1. Send the stone to the laboratory for analysis 2. Immediately test for guaiac 3. Test the stone for glucose 4. Administer pain medication

1. The stone should be sent to the laboratory for analysis to determine the type of stone. This will help to determine the diet he should follow. Stones do not usually contain blood or glucose. The laboratory needs to do the analysis. Passing the stone may be painful, but the pain is usually relieved after the stone is passed.

The nurse calculates intake and output for an adult client. His intake for the shift is 1000 mL. The total amount of drainage emptied from the drainage bag is 2550 mL. During the shift, 1825 mL of genitourinary irrigant has infused. What is the client's eight-hour urine output? 1. 725 mL 2. 650 mL 3. 825 mL 4. 750 mL

1. Total drainage from the bag is 2550 mL. The amount of irrigant infused is 1825 mL. Subtract 1825 mL from 2250 mL and the answer is 725 mL of urine.

The client who has urinary retention has had an indwelling catheter inserted. Which action is not appropriate for the nurse to take? 1. Limit the client's fluid intake 2. Monitor blood pressure frequently 3. Weigh the client daily 4. Assess renal function

1.Fluid intake should be encouraged to help prevent the development of a urinary tract infection. It is not appropriate to limit fluid intake. Following the removal of urine from a distended bladder, there is a risk of shock. The nurse should monitor the blood pressure. The nurse should weigh the client daily to assess for fluid retention. The nurse would assess renal function by monitoring intake and output.

The nurse is caring for a client admitted for treatment of acute glomerulonephritis. Which question should the nurse ask when obtaining information about the present illness? 1. "Have you had a sore throat recently?" 2. "Has anyone in your family had chickenpox recently?" 3. "Have you had a bladder infection in the last six weeks?" 4. "Does anyone in your family have a history of kidney disease?"

1.When obtaining a history of the present illness, the nurse questions the client about precipitating factors. Acute glomerulonephritis (AGN) usually occurs 10 to 14 days after a streptococcal (strep) infection. Strep throat or strep-related otitis media is the most common precipitating event. Chickenpox is caused by herpes zoster virus and is not usually associated with AGN. A bladder infection is not usually associated with AGN. AGN follows a strep infection and is not specifically an inherited condition.

The physician has prescribed a diuretic for an adult client. Which nursing intervention is most important in relation to diuretic therapy? 1. Test the urine for sugar and acetone 2. Measure daily weights 3. Maintain accurate intake and output 4. Assess for pedal edema

2. A diuretic causes increased urine output. Monitoring daily weights is the best way to assess changes in hydration status. Testing urine for sugar and acetone is not indicated for this client. There are no data stating that the client is a diabetic. Intake and output may be indicated, but daily weights will give a more reliable indication of actual fluid loss. It is not wrong to assess for pedal edema, but daily weights will give a better indicator of fluid loss. Edema can be in places other than the feet.

A 67-year-old man is admitted with dysuria that has gotten worse over the past six months. Rectal examination revealed an enlarged prostate. Following urination, he was catheterized and found to have 250 cc of thick, foul-smelling, residual urine. He is admitted with a diagnosis of benign prostatic hypertrophy. Which symptom is least likely to be present in this client? 1. Urinary frequency 2. Pus in the urine 3. Dribbling 4. Decreased force of urinary stream

2. Benign prostatic hypertrophy (BPH) causes retention, urinary frequency, dribbling, and decreased force of the urinary stream. It does not cause pus in the urine. If pyuria (pus in the urine) is present, this indicates a secondary infection.

An adult male is admitted with severe right flank pain, nausea, and vomiting of four hours in duration. The admitting diagnosis is a kidney stone. Orders include to encourage fluids to 1000 cc per shift. What is the primary reason for encouraging fluids in this client? 1. To prevent renal failure 2. To help the stone pass 3. To prevent infection 4. To relieve his dehydration

2. Encouraging fluids will often help the stone to pass. The client in this question has a kidney stone there is no mention of impending renal failure. High fluid intake is advised for clients who have bladder infections. However, that is not the diagnosis for this client. Increasing fluid intake may be indicated for a client who is dehydrated; however, that is not the diagnosis for this client.

A client has just had a needle biopsy of the kidney. What should the nurse do immediately following the procedure? 1. Keep him NPO; take his blood pressure every 5 minutes for 1 hour and then every 15 minutes 2. Keep him flat for 24 hours; take his blood pressure every 5 minutes for 1 hour, then every 15 minutes 3. Check his blood pressure every 30 minutes for 2 hours; monitor intake and output; position in the Sims' position 4. Check intake and output; send all urine to lab for analysis; ambulate after 8 hours; position in high-Fowler's position.

2. He should be flat to prevent bleeding from the kidney, a very vascular organ. Blood pressure needs frequent monitoring to determine if the client is bleeding. Bleeding is the most common complication following needle biopsy of the kidney.

An adult is scheduled for an intravenous pyelogram. Which comment by the client is of greatest concern to the nurse? 1. "I am afraid of needles." 2. "I get short of breath when I eat crab meat." 3. "When I had an arteriogram, I felt nauseated when they injected the dye." 4. "I am allergic to tetanus shots"

2. Shortness of breath when eating crab meat suggests an allergy to iodine. Iodine dye is used to visualize the kidney during an intravenous pyelogram. This should be reported immediately to the physician. The client will have an intravenous needle, but fear of needles is not the greatest concern. Feeling nauseated and a feeling of warmth along the vein are normal sensations when receiving iodine dye. Tetanus allergy does not indicate an allergy to iodine.

The nurse is caring for a client who has acute renal failure. His potassium rises to 7.3 mEq/L. A Kayexalate enema is ordered. What is the primary purpose of the Kayexalate enema? 1. To remove fluid from the extracellular spaces 2. To exchange potassium ions for sodium ions 3. To reduce abdominal pressure 4. To introduce potassium into the bowel

2. The client's potassium is dangerously high. The normal range is 3.5 to 5.0 mEq/L. Kayexalate is a sodium-potassium exchange resin. It removes potassium from the bloodstream. Although it will not correct the underlying problem, it will lower the serum potassium to safer levels and perhaps prevent serious or even fatal cardiac dysrhythmias. Kayexalate does not remove fluid or reduce abdominal pressure. Kayexalate does not introduce potassium into the bowel. A client who has hyperkalemia does not need additional potassium.

After inserting the indwelling catheter, how should the nurse position the drainage container? 1. With the drainage tubing taut to maintain maximum suction on the urinary bladder 2. Lower than the bladder to maintain a constant downward flow of urine from the bladder 3. At the head of the bed for easy and accurate measurement of urine 4. Beside the client in the bed to avoid embarrassment

2. The drainage bag is positioned below the bladder with tubing angled so that there is a constant downward flow of urine from the bladder. This position helps to prevent ascending infection.

A client asks the nurse if he can get his wife pregnant after a vasectomy. What is the best response for the nurse to make? 1. "No. The procedure works immediately and is permanent." 2. "The first few ejaculations after a vasectomy contain active sperm." 3. "Yes. You should continue to practice birth control for six months." 4. "No. The doctor will flush the sperm out after the procedure is completed."

2. The first few ejaculations contain sperm that are already in the tubes. Before he is considered sterile, he should have two ejaculates a month apart that test sperm free. It is usually at least six to eight weeks before a man is considered sterile following a vasectomy. The surgeon does not flush the sperm from the man's tubes.

The nurse is caring for an adult who has an indwelling urinary catheter with a continuous bladder irrigation infusing. How should the nurse calculate the urine output when the drainage bag is emptied? 1. Subtract the total drainage from the amount of irrigation solution used 2. Measure the amount of drainage and subtract the amount of solution infused 3. Record both the total drainage and the amount of irrigant used on the intake and output record 4. Calculate the total fluid intake and subtract this amount from the total drainage

2. The irrigating solution goes in through the catheter, bathes the bladder, and flows out through the tubing into the collection bag. The nurse should measure the total amount of drainage and subtract the amount of irrigating solution infused because this is not urine output. Answer 1 makes no sense because the drainage is larger than the amount of irrigating solution used. The question asked how the nurse calculates total urine output. Answer 3 does not address the issue of calculating the total urine output. Recording total fluid intake will most likely be done for this client, but subtracting it from the drainage does not tell us the client's urine output.

The nurse instructs a woman in the proper procedure for obtaining a clean-catch urine specimen. What should the nurse tell her to do? 1. Clean the perineal area with soap and water and then void into the collection container. 2. Clean around the urethral opening using antibacterial cleaning pads, wiping from front to back. Urinate and let some of the urine go into the toilet; then collect urine in the sterile container. 3. Wash the area around the urethra and vagina. Insert the end of the sterile catheter into your urethra and collect the urine that is drained. 4. Use the special cotton balls and clean your perineal area, wiping in circles from the outer labia inward. Collect the urine in a sterile container.

2. This describes the correct technique for a clean- catch midstream urine collection. Antiseptic wipes, not soap and water, are used. The container must be sterile for urine for culture. A midstream collection is necessary. The initial urine voided may contain organisms from near the urethral opening. The object of the urine culture is to culture urine in the bladder.

A client who has kidney stones complains of pain. The nurse finds him pacing the hall. What is the most appropriate action for the nurse to take? 1. Tell him to get back in bed where he will be more comfortable 2. Encourage him to walk if it helps to relieve the pain 3. Remind him to walk only when he has someone with him 4. Put him back in bed immediately and position him in semi-sitting position

2. Walking often helps to relieve the pain and will help the stone to pass. The nurse would instruct the client to have assistance with walking only if he is sedated from pain medication.

A 35-year-old man asks the nurse about a vasectomy. In discussing a vasectomy with this man, which information is most important to provide? 1. A vasectomy involves tubal ligation done by surgery. 2. This is a permanent method of contraception. 3. The surgery takes approximately one hour. 4. A vasectomy may cause intermittent impotence.

2.A vasectomy is considered a permanent method of contraception even though it is occasionally possible to reverse. A vasectomy is essentially a ligation of the tube (vas deferens) and is done by surgery, so answer 1 is a true statement. However, the information in answer 2, that this is a permanent method of sterilization, is much more essential. A vasectomy causes sterility but not impotence (inability to maintain an erection); it does not interfere with sexual functioning. The procedure does not take an hour; it takes only a few minutes.

The nurse is teaching testicular self-examination to a group of young men on a college campus. Which information should be included in the discussion? 1. Perform the examination immediately following sexual intercourse. 2. See your physician for an examination yearly. 3. A testicular self-exam should be done monthly. 4. Daily examination of the testicles is recommended.

3. All males past the age of puberty should perform testicular self-examination every month. The man should do this on the same day every month, such as the first or the fifteenth. The exam should be done in the shower, followed by a visual inspection looking in the mirror. There is no relation to sexual intercourse. Testicular self- examination is performed by the man himself. A physician will examine the testicles when a physical is done. This may not be yearly for young men. Testicular cancer is primarily a disease of young men.

A client who had a transurethral prostatectomy is returned to the unit with continuous bladder irrigation. The nurse understands that the primary purpose of continuous bladder irrigation for this client is to: 1. prevent a urinary tract infection. 2. maintain bladder tone. 3. prevent clots in the bladder. 4. prevent urethral stricture.

3. Continuous bathing of the bladder with the irrigating solution will prevent formation of clots in the bladder. The primary purpose of continuous bladder irrigation (CBI) is not to prevent urinary tract infection. CBI does not maintain bladder tone. When a client has CBI, the client has an indwelling catheter. CBI does not prevent urethral stricture formation.

A urinalysis reveals white cells and bacteria in the urine of a female client suspected of having a bladder infection. The client is instructed to take the prescribed anti-infective. What else should the nurse include when teaching the client? 1. Limit fluid intake until the pain subsides 2. Wipe from back to front after voiding 3. Empty her bladder immediately after having sexual relations 4. Take the medication until she is pain free for 48 hours

3. Failure to empty the bladder after sexual relations is thought to be a cause of bladder infections. Fluids should be encouraged, not restricted. She should wipe from front to back to prevent rectal organisms from entering the bladder, also thought to be a cause of bladder infections. All of the medication should be taken to adequately treat the infection and to prevent the development of resistant organisms.

A 64-year-old client with late-stage chronic renal failure is admitted. What should the nurse expect in the nursing care plan for this client? 1. Insert a urinary catheter to promote bladder drainage. 2. Elevate the client's feet when out of bed to promote venous return. 3. Assess the client's lung sounds each shift to monitor fluid status. 4. Supplement the client's diet with protein powder shakes to provide essential amino acids to promote healing.

3. Lung sounds should be assessed to monitor for pulmonary edema, which is a complication of chronic renal failure. Inserting a catheter does not increase kidney function. The client will be oliguric in late-stage chronic renal failure. Elevating the feet increases fluid flow to the heart, making the heart work harder. This should not be done because congestive heart failure is associated with chronic renal failure. Protein intake is restricted in chronic renal failure.

An adult has been on bed rest for several weeks. A nursing care goal is to prevent the formation of renal calculi. Which of the following liquids is it especially important to include in the client's diet? 1. Tomato juice 2. Coffee 3. Cranberry juice 4. Milk

3. Most urinary calculi that form as a result of prolonged immobility are alkaline. Cranberry juice leaves an acid ash, which keeps the urine acidic. The other liquids leave an alkaline ash, which could lead to the development of calculi.

The nurse is caring for an adult who recently received a kidney transplant. Which statement, if made by the client, indicates a lack of understanding of his long-term management? 1. "I plan to go back to work as soon as I feel strong enough." 2. "We have started using gloves whenever we are scrubbing things." 3. "My spouse has helped me work out a schedule for taking all these medications." 4. "If my face gets puffy or my feet swell, I will stop taking the new medications."

4. A puffy face (moon face) and swollen feet may be side effects of steroid medications. A person who has had an organ transplant will receive immunosuppressant drugs, including a steroid, for the rest of his/her life. A person who has had a kidney transplant should be able to return to work once strength has been regained. If the client's work involved excessive exposure to infectious agents, the client might have to change jobs. Wearing gloves is an excellent way to reduce the chance of contracting an infection. The client will be taking a number of antirejection drugs for life.

A woman is being seen in the walk-in clinic for recurrent cystitis. The nurse is teaching her about measures to prevent future episodes of cystitis. What should the nurse include in the teaching? 1. Drink 1000 mL of fluid each day, including a serving of cranberry juice at bedtime. 2. Take a daily bath, and avoid the use of bath oils and soaps. 3. Take all the medication prescribed, even if you feel better. 4. Go to the bathroom and void soon after sexual intercourse.

4. Bacteria may enter the urethra during intercourse. Voiding soon after intercourse helps flush organisms from the urinary tract. Daily fluid intake should be at least 2500 to 3000 mL to prevent recurring cystitis. Showers, not baths, are recommended. Sitting in a tub may cause a reflux of bacteria into the bladder. Finishing all medication is an appropriate response to a current infection but does not prevent recurring infections.

The nurse is preparing to insert an indwelling catheter. What type of technique should the nurse use to perform this procedure? 1. Clean technique 2. Medical asepsis 3. Isolation protocol 4. Sterile technique

4. Catheterization is performed by using the sterile technique. Medical asepsis is the clean technique.

The nurse has inserted an indwelling catheter into an adult male. The nurse tapes the urinary drainage tube laterally to the thigh for which of the following reasons? 1. To ensure client comfort 2. To prevent reflux of urine 3. To maintain tension on the balloon of the Foley 4. To prevent compression at the penoscrotal junction

4. Compression at the penoscrotal junction will cause obstruction of urine flow. Taping the catheter to the thigh straightens out the urethra and prevents compression of the penoscrotal junction. Leaving the penis in a dependent position increases pressure at the penoscrotal junction. Taping the catheter to the thigh does not prevent the reflux of urine. Keeping the tubing gently sloping in a downward direction will help to prevent reflux. There is no need to maintain tension on the balloon of the indwelling catheter. If the balloon is inflated and positioned properly, it will stay in position. The client may or may not be more comfortable with the catheter in this position. However, comfort is not the reason for taping the catheter to the thigh.

The nurse is attempting to pass an indwelling catheter in an adult male and is having difficulty. What is the most appropriate action for the nurse? 1. Remove the catheter and reinsert it with the client positioned differently 2. Try a straight catheter instead 3. Try a smaller catheter 4. Discontinue the procedure and notify the physician

4. Difficulty passing a catheter suggests an obstruction of some nature. The nurse should discontinue the procedure and notify the physician.

A 78-year-old man is scheduled for a transurethral resection of the prostate (TURP) tomorrow morning for treatment of benign prostatic hypertrophy. What instruction should the nurse give him about the initial postoperative period? 1. "Void every two hours whether or not you feel the urge to do so." 2. "Get up and walk to decrease discomfort from bladder spasms." 3. "Cough and deep breathe every two hours to prevent clot formation." 4. "Expect cherry-red urine that will gradually turn pink."

4. It is important to tell the client that his urine will be red during the postsurgical period so that he is not frightened. The client will have an indwelling urinary catheter after surgery. He may even have a continuous, normal saline irrigation. There is no need to give instructions regarding voiding until after the catheter has been removed. Walking does not usually relieve bladder spasms. Coughing and deep breathing are important postoperative interventions, but they do not prevent clot formation.

A 35-year-old man is admitted with severe renal colic. The nurse should monitor this man for possible complications. Which of the following is a complication of renal colic? 1. Anemia 2. Polyuria 3. Hypertension 4. Oliguria

4. Renal colic is severe pain associated with ureteral spasms when the ureter is irritated by a stone. A stone may occlude the ureter and block urine flow from the kidney. This can also result in hydronephrosis, a complication that can lead to kidney necrosis. Anemia and hypertension are complications of renal failure. Polyuria is not associated with renal colic.

A 5-year-old has been wetting his bed since coming into the hospital. The best approach for the nurse to use to help him regain his voluntary bladder control is to do which of the following? 1. Put diapers on him until he promises to stay dry 2. Leave him in his wet bed so he will learn he should not wet his bed 3. Promise him a lollipop if he will call when he needs to void 4. Assist him to the bathroom at regular intervals

4. Taking him to the bathroom at regular intervals will help him regain control. Regression is common in children who are hospitalized. Putting diapers on him and leaving him in his wet bed are punitive, which is not therapeutic. Promising him a lollipop is bribing, which is not therapeutic.

The nurse is caring for a client who is in acute renal failure. Which of the following selections would be best to give for a snack? 1. A slice of watermelon 2. Orange juice 3. A turkey sandwich 4. A dish of applesauce

4.A client in acute renal failure is on a low-sodium, low-protein, low-potassium, high-carbohydrate diet. Applesauce is all of these. Watermelon and orange juice are high in potassium. Turkey contains protein, and the bread contains sodium.