Genitourinary Disorders - ML8

Which information would the nurse include in the teaching plan for a 32-year-old female client requesting information about using a diaphragm for family planning? Diaphragms should not be used if the client develops acute cervicitis. The diaphragm should be washed in a weak solution of bleach and water. Douching with an acidic solution after intercourse is recommended. The diaphragm should be left in place for 2 hours after intercourse.

Diaphragms should not be used if the client develops acute cervicitis. The teaching plan should include a caution that a diaphragm should not be used if the client develops acute cervicitis, possibly aggravated by contact with the rubber of the diaphragm. Some studies have also associated diaphragm use with increased incidence of urinary tract infections. Douching after use of a diaphragm and intercourse is not recommended because pregnancy could occur. The diaphragm should be inspected and washed with mild soap and water after each use. A diaphragm should be left in place for at least 6 hours but no longer than 24 hours after intercourse. More spermicidal jelly or cream should be used if intercourse is repeated during this period.

Which of the responsibilities related to the care of a client with a Foley catheter are appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? Select all that apply. Perform bladder irrigation as prescribed. Provide Foley catheter and perineal care each shift. Apply catheter-securing device to the client's leg. Ensure the urine drainage bag is below the level of the bladder at all times. Empty drainage bag, and record output at specified times. Flush the catheter as needed to ensure patency.

Empty drainage bag, and record output at specified times. Apply catheter-securing device to the client's leg. Provide Foley catheter and perineal care each shift. Ensure the urine drainage bag is below the level of the bladder at all times. While the scope of practice for a UAP may vary by state, province, or territory, as well as by place of employment, general duties include recording input and output, including emptying and recording urine output from a Foley catheter. A UAP with proper training may apply a securing device to maintain safety, provide regular Foley catheter and perineal care and ambulate a client with a catheter, continually monitoring that the collection bag remains below the level of the bladder to help prevent infection. Activities such as irrigating or flushing a catheter should not be assigned to a UAP as these activities involve nursing assessment skills.

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

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

A client believes she is experiencing premenstrual syndrome (PMS). The nurse should next ask the client about what symptom? tension and fatigue before menses and through the second day of the menstrual cycle menstrual cycle irregularity with increased menstrual flow mood swings immediately after menses midcycle spotting and abdominal pain at the time of ovulation

tension and fatigue before menses and through the second day of the menstrual cycle The timing of symptoms is important to the diagnosis of PMS. The client should keep a 3-month log of symptoms and menses. With PMS, the symptoms begin 3 to 7 days before menses and resolve 1 to 2 days after the menstrual cycle has started. Menstrual cycle irregularity and mood swings after menses are not related to PMS, and other causes should be investigated. Midcycle spotting and pain are related to ovulation.

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

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

A client returns from extracorporeal shock wave lithotripsy with ecchymosis over the left flank area. Vital signs are within normal limits, and the client appears to be in no acute distress. Which nursing action is appropriate? Notify the healthcare provider immediately. Apply a cold compress to the site. Place the client in the left lateral position. Maintain NPO status (nothing by mouth) in anticipation of surgical intervention.

Apply a cold compress to the site. Ecchymosis is anticipated following extracorporeal shock wave lithotripsy. Applying a cold compress to the site may help minimize bruising caused by the procedure. This is not a situation requiring the healthcare provider to be notified, as it is an expected assessment finding. The client does not have to remain NPO. Placing the client on the side may increase pain.

A nurse is preparing the plan of care for a client with neurogenic flaccid bladder. Which outcome is appropriate for this client? The client has bladder sensation and no discomfort. The client's bladder does not become over distended. The client will not be incontinent. The client has conscious control over bladder function.

The client's bladder does not become over distended. Flaccid bladder is a type of neurogenic bladder commonly resulting from trauma. The client's bladder continues to fill and overflow incontinence is common. Stasis of urine can lead to infection, therefore fluid intake is encouraged. The client does not feel pain or discomfort and will not have sensation or control over urination.

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? Draw blood from the cannula for routine laboratory work. Inject heparin into the cannula each shift. Percuss the cannula for bruits each shift. Use the unaffected arm for blood pressure measurements.

Use the unaffected arm for blood pressure measurements. The unaffected arm should be used for blood pressure measurement. The external cannula must be handled carefully and protected from damage and disruption. In addition, a tourniquet or clamps should be kept at the bedside because dislodgment of the cannula would cause arterial hemorrhage. The arm with the cannula is not used for blood pressure measurement, IV therapy, or venipuncture. Patency is assessed by auscultating for bruits every shift. Heparin is not injected into the cannula to maintain patency. Because it is part of the general circulation, the cannula cannot be heparinized.

The nurse should teach the client with erectile dysfunction (ED) to alter his lifestyle by doing which? avoiding alcohol decreasing smoking following a low-salt diet increasing attempts at sexual intercourse

avoiding alcohol Avoidance of alcohol can improve the outcome of therapy. Alcohol and smoking can affect a man's ability to have and maintain an erection. The client should be encouraged to follow a healthy diet, but no specific diet is associated with improvement of sexual function. The client should cease smoking, not just decrease smoking. Increasing attempts at intercourse without treatment will not facilitate improvement. The client should be reassured that ED is a common problem and that help is available.

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. Cancer cells were found in the smear. The Pap smear alone is not very important diagnostically because there are many false-positive results. Abnormal viral cells were found in the smear.

The cells could cause various conditions and help identify a problem early. The Pap smear identifies atypical cervical cells that may be present for various reasons. Cancer is the most common possible reason, but not the only one. The Pap smear does not show abnormal viral cells unless specific gene typing is done for human papillomavirus. An adequate smear provides accurate diagnostic data; the false-positive rate is only about 5%.

A nurse has a four-patient assignment in the medical step-down unit. When planning care for the clients, which client would have the following treatment goals: fluid replacement, vasopressin replacement, and correction of underlying intracranial pathology? the client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion the client with diabetic ketoacidosis the client with diabetes insipidus the client with diabetes mellitus

the client with diabetes insipidus Maintaining adequate fluid, replacing vasopressin, and correcting underlying intracranial problems (typically lesions, tumors, or trauma affecting the hypothalamus or pituitary gland) are the main objectives in treating diabetes insipidus. Diabetes mellitus does not involve vasopressin deficiencies or an intracranial disorder, but rather a disturbance in the production or use of insulin. Diabetic ketoacidosis results from severe insulin insufficiency. An excess of vasopressin leads to SIADH, causing the client to retain fluid.

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

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

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: report the symptoms to the health care provider. test his urine for ketones. take his blood pressure lying, standing, and sitting. review his other medications.

take his blood pressure lying, standing, and sitting. Doxazosin is also used as an antihypertensive agent; the client may be experiencing orthostatic hypotension. The nurse should first take the client's blood pressure; later, the nurse can review other medications.Testing the urine for ketones would be appropriate if the client had diabetes mellitus.The client's report of symptoms should be reported to the health care provider with the blood pressure readings.

A nurse is assessing a client when she returns from same-day surgery for a dilatation and curettage. The nurse checks preoperative vital signs at 0830 to compare them with the current vital signs at 2230 (see chart). What should the nurse do first? Call the health care provider for pain medication. Cover the client with warmed blankets. Administer oxygen at 4 L/min. Increase the IV fluid rate.

Cover the client with warmed blankets. The client's body temperature dropped 2.5° F (1.4° C) from the preoperative to postoperative phase. The client lost heat during the preoperative period. The client has not had time to regain the heat she has lost and should not be discharged postoperatively until her postoperative vital signs, which include body temperature, are closer to her preoperative vital signs. The client's pulse rate, respiratory rate, and blood pressure have compensated according to the client's hypothermic state and will reflect changes as the client warms up. There are no indications that the client needs more pain medication, oxygen, or IV fluids.

A client is being discharged to home 3 days after transurethral resection of the prostate (TURP). What should the nurse instruct the client to do? Select all that apply. Take deep breaths and cough every 2 hours. Drink at least 3,000 mL of water per day. Report a temperature over 100.4° F (38° C). Increase calorie intake by eating six small meals a day. Report bright red bleeding to the health care provider (HCP).

Drink at least 3,000 mL of water per day. Report a temperature over 100.4° F (38° C). Report bright red bleeding to the health care provider (HCP). The nurse should instruct the client to drink a large amount of fluids (about 3,000 mL/day) to keep the urine clear. The urine should be almost without color. About 2 weeks after TURP, when desiccated tissue is sloughed out, a secondary hemorrhage could occur. The client should be instructed to call the surgeon or go to the emergency department if at any time the urine turns bright red. The nurse should also instruct the client to report signs of infection such as a temperature over 100.4° F (38° C). The client is not specifically at risk for nutritional problems after TURP and can resume a diet as tolerated. The client is not specifically at risk for airway problems because the procedure is done under spinal anesthesia and the client does not need to take deep breaths and cough.

Which steps should a nurse follow to insert a straight urinary catheter? Prepare the client and equipment, create a sterile field, test the catheter balloon, clean the meatus, and insert the catheter until urine flows. Prepare the client and equipment, create a sterile field, put on gloves, clean the urinary meatus, and insert the catheter until urine flows. Create a sterile field, drape the client, clean the meatus, and insert the catheter 6″. Put on gloves, prepare equipment, create a sterile field, expose the urinary meatus, and insert the catheter 6″.

Prepare the client and equipment, create a sterile field, put on gloves, clean the urinary meatus, and insert the catheter until urine flows. Preparing the client and equipment, creating a sterile field, putting on gloves, cleaning the urinary meatus, and inserting the catheter until urine flows are all the vital steps for inserting a straight catheter. The nurse must prepare the client and equipment before creating a sterile field. Putting on gloves before creating a sterile field and performing the other tasks is incorrect. Testing the catheter balloon describes the procedure for inserting a retention catheter, rather than a straight catheter.

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 should be accepted as a relatively normal part of aging. Urinary incontinence has many causes and can often be improved with intervention. Among older adults, urinary incontinence is most often a sign of depression. Being incontinent can increase the client's risk for dehydration and confusion.

Urinary incontinence has many causes and can often be improved with intervention. Urinary incontinence is not a normal part of aging, nor is it a disease. Urinary incontinence is not caused by depression. It may be caused by confusion or dehydration but does not cause these issues. Other risk factors include fecal impaction, restricted mobility, or other causes. Some medications, including diuretics, hypnotics, sedatives, anticholinergics, and antihypertensives, may trigger urinary incontinence. Most clients' urinary incontinence can be improved with careful assessment for contributing factors and targeted interventions.

A graduate nurse is asking for information about chronic renal failure. Which statement by the nurse would be most accurate when providing teaching? "It results in an inability of the kidneys to convert waste products to creatinine and blood urea nitrogen." "It is most commonly caused by recurrent pyelonephritis." "It is characterized by azotemia, fluid volume excess, and hyperkalemia." "It results in an increase in erythropoietin, leading to chronic anemia and fatigue."

"It is characterized by azotemia, fluid volume excess, and hyperkalemia." When chronic renal failure occurs, the body is unable to eliminate the wastes, resulting in azotemia. In addition, the kidneys are not able to eliminate the body fluids, resulting in fluid volume overload. There is also a rise in potassium levels resulting in hyperkalemia. The most common cause of chronic renal failure is diabetes. There is a depression of erythropoietin with chronic renal failure. The liver converts wastes to creatinine and blood urea nitrogen, not the kidneys.

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." "The radioactivity will gradually decrease, and you will be discharged when the radioactive material reaches its half-life." "The radiation is necessary to treat your tumor." "Careful shielding prevents the area above your waist from radioactivity."

"The radioactive material is controlled and stays with the source; once the material is removed, no radioactivity will remain." The radioactivity comes from a radioactive material such as radium or cesium. Radioactivity affects tissues but does not make them radioactive. Once the radioactive source is removed, no radioactivity remains. Accurate information can help alleviate ungrounded fears.The time required for a radioactive substance to be half-dissipated is called its half-life, but this does not determine discharge time. The client receiving sealed internal radiotherapy is not discharged until the radioactive source is removed.While the radiation is necessary for treatment, telling the client this does not provide information to address her concerns.With cervical implants, there is no way to shield the area above the waist from radiation.

A client has polycystic kidney disease. The client asks the nurse, "How did I get these fluid-filled bubbles on my kidneys?" How should the nurse respond to help the client understand risk factors for this disease? "There is a higher incidence of polycystic kidney disease among blood relatives." "Exposure to dyes used to color fruits and vegetables increases the risk of polycystic kidney disease." "Drinking alcohol daily allows the kidneys to develop cysts." "Second-hand smoke puts you at greater risk for developing cysts."

"There is a higher incidence of polycystic kidney disease among blood relatives." Although it is not clearly understood why cysts form in polycystic kidney disease, the condition is known to be inherited. Environmental exposures such as smoking and breathing second-hand smoke promote development of bladder cancer. Although drinking alcohol requires the kidneys to excrete the alcohol, it is not thought to cause the kidneys to develop cysts. Exposure to dyes used in foods does not increase the risk for polycystic disease.

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 immediately after the procedure." "You can safely have unprotected intercourse as soon as discomfort from the procedure disappears." "You can safely have unprotected intercourse after 6 to 10 ejaculations." "You can safely have unprotected intercourse when your sperm count indicates sterilization."

"You can safely have unprotected intercourse when your sperm count indicates sterilization." After a vasectomy, sterilization isn't ensured until the client's sperm count measures zero. This usually requires 6 to 36 ejaculations. Having intercourse immediately after the procedure or as soon as discomfort disappears may lead to pregnancy.

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'll get a sterile syringe and remove urine from the catheter through the collection port to place in the specimen container." "I should collect urine from the catheter drainage bag at the end of the shift and place it in the specimen container." "I'll empty the catheter drainage bag, have the client drink some water, and an hour later collect the urine that drains into the bag." "I'll disconnect the drainage tube from the catheter and let urine run from the catheter into the specimen container."

"I'll get a sterile syringe and remove urine from the catheter through the collection port to place in the specimen container." When obtaining a urine specimen from an indwelling catheter, a sterile syringe and needle should be used to access the catheter port that allows removal of urine from the closed system. This technique preserves sterility of the system and the urine specimen.Urine cannot be collected from the drainage bag because it would not be a fresh specimen.Disconnecting the tube from the catheter bag could introduce organisms into the urinary system, causing a urinary tract infection.

A woman with cystitis is to take a 10-day prescription of an antibiotic. The client asks the nurse if she can continue to have sexual intercourse. The nurse should tell the client: "Limit intercourse to once a day in the early morning after your bladder has rested." "Avoid intercourse until you have completed the antibiotic therapy, and then limit intercourse to once a week." "As long as you are comfortable, you can have intercourse as often as you wish, but be sure to urinate within 15 minutes after intercourse." "You can have intercourse as often as you wish, but be sure your partner uses a condom."

"As long as you are comfortable, you can have intercourse as often as you wish, but be sure to urinate within 15 minutes after intercourse." Intercourse is not contraindicated with cystitis. Voiding immediately after intercourse flushes bacteria from the urethra, which should help prevent recurrence for the client.There is no reason to wait until the antibiotic therapy is completed to have intercourse. There is no reason to limit the frequency of intercourse. A condom does not prevent cystitis, because cystitis results from the introduction of the client's own organisms (usually Escherichia coli) into the urethra. A male partner cannot acquire cystitis from a woman with cystitis.

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? "Have you had a transrectal ultrasound within the last 10 years?" "Do you perform monthly testicular self-examinations?" "How many times a night do you get up to void?" "Do you have a digital rectal examination and prostate-specific antigen tests yearly?"

"Do you have a digital rectal examination and prostate-specific antigen tests yearly?" Prostate-specific antigen (PSA) and digital rectal examinations, although not specific for prostate cancer, will indicate possible changes in the prostate gland. The transrectal ultrasound would be performed as a follow-up for an increased PSA and/or an enlarged prostate gland. Testicular exams will not reveal changes in the prostate. The client already told the nurse he has nocturia, so this question is gathering more information about symptoms, not detection of the disease.

The nurse teaches 17-year-old girl with has a severe gonorrheal infection about her disease. The nurse realizes that the girl understands the implications of her disease when the client makes which statement? "I could have trouble getting pregnant." "I won't have any more problems once I learn to protect myself." "My partner doesn't need treatment." "Once I'm treated, I'll have immunity."

"I could have trouble getting pregnant." With a severe gonorrheal infection, scarring of the fallopian tubes may occur, and becoming pregnant may be difficult or impossible. If the girl's partner is not treated, she can be reinfected. There is no immunity against gonorrhea and, if exposed again, the girl can again become infected. Although a condom may provide some protection against contracting gonorrhea, it is not an adequate protection against the condition and will not help clear up an existing infection. It is only with proper antibiotic administration that the condition can be eradicated.

A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs) about prevention. What statement indicates the client understands the teaching? "I should wipe from back to front." "I should take at least 1,000 mg of vitamin C each day." "I should take a tub bath at least 3 times per week." "I should empty my bladder after eating a meal."

"I should take at least 1,000 mg of vitamin C each day." The client demonstrates understanding of teaching when she states that she should take vitamin C each day. Increasing vitamin C intake to at least 1,000 mg per day helps acidify the urine, decreasing the amount of bacteria that can grow. The client should wipe from front to back to avoid introducing bacteria from the anal area into the urethra. The client should shower, not bathe, to minimize the amount of bacteria that can enter the urethra. The client should increase her fluid intake, and void every 2 to 3 hours and completely empty her bladder. It is not sufficient to empty the bladder only after eating a meal. Holding urine in the bladder can cause the bladder to become distended, which places the client at further risk for UTIs.

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 have the prescription renewed once." "I will take the pills until the symptoms go away and then reduce the dose to one pill a day." "I will take the pills until I feel better and keep the rest for recurrences." "I will take all the pills and then return to my doctor."

"I will take all the pills and then return to my doctor." Antibiotics are prescribed for a definite treatment period, and all the pills should be taken. A urine culture should be done after the course of antibiotic therapy to ensure that the urine is bacteria free.Stopping the medication early may cause the infection to recur.Tapering the dosage is inappropriate with antibiotics because it lowers the therapeutic blood level.Refilling the prescription would be indicated only if urine culture indicates that the urine is not bacteria free and the health care provider prescribes another course of antibiotics.

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." "Be aware that your urine will be cherry-red for 5 to 7 days." "Apply an antibacterial dressing to the incision daily." "Take your temperature every 4 hours."

"Increase your fluid intake to 2 to 3 L per day." The nurse should instruct the client to increase fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.

A male client enters the oncology clinic for an evaluation. The nurse explains that the healthcare provider has ordered a prostate-specific antigen (PSA) test. The client asks the nurse, "How will this test tell if I have prostate cancer?" What is the nurse's best response? "Individuals who have a PSA higher than 10 have a 60-70% chance of having prostate cancer." "Individuals with a 2.5 ng/mL PSA and a mother who had breast cancer need to have a biopsy of the prostate gland." "The evidence shows that individuals who have levels under 4 ng/mL need yearly follow-up." "If your level is between is between 6 and 8 ng/mL, you have nothing to worry about."

"Individuals who have a PSA higher than 10 have a 60-70% chance of having prostate cancer." Most men have PSA levels under 4 ng/mL, which has traditionally been used as the cutoff for concern about the risk of prostate cancer. Men with prostate cancer often have PSA levels higher than 4. Those with a PSA between 4 and 10 have a 25% chance of having prostate cancer and if the PSA is higher than 10, the risk increases to 67%.

Which instruction would a nurse include in the discharge teaching for a client who has an ileal conduit? "Decrease your fluid intake." "It is only necessary to wear the appliance pouch at bedtime." "You can decrease fecal collection in the pouch by watching your diet." "Mucous in the pouch is expected."

"Mucous in the pouch is expected." An ileal conduit is a type of urinary diversion in which a segment of the ileum or colon is diverted to the skin and a stoma is formed. Urine will leak continuously into the pouch and a drainage bag must be worn for collection at all times except when cleaning the bag. Mucous in the pouch is a normal finding since the intestines are used to create the diversion. Increased fluid intake is encouraged to prevent dehydration. Feces should not be in the pouch.

A woman is using progestin injections for contraception. When does the nurse instruct the client to return for her next injection? 4 months 6 months 1 month 3 months

3 months At the time a client receives a progestin injection, a follow-up appointment should be made for 3 months later. The nurse should emphasize the need to adhere to the medication schedule to prevent an unplanned pregnancy. One of the most common reasons for failure of this contraceptive is lack of adherence to the appointment schedule for injections every 3 months.

The nurse is reading the nurse's note from the previous shift to evaluate the client with a risk for impaired skin integrity due to fluid volume excess. Which aspects would demonstrate this improvement? Client statement of thirst and request for the cup of water. Foot of bed elevated 30 degrees for peripheral edema. Presence of urine output that is amber in color. Ambulation to the bathroom without noted dyspnea.

Ambulation to the bathroom without noted dyspnea. The client would have ambulation without dyspnea as a sign of improvement with fluid volume excess. Amber urine is a sign of a continued imbalance of fluid volume and the client's response of thirst is likely due to fluid restriction, not an indication of improvement. The foot of bed elevation would be a treatment and not a sign of improvement with fluid volume excess.

Eight hours after laparoscopic abdominal surgery, a client has a distended bladder and is unable to void in bed using a urinal. The client can be out of bed as tolerated, but has not done so yet. What should the nurse do next? Notify the health care provider to request a prescription for catheterization. Encourage the client to ambulate to prevent further bladder distention. Pour running water over perineum to stimulate emptying of the bladder. Assist the client to stand at the bedside to use the urinal.

Assist the client to stand at the bedside to use the urinal. The nurse should first try to facilitate the client's ability to void by having the client stand at the bedside and use the urinal. Pouring running water over the perineum is a strategy that could be used if the client cannot void in a standing position. Ambulation will not help the client void. If such conservative methods fail, the nurse should obtain a prescription to catheterize the client, but an indwelling urinary catheter increases the risk of urinary tract infection because microbes ascend the catheter and travel to the bladder.

A client with chronic renal failure receives hemodialysis treatments through a mature arteriovenous (AV) fistula. What intervention will the nurse include in the care plan? Auscultate the AV fistula for a bruit. Palpate the AV fistula for a bruit. Apply lotion to the AV fistula daily. Clean the AV fistula with sterile saline.

Auscultate the AV fistula for a bruit. The nurse needs to auscultate the AV fistula for a bruit to assess for blood flow. The AV fistula does not require lotion for moisture. It also does not need to be cleaned with saline; it is intact skin except when it's being accessed for dialysis. The nurse will palpate the fistula for a thrill.

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? Flank and abdominal discomfort decreases. Urine output increases to 2,000 ml/day. Bacteria are absent on urine culture. The red blood cell (RBC) count is normal.

Bacteria are absent on urine culture. Co-trimoxazole is a sulfonamide antibiotic used to treat urinary tract infections. Therefore, absence of bacteria on urine culture indicates that the drug has achieved its desired effect. Although flank pain may decrease as the infection resolves, this finding isn't a reliable indicator of the drug's effectiveness. Co-trimoxazole doesn't affect urine output or the RBC count.

A client is scheduled for a creatinine clearance test. What should the nurse do to prepare the client? Provide the client with a sterile urine collection container. Insert an indwelling urethral catheter. Tell the client to obtain 3,000 mL fluids the day before the test. Instruct the client about the need to collect urine for 24 hours.

Instruct the client about the need to collect urine for 24 hours. A creatinine clearance test is a 24-hour urine test that measures the degree of protein breakdown in the body. The collection is not maintained in a sterile container. There is no need to insert an indwelling urinary catheter as long as the client is able to control urination. It is not necessary to increase fluids to 3,000 mL.

A nurse is caring for a client diagnosed with acute kidney injury with an indwelling urinary catheter. The nurse notes that the total urine output for the previous 24 hours is 35 ml. What action should the nurse perform first? Teach the client about what to expect during hemodialysis treatments. Insert an intravenous catheter, and encourage the client to increase oral intake. Notify the healthcare provider that the client meets the criteria for anuria. Scan the client's bladder to determine if residual volumes are present.

Scan the client's bladder to determine if residual volumes are present. The client with acute kidney injury can potentially progress to anuria (urine output less than 50 ml/24 hr), which can be an indication for beginning hemodialysis. The healthcare provider will also consider the client's kidney function test results when making this decision. However, the nurse should first check the accuracy of the measured output by performing a bladder scan for residual volume that can confirm if the catheter is occluded or if anuria is indeed present. Only once anuria is confirmed should the nurse notify the healthcare provider and then take actions based on the prescribed interventions.

The client is having peritoneal dialysis. During the exchange, the nurse observes that the flow of dialysate stops before all the solution has drained out. What should the nurse do next? Have the client walk. Turn the client from side to side. Have the client sit in a chair. Reposition the peritoneal catheter.

Turn the client from side to side. Fluid return with peritoneal dialysis is accomplished by gravity flow. Actions that enhance gravity flow include turning the client from side to side, raising the head of the bed, and gently massaging the abdomen. The client is usually confined to a recumbent position during the dialysis. The nurse should not attempt to reposition the catheter.

The nurse is obtaining a health history from a client with a sexually transmitted disease. Which description from the client indicates the likelihood of syphilis? "In my genital area I have: itching." a wart." a moist ulcer." tender pimples."

a moist ulcer." The chancre of syphilis is characteristically a painless, moist ulcer. The serous discharge is very infectious. Because the chancre is usually painless and disappears, the client may not be aware of it or may not seek care. The chancre does not appear as pimples or warts, and does not itch, thus making diagnosis difficult.

Aluminum hydroxide gel is prescribed for the client with chronic renal failure to take at home. What is the expected outcome of this drug? preventing Curling's stress ulcers reversing metabolic acidosis relieving the pain of gastric hyperacidity binding phosphate in the intestine

binding phosphate in the intestine A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body's calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Antacids will not prevent Curling's stress ulcers and do not affect metabolic acidosis.

In discussing home care with a client after transurethral resection of the prostate (TURP), what should the nurse tell the male client about dribbling of urine after this surgery? Dribbling of urine: can be a chronic problem. is an abnormal sign that requires intervention. is a sign of healing within the prostate. can persist for several months.

can persist for several months. Dribbling of urine can occur for several months after TURP. The client should be informed that this is expected and is not an abnormal sign. The nurse should teach the client perineal exercises to strengthen sphincter tone. The client may need to use pads for temporary incontinence. The client should be reassured that continence will return in a few months and will not be a chronic problem. Dribbling is not a sign of healing, but is related to the trauma of surgery.

Which abnormal blood value would not be improved by dialysis treatment? hyperkalemia hypernatremia decreased hemoglobin concentration elevated serum creatinine level

decreased hemoglobin concentration Dialysis has no effect on hemoglobin levels because some red blood cells are injured during the procedure; dialysis aggravates a low hemoglobin concentration and may contribute to anemia. Dialysis will clear metabolic waste products from the body and correct electrolyte imbalances.

The nurse is assessing a client who has benign prostatic hypertrophy (BPH). The nurse should determine if the client has which symptom? flank pain hematuria impotence difficulty starting the urinary stream

difficulty starting the urinary stream The symptoms of BPH are related to obstruction as a result of an enlarged prostate. Difficulty in starting the urinary stream is a common symptom, along with dribbling, hesitancy, and urinary retention. Impotence does not result from BPH. Flank pain is most commonly related to pyelonephritis. Hematuria occurs in urinary tract infections, renal calculi, and bladder cancer, to name some of the most common causes.

A 28-year-old female client is prescribed danazol for endometriosis. The nurse should instruct the client to report which symptoms to the health care provider? increased libido weight loss headaches hair loss

headaches Adverse effects of danazol include headaches, dizziness, irritability, and decreased libido. Masculinization effects, such as deepened voice, facial hair, and weight gain, also may occur.

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

high purine To control uric acid calculi, the client would follow a low-purine diet, which excludes high-purine foods such as organ meats. The other diets do not control uric acid calculi.

The nurse is caring for a client with acute renal failure. Rank in chronological order the phases of acute renal failure. All options must be used. recovery phase oliguric phase initial insult diuretic phase

initial insult oliguric phase diuretic phase recovery phase Clients with acute renal failure pass through the phases in the following order: initial insult, oliguric phase, diuretic phase, and recovery phase. A small percentage of clients will not progress beyond the oliguric phase and will progress to end-stage renal disease.

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? appliance separation urine reflux into the stoma urine leakage the need to restrict fluids

urine reflux into the stoma The most important reason for attaching the appliance to a standard urine collection bag at night is to prevent urine reflux into the stoma and ureters, which can result in infection. Use of a standard collection bag also keeps the appliance from separating from the skin and helps prevent urine leakage from an overly full bag, but the primary purpose is to prevent reflux of urine. A client with a urinary diversion should drink 2,000 to 3,000 mL of fluid each day; it would be inappropriate to suggest decreasing fluid intake.

An adolescent client is hospitalized with acute glomerulonephritis. The nurse reviews the client's urine chemistry laboratory reports (see figure). Which finding does the nurse draw to the attention of the health care provider (HCP)? Urine specific gravity: 1.035 Protein: 12 mg/ 24 hr Potassium: 35 mEq/24 hr Creatinine: 2 mg/ 24 hr urine specific gravity protein potassium creatinine

urine specific gravity The nurse verifies that the HCP has noted the elevated specific gravity. Clients with glomerulonephritis have concentrated urine from oliguria caused by the inflammation of the glomeruli. The other laboratory results are in normal range.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? blood glucose level of 200 mg/dl (11.1 mmol/L) potassium level of 3.5 mEq/L (3.5 mmol/L) hematocrit (HCT) of 35% white blood cell (WBC) count of 20,000/mm3 (0.02 L)

white blood cell (WBC) count of 20,000/mm3 (0.02 L) An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

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 term should the nurse use to document the client's condition? orgasmic dysfunction celibacy vaginismus dyspareunia

vaginismus The client is experiencing an involuntary contraction of the muscles surrounding the vaginal orifice; this should be documented as vaginismus. Dyspareunia is painful intercourse. Difficulty achieving orgasm is documented as orgasmic dysfunction. Abstention from sexual intercourse is documented as celibacy.

The nurse is assigned a client with end-stage ovarian cancer with recurrent ascites, and the client is to undergo paracentesis. Which activity is best to delegate to an experienced licensed practical nurse (LPN/VN)? vital signs every 15 minutes after the paracentesis providing discharge instructions after the paracentesis completing the client admission obtaining a paracentesis tray from central supply

vital signs every 15 minutes after the paracentesis To delegate nursing care effectively, a nurse must know the client's condition, the competence and scope of practice of all nursing team members, and the level of supervision needed for the delegated nursing care task. The nurse must also consider the training, cultural competence, and experience of the delegate. Delegating nursing care requires critical thinking and professional judgment to ensure that the delegated nursing care task is the right task for the right person, the task is delegated under the right circumstances, the delegate receives the right directions and communication, and the performance of the task is properly supervised and evaluated. An experienced LPN/LVN would monitor and report vital signs to the RN. The paracentesis tray can be obtained by the unit clerk or unlicensed assistive personnel (UAP). The admission assessment and teaching require the RN's expertise and education.

Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with benign prostatic hyperplasia (BPH)? voiding pattern creatinine clearance prostate size serum testosterone level

voiding pattern The client's voiding pattern should be checked to evaluate the effectiveness of alpha-adrenergic blockers. These drugs relax the smooth muscle of the bladder neck and prostate, so the urinary symptoms of BPH are reduced in many clients. These drugs don't affect the size of the prostate, production or metabolism of testosterone, or renal function.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: an increased serum calcium level secondary to kidney failure. a decreased serum phosphate level secondary to kidney failure. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. metabolic alkalosis secondary to retention of hydrogen ions.

water and sodium retention secondary to a severe decrease in the glomerular filtration rate. The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? alkaline basic acidic neutral

acidic Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals acidic urine pH. A pH above 7.0 is considered an alkaline or basic solution. A pH of 7.0 is considered neutral.

A charge nurse is making arrangements for an elderly client newly admitted from the emergency department for treatment of suspected pyelonephritis. The charge nurse notes that the client has been assigned to a semiprivate room with another client who has the same last name. What should the nurse do first? Make signs to alert staff members that both clients in the room have the same last name. Ask the admissions department to assign the elderly client to a new room. Verbally remind the staff to check each client's identification bracelet before administering medications. Ask the client if they'd be willing to answer to a different last name.

Ask the admissions department to assign the elderly client to a new room. To prevent errors, the charge nurse should ask the admissions department to assign the elderly client to another room. Making signs and verbally alerting staff members don't eliminate the risk of error. It isn't appropriate to ask the client if they'd be willing to answer to a different last name.

The nurse instructs the unlicensed assistive personnel on how to collect a 24-hour urine specimen. Which of the following instructions is correct for a collection that is scheduled to start at 7 a.m. (0700) Monday and end at 7 a.m. (0700) Tuesday? Collect and save the urine voided at 7 a.m. (0700) on Monday. Send the first voided urine specimen on Monday to the laboratory for culture. Collect and save the urine voided at 7 a.m. (0700) on Tuesday. Keep each day's urine collection in separate containers.

Collect and save the urine voided at 7 a.m. (0700) on Tuesday. When finishing a 24-hour urine collection, the final voided urine is saved and added to the collection container. The first urine specimen, voided at 7 a.m. (0700) Monday, is discarded. The urine is not sent for a urine culture. It is not necessary to separate each day's collection of urine.

Which nursing action is most appropriate for a client who has urge incontinence? Have the client urinate on a timed schedule. Teach the client intermittent self-catheterization technique. Administer prophylactic antibiotics. Provide a bedside commode.

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

An older adult who is to be on bed rest has become incontinent of urine. To prevent pressure ulcers, the nurse should do which tasks? Select all that apply. Use a sanitary napkin to absorb urine. Inspect the groin for wetness. Institute a turning schedule. Have client wear incontinence briefs. Anchor a Foley catheter.

Institute a turning schedule. Inspect the groin for wetness. Have client wear incontinence briefs. This client is at risk for pressure ulcers because of age, being on bed rest, and being incontinent. The nurse assesses all pressure points and the groin area, assures that the client changes positions every 2 hours, and has the client wear incontinence pads containing absorbent material (specially designed to absorb many times its weight in water) or disposable incontinence briefs. Sanitary napkins are not designed to contain/absorb urine. Anchoring a Foley catheter increases the risk for infection.

The nurse is teaching the client with an ileal conduit how to prevent a urinary tract infection. Which measure would be most effective? Use sterile technique to change the appliance. Irrigate the stoma daily. Avoid people with respiratory tract infections. Maintain a daily fluid intake of 2,000 to 3,000 mL.

Maintain a daily fluid intake of 2,000 to 3,000 mL. Maintaining a fluid intake of 2,000 to 3,000 mL/day is likely to be most effective in preventing urinary tract infection. A high fluid intake results in high urine output, which prevents urinary stasis and bacterial growth. Avoiding people with respiratory tract infections will not prevent urinary tract infections. Clean, not sterile, technique is used to change the appliance. An ileal conduit stoma is not irrigated.

The return for a client receiving peritoneal dialysis is sluggish. Which action should the nurse take to facilitate the drainage of the fluid? Select all that apply. Irrigate the infusion catheter. Turn the client from side to side. Push the catheter further into the peritoneal cavity. Raise the head of the bed. Inspect the tubing for kinks.

Raise the head of the bed. Inspect the tubing for kinks. Turn the client from side to side. The care of the client receiving peritoneal dialysis includes monitoring the client during the draining phase of the treatment. If the fluid does not drain, the head of the bed can be raised or the client turned from side to side. Inspecting the tubing for kinks should also be done. The catheter is not irrigated and should never be pushed further into the peritoneal cavity.

A client tells the nurse that she has had sexual contact with someone whom she suspects has genital herpes. What information should the nurse give to the client? Continue sexual activity unless lesions are present. Anticipate lesions within 25 to 30 days. Report any difficulty urinating. Drink extra fluids to prevent lesions from forming.

Report any difficulty urinating. The client should be encouraged to report painful urination or urinary retention. Lesions may appear 2 to 12 days after exposure. The client is capable of transmitting the infection even when asymptomatic, so a barrier contraceptive should be used. Drinking extra fluids will not stop the lesions from forming.

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

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

A client comes to the emergency department reporting a sudden onset of sharp, severe, radiating pain in the lumbar and left flank regions. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. What is the nurse's priority action? Restrict fluid intake. Strain all urine. Elevate the head of the bed. Apply a cold compress to the site of pain.

Strain all urine. The symptoms are characteristic of renal calculi. Straining the urine allows for the visualization of stones if/when they pass. Elevating the head of the bed is not likely to ease symptoms, and a cold compress may diminish blood flow to the area. Restricting fluids may facilitate further calculi formation.

Which woman is at greatest risk for bacterial vaginosis? a 75-year-old with chronic obstructive disease a 12-year-old who has just started her menstrual cycles A 52-year-old experiencing menopause a 28-year-old who is sexually active

a 28-year-old who is sexually active Bacterial vaginosis is the most common vaginal infection in reproductive-age women, and up to 50% of women may be asymptomatic. Bacterial vaginosis is not usually transmitted sexually, and treatment of the male sex partner has not been beneficial in preventing recurrence of bacterial vaginosis.Bacterial vaginosis is not associated with aging, chronic illness, menopause, or onset of menstruation.

The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate? high-calcium, high-potassium, high-protein low-protein, high-potassium low-protein, low-sodium, low-potassium high-carbohydrate, high-protein

low-protein, low-sodium, low-potassium Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high-carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day.

The client has a continuous bladder irrigation after a transurethral resection. A major goal related to the irrigation is to: recognize signs of prostate cancer. maintain catheter patency. reduce incisional bleeding. perform activities of daily living.

maintain catheter patency. Maintaining catheter patency during the immediate postoperative period after a transurethral resection is a priority because postoperative bleeding can occlude the catheter. Catheter occlusion can lead to urine retention, pain, bladder spasm, and the need to replace the catheter.Incisional bleeding is not expected unless a complication occurs.The client in the immediate postoperative period is not ready for teaching about the signs of prostate cancer.Performing activities of daily living, such as bathing, is not a priority immediately after surgery.

A client diagnosed with cancer of the cervix in situ is scheduled to have a conization. Which is a priority during the 1st 24 postoperative hours? monitoring vaginal bleeding maintaining strict bed rest monitoring vital signs hourly maintaining electrolyte balance

monitoring vaginal bleeding Uncontrolled vaginal bleeding is the priority concern during the 1st 24 hours after conization of the cervix. This is best monitored by keeping an accurate pad count, which assesses the extent of bleeding.Hourly vital signs and strict bed rest are unnecessary unless complications develop.Electrolyte imbalance is not anticipated with this procedure.

A client is receiving hemodialysis for chronic kidney failure. The nurse understands the client is at an increased risk for which condition? renal calculi due to the increased urine output development of peritonitis during dialysis serum hepatitis bladder infections

serum hepatitis Serum hepatitis (hepatitis B) is transmitted by blood or blood products. The hemodialysis and routine transfusions needed for a client in renal failure constitute a great risk of exposure. Other answers are incorrect because dialysis is done through a dialysis catheter, not peritoneum. There is no reason for increased calculi or infection based on urine output.

Which client will the nurse prioritize to assess first? the client with ESRD (end-stage renal disease) just admitted the night before the client 2 days post-laparoscopic cholecystectomy the client admitted 24 hours earlier with mild chest pain and negative serial levels of troponin T in the range of 0-0.1 µg/L the client with type 1 diabetes mellitus and a morning blood glucose level of 110 mg/dL

the client with ESRD (end-stage renal disease) just admitted the night before The client with ESRD is at risk of significant anemia because the kidneys are responsible for erythropoietin production; the client is also at risk for significant potassium and sodium imbalances. The client with negative troponin levels and mild chest pain is most likely not having a cardiac event. The client with a blood glucose of 110 is in no danger. A client who is 2 days post a laparoscopic cholecystectomy is stable.

A client receiving total parenteral nutrition (TPN) is ordered to undergo a 24-hour urine test for creatinine clearance. Which actions should the client take to initiate this collection? Start with the first voiding of the day and then continue for exactly 24 hours. Discard the first morning void, then continue the collection for exactly 24 hours. Begin at 0800 and then continue until 0759 on the following day. Start immediately after initiation of TPN and then continue for exactly 24 hours.

Discard the first morning void, then continue the collection for exactly 24 hours. Evidence-based practice (EBP) dictates that the nurse should start the test after the first morning void, but this first void should be discarded. The other choices are not correct.

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? fluid restriction self-catheterization artificial sphincter use Kegel exercises

Kegel exercises Kegel exercises are noninvasive and are recommended as the initial intervention for incontinence. Fluid restriction is useful for the client with increased detrusor contraction related to acidic urine. Artificial sphincter use isn't a primary intervention for post-prostatectomy incontinence. Self-catheterization may be used as a temporary measure but isn't a primary intervention.

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? Report hematuria to the health care provider (HCP). Administer morphine every 3 hours. Strain the urine carefully. Apply warm compresses to the flank area.

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

A nurse is discharging a client diagnosed with a urinary tract infection. Which information should the nurse include in the discharge teaching? Select all that apply. Take all antibiotics as prescribed. Strain all urine. Avoid coffee, tea, and alcohol. Limit fluid intake. Wipe from back to front.

Take all antibiotics as prescribed. Avoid coffee, tea, and alcohol. Fluid intake is encouraged to prevent stasis of urine. It is not necessary to strain the urine and wiping from front to back is proper technique to avoid infection. Coffee, tea, and alcohol are irritants and should be avoided. Antibiotics should be taken as prescribed to prevent resistance and reinfection.

A nurse is providing instruction about peritoneal dialysis to a client. Which action warrants immediate action by the nurse? The client inspects the effluent. The client prepares to connect the tubing using aseptic technique. The client keeps the dialysate cold until ready for use. The client empties the bladder before the infusion.

The client keeps the dialysate cold until ready for use. Dialysate should be warmed before use. Cold dialysate will contribute to abdominal cramping and will decrease diffusion of electrolytes. The other actions are appropriate.

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 blood pressure increased osmolality of the plasma decreased serum sodium level increased urine output SUBMIT ANSWER

decreased serum sodium level SIADH is characterized by excess antidiuretic hormone (ADH, vasopressin) secretion, despite low plasma osmolality. Excess ADH causes water to be retained. As blood volume expands, plasma becomes diluted resulting in dilutional hyponatremia. Aldosterone is suppressed, resulting in increased renal sodium excretion. Water moves from the hypotonic plasma and the interstitial spaces into the cells.

The client with acute pyelonephritis wants to know the possibility of developing chronic pyelonephritis. The nurse's response is based on knowledge of which disorder that most commonly leads to chronic pyelonephritis? recurrent urinary tract infections acute pyelonephritis acute renal failure glomerulonephritis

recurrent urinary tract infections Chronic pyelonephritis is most commonly the result of recurrent urinary tract infections. Chronic pyelonephritis can lead to chronic renal failure. Single cases of acute pyelonephritis rarely cause chronic pyelonephritis. Acute renal failure is not a cause of chronic pyelonephritis. Glomerulonephritis is an immunologic disorder, not an infectious disorder.

A nurse is caring for a client who is a hospital employee. The client is diagnosed with genital herpes and is being treated for a urinary tract infection (UTI). A coworker asks the nurse about how the client is doing. What is the nurse's best response? "Would you like me to let the client know you said hello?" "You work on this unit, so you can check the medical record." "The client is upset that everyone knows about the herpes." "The antibiotics are really helping with the UTI."

"Would you like me to let the client know you said hello?" Offering to tell the client that the coworker said hello is the only appropriate response. The disclosure of the herpes and UTI are a breach in confidentiality. Nurses should never encourage employees to read medical records that are not their assigned clients.

A client scheduled for hemodialysis is prescribed an oral antihypertensive daily. What is the correct action by the nurse regarding the medication? Administer it after the hemodialysis treatment. Administer it prior to the hemodialysis treatment. Contact the health care provider for a prescription to hold it on dialysis days. Administer it during the hemodialysis treatment.

Administer it after the hemodialysis treatment. The nurse should administer the medication after the hemodialysis treatment to prevent a hypotensive episode. The medication should not be held on the days the client has dialysis unless the client's blood pressure contraindicates giving the medication. Administering the medication prior to the treatment may lead to the client becoming hypotensive during dialysis or having the medication filtered out of the bloodstream during the hemodialysis treatment.

A client has a transurethral resection of the prostate to treat benign prostatic hyperplasia. The client returns to the room with continuous bladder irrigation and reports bladder pain. What is the priority nursing action? Notify the healthcare provider immediately. Calculate the client's recent intake and output. Assess irrigation catheter for patency and drainage. Administer morphine sulfate 2 mg IV, as prescribed.

Assess irrigation catheter for patency and drainage. Although postoperative pain is expected, the nurse should make sure that other factors, such as an obstructed irrigation catheter, aren't the cause of the pain. After confirming catheter patency, the nurse should administer an analgesic, such as morphine sulfate, as prescribed. The intake and output is part of the assessment, but the patency of the catheter is the priority. Notifying the healthcare provider is not necessary unless the pain is severe or unrelieved by the prescribed medication.

A client is recovering from renal angiography in which a femoral puncture site was used. What is the nurse's priority action during post-procedure care? Immobilize the leg used during the procedure for 2 hours using soft restraint. Check the client's pedal pulses and extremity appearance every 4 hours. Change the puncture site dressing when client's vital signs are stable. Apply manual pressure to puncture site for at least 30 minutes.

Check the client's pedal pulses and extremity appearance every 4 hours. After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently (at least every 4 hours) to detect reduced circulation to the feet caused by vascular injury. The nurse should also monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. Manual pressure is applied immediately post-procedure before the pressure bandage is applied. Unless the client is having ongoing bleeding, the pressure is applied for 15 minutes or less; 30 minutes is excessive. The client should be kept on bedrest and asked to keep leg straight for several hours but should not be restrained. The nurse should leave this dressing in place for several hours and remove it only if instructed to do so.

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. What should the nurse do with the urine specimen? Discard the urine and obtain a new specimen. Refrigerate the specimen until it can be transported to the laboratory. Add fresh urine to the collected specimen and send the specimen to the laboratory. Send the urine to the laboratory as quickly as possible.

Discard the urine and obtain a new specimen. The appropriate action would be to discard the specimen and obtain a new one. Urine that is allowed to stand at room temperature will become alkaline, with multiplying bacteria. The specimen should be examined within 1 hour after urination.

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? Administer the dialysate. Assess dialysate for particulates. Obtain new dialysate. Document expiration date.

Obtain new dialysate. If the dialysate solution is expired, the nurse should obtain new dialysate to administer regardless of the fact that the solution expired only 1 day ago. Documenting the expiration date is important, but administering outdated dialysate is a client safety issue, so obtaining new dialysate is a higher priority. The color of dialysate should always be assessed prior to administration; however, regardless of the color or clarity, new dialysate should be obtained versus administration of the outdated dialysate.

A client with chronic renal failure is receiving hemodialysis three times a week. What should the nurse do to protect the fistula? Take the blood pressure in the arm with the fistula. Maintain a pressure dressing on the shunt. Report the loss of a thrill or bruit on the arm with the fistula. Start a second IV in the arm with the fistula.

Report the loss of a thrill or bruit on the arm with the fistula. The nurse must always auscultate for a bruit and palpate for a thrill in the arm with the fistula and promptly report the absence of either a thrill or bruit to the health care provider (HCP) as it indicates an occlusion. The client should not have a pressure dressing on the shunt and should avoid wearing tight clothing or carrying heavy items such as purse over the area of the shunt to avoid restricting blood flow in the shunt. No procedures such as IV access, blood pressure measurements, or blood draws are done on an arm with a fistula as they could damage the fistula.

A client with bladder cancer had the bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude? Stoma dilation wasn't performed. The skin wasn't lubricated before the pouch was applied. A skin barrier was applied properly. The pouch faceplate doesn't fit the stoma.

The pouch faceplate doesn't fit the stoma. If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn't be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn't performed with an ileal conduit, although it may be done with a colostomy if ordered.

A client underwent a transurethral resection of the prostate gland 24 hours ago and is prescribed continuous bladder irrigation. What nursing intervention is appropriate? Decrease the rate of irrigation when output is increasingly red in color. Use sterile technique if manual irrigation of the catheter is required. Restrict fluids to prevent the client's bladder from becoming distended. Prepare to remove the catheter when urine appears amber in color.

Use sterile technique if manual irrigation of the catheter is required. During continuous bladder irrigation, the catheter may become blocked by blood clots, especially if the irrigation rate has not been sufficient. If manual irrigation is needed, the nurse should use sterile technique to reduce the risk of infection. The rate of irrigation should be increased, not decreased, if more blood is evident in the output. The nurse should encourage the client to drink fluids to maintain good glomerular filtration rate. The catheter remains in place for 2 to 4 days after surgery and is removed only with a healthcare provider's order. During irrigation, the urine will not appear amber, because it is diluted by the irrigation solution.

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? impaired urinary elimination imbalanced nutrition: less than body requirements risk for infection acute pain

acute pain Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of acute pain takes highest priority. Diagnoses of risk for infection and impaired urinary elimination are appropriate when the client's pain is controlled. A diagnosis of imbalanced nutrition: Less than body requirements isn't pertinent at this time.

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? weight gain of 3 lb (1.36 kg) in 2 days cloudy dialysate drainage return shortness of breath distended abdomen

cloudy dialysate drainage return Normally, dialysate drainage return should be clear. With peritonitis, large numbers of bacteria, white blood cells, and fibrin cause the dialysate to appear cloudy. Abdominal distention is unrelated to peritonitis. However, it might suggest an obstruction. Weight gain and shortness of breath are associated with fluid excess, not infection.

A client with type 2 diabetes mellitus who is taking metformin is scheduled for a computed tomography (CT) with contrast of the abdomen tomorrow. Which priority nursing assessment is done before the procedure? administering a sodium biphosphate and sodium phosphate enema until clear the evening before ensuring that client has taken nothing by mouth for 24 hours administering polyethylene glycol electrolyte solution over 12 hours until stools are clear and liquid ensuring that the metformin has been withheld for 48 hours prior to the scan

ensuring that the metformin has been withheld for 48 hours prior to the scan Iodine-based CT contrast can cause kidney damage in clients taking metformin. To prevent possible renal failure, metformin needs to be discontinued 48 hours prior to the scan. A CT of the abdomen with contrast does not require NPO status or an empty colon.

A client with chronic renal failure (CRF) has a hemoglobin of 10.2 g/dl and hematocrit of 40%. Which choice would be a primary assessment? presence of thrush and circumoral pallor presence of dyspnea and cyanosis presence of fatigue and weakness presence of edema and fluid volume overload

presence of fatigue and weakness A hemoglobin of 10.2 is low; however the hematocrit is normal. RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Although chronic renal failure can cause fluid volume overload, the normal hematocrit level does not indicate fluid volume overload. Dyspnea and cyanosis is associated with fluid excess, not anemia. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, are not signs of anemia.

The correct procedure for collecting a urine specimen from an indwelling catheter is to: open the spigot on the collecting bag and allow urine to empty into the specimen container. remove urine from the drainage tube with a sterile needle and syringe and place urine from the syringe into the specimen container. disconnect the drainage tube from the collecting bag and allow urine to flow from the tubing into the specimen container. disconnect the drainage tube from the indwelling catheter and allow urine to flow from the tubing into the specimen container.

remove urine from the drainage tube with a sterile needle and syringe and place urine from the syringe into the specimen container. To obtain a urine specimen from a client with an indwelling urinary catheter attached to a closed urine drainage system, the nurse removes the specimen from the drainage tube using a sterile needle and syringe. This technique is not likely to predispose the client to a urinary tract infection because the drainage system is not opened to the air. Furthermore, this urine specimen would be fresh, unlike the urine collected in the drainage bag.A specimen from the drainage bag spigot is likely to be contaminated.To reduce the risk of infection, closed urinary systems should never be opened.

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 60 minutes to allow for glucose exchange; diarrhea isn't necessary to reduce the potassium level. retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn't necessary to reduce the potassium level. retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea.

retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. Sodium polystyrene sulfonate is a sodium-exchange resin. Thus, the client will gain sodium as potassium is lost in the bowel. For the exchange to occur, sodium polystyrene sulfonate must be in contact with the bowel for at least 30 minutes. Sorbitol in the sodium polystyrene sulfonate enema causes diarrhea, which increases potassium loss and decreases the potential for sodium polystyrene sulfonate retention.

After transurethral resection of the prostate, the nurse notices that the urine draining from the catheter is bright red, has numerous clots, and is viscous. Which nursing action is most appropriate? Milk the catheter tube vigorously. Increase the client's fluid intake. Assess vital signs and notify the surgeon. Irrigate the catheter to remove clots.

Assess vital signs and notify the surgeon. Blood clots are normal after transurethral resection of the prostate, but bright red urine can indicate a hemorrhage. The nurse should assess the client's vital signs and notify the surgeon. Irrigation of the catheter may help remove clots, but it does not decrease bleeding. Milking a urinary catheter or increasing fluid intake is not effective for controlling bleeding or decreasing clots.

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. Request a prescription for insertion of an indwelling urinary catheter. Determine the client's weight before beginning the collection of urine. Inform the client to discard the last voided specimen at the conclusion of urine collection.

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

When auscultating an arteriovenous (AV) fistula, a bruit is noted. What is the appropriate action by the nurse? Contact the healthcare provider. Assess for signs and symptoms of fluid overload. Assess for signs and symptoms of infection. Document the presence of a bruit.

Document the presence of a bruit. When auscultating an AV fistula, a bruit is an expected finding. The nurse should document the presence of the bruit. While assessing for signs and symptoms of infection at the fistula site is part of the assessment of a hemodialysis client, doing so does not address the finding of a bruit, which is asked in the question. A bruit is not indicative of fluid overload so there is no indication to assess for fluid overload at this time.

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? Follow measures to alkalinize the urine. Increase daily fluid intake to at least 2 to 3 L. Strain all urine for one week. Eliminate dairy products from the diet.

Increase daily fluid intake to at least 2 to 3 L. A high daily fluid intake is essential for all clients who are at risk for calculi formation because it prevents urinary stasis and concentration, which can cause crystallization. Depending on the composition of the stone, the client also may be instructed to institute specific dietary measures aimed at preventing stone formation. Clients may need to limit purine, calcium, or oxalate. Urine may need to be either alkaline or acid. There is no need to strain urine regularly.

A client is to receive peritoneal dialysis. What should the nurse do to prepare the client for the procedure? Assess the dialysis access for a bruit and thrill. Insert an indwelling urinary catheter and drain all urine from the bladder. Warm the dialysis solution in the warmer. Ask the client to turn toward the left side.

Warm the dialysis solution in the warmer. Solution for peritoneal dialysis should be warmed to body temperature in a warmer or with a heating pad; do not use the microwave. Cold dialysate increases discomfort. Assessment for a bruit and thrill is necessary with hemodialysis when the client has a fistula, graft, or shunt. An indwelling urinary catheter is not required for this procedure. The nurse should position the client in a supine or low Fowler's position.

A client has a ureteral catheter in place after renal surgery. What should the nurse do to provide safe care of the ureteral catheter? Irrigate the catheter with 30 ml of normal saline every 8 hours. Ensure that the catheter drains at least 15 mL/h. Clamp the catheter every 2 hours for 30 minutes. Ensure that the catheter is draining freely.

Ensure that the catheter is draining freely. The ureteral catheter should drain freely without bleeding at the site. The catheter is rarely irrigated, and any irrigation would be done by the health care provider (HCP). The catheter is never clamped. The client's total urine output (ureteral catheter plus voiding or indwelling urinary catheter output) should be at least 30 mL/h.

After surgery to remove a ruptured fallopian tube, a multigravid client receives discharge instructions about potential complications to report to her physician. Which of the following, if stated by the client as a complication, indicates a need for additional teaching? Bleeding. Headache. Fever. Pain.

Headache. The client should not experience a headache or dizziness. Symptoms that the client should report include pain (caused by stretching of the tube), temperature elevation (suggesting infection), and bleeding (suggesting hemorrhage). The client should also be instructed that infertility may occur as a result of the removal of one fallopian tube.

The nurse is caring for a homeless client with pneumonia. Laboratory testing reveals the following results: blood urea nitrogen (BUN) 180 mg/dl, creatinine 30 mg/dl (2652 mmol/L), potassium 6.2 mEq/L (6.2 mmol/L), and hemoglobin 6.2% (62 g/L). Based on the health care provider's order, which drug order would the nurse question? ferrous sulfate gentamicin sulfate erythropoietin aluminum hydroxide gel

gentamicin sulfate Based on the high BUN, creatinine, and potassium levels, the client is in renal failure. Gentamicin sulfate is nephrotoxic and can exacerbate the renal failure. Ferrous sulfate and erythropoietin would be given to treat the client's anemia. Aluminum hydroxide gel would also be appropriate because it binds with phosphate, which is elevated in renal failure.

The nurse is caring for a client who possibly may need kidney dialysis. When evaluating the client's renal function to report to the health care provider, which data will the nurse use? Select all that apply. trending vital signs glomerular filtration rate 24-hour urinary output serum creatinine level blood count report flank pain level

glomerular filtration rate 24-hour urinary output serum creatinine level When evaluating renal functioning, the nurse would report to the health care provider information on the client's current urine output, the glomerular filtration rate, and serum creatinine levels that identify the degree of kidney dysfunction. This objective data provides diagnostic information. Vital signs and pain level reflect the impact of the renal disease. Blood count reports to do not assist in evaluating renal function.

A client has urge incontinence. When obtaining the health history, the nurse should ask the client about which factors that could precipitate incontinence? frequent dribbling of urine loss of urine when coughing involuntary urination inability to empty the bladder

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

A client is started on sulfamethoxazole-trimethoprim for reports of severe burning on urination and frequent, urgent voiding of small amounts of urine. As the nurse explains the medication, the client requests something to relieve the painful urination. Which treatment order would the nurse anticipate for the client's discomfort? nitrofurantoin ibuprofen phenazopyridine hydration with water and cranberry juice

phenazopyridine Phenazopyridine may be ordered in conjunction with an antibiotic for painful bladder infections to promote comfort. Because of its local anesthetic action on the urinary mucosa, phenazopyridine specifically relieves bladder pain. Nitrofurantoin is another choice for antibiotic treatment and would not be recommended in conjunction with trimethoprim-sulfamethoxazole. Although ibuprofen is an analgesic, phenazopyridine has more direct effect on urinary tract infections.

A young adult woman tells the nurse she has a slight yellow vaginal discharge. The nurse should tell the client to contact her health care provider if she has which additional symptoms? Select all that apply. loss of appetite abdominal pain a temperature above 101ºF (38.3ºC) vaginal discharge that has a fishy odor starting her menstrual period

vaginal discharge that has a fishy odor abdominal pain a temperature above 101ºF (38.3ºC) The client's discharge may be a symptom of bacterial vaginosis, a clinical syndrome resulting from the replacement of the normal vaginal Lactobacillus species with overgrowth of anaerobic bacteria that cause a cluster of symptoms. Often the discharge disappears, but the nurse should instruct the client to seek care from her HCP if the discharge has a fishy odor, there is abdominal pain, or an elevated temperature. The client's menstrual cycles will continue as normal. A decreased appetite is not a sign of a vaginal infection

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? stoma site not sensitive to touch red, sensitive skin around the stoma site clear mucus mixed with yellow urine drained from the appliance bag beefy red stoma site

red, sensitive skin around the stoma site Red, sensitive skin around the stoma site may indicate an ill-fitting appliance. Beefy redness at a stoma site that isn't sensitive to touch is a normal assessment finding. Urine mixed with mucus is also a normal finding.

The nurse caring for a client with an arteriovenous (AV) fistula notes that the fingers distal to the fistula are cold to the touch and the capillary refill time is greater than 3 seconds. What is the priority action by the nurse? Assess client's blood pressure. Keep arm elevated. Contact the healthcare provider. Turn the client on the left side.

Contact the healthcare provider. Cold fingers and slow capillary refill time to the fingers distal to an AV fistula is an indication of arterial steal syndrome. The healthcare provider should be contacted immediately. Assessing the blood pressure will not add relative data as blood pressure does not impact arterial steal syndrome. Keeping the arm elevated and/or turning the client on the left side will not help to resolve the arterial steal syndrome.

The nurse is creating a medication list and notes that the client takes saw palmetto. What should the nurse assess next? "Describe your joint pain." "Are you doing anything to lower your cholesterol level?" "Tell me about your normal voiding patterns." "Tell me about your sleep patterns."

"Tell me about your normal voiding patterns." It would be important to assess about the client's ability to void. Saw palmetto is used to relieve symptoms of benign prostatic hypertrophy. Joint pain would be important if the client was taking glucosamine. Niacin could be used to lower cholesterol, and melatonin would be appropriate for insomnia.

A charge nurse is completing day-shift client care assignments on the genitourinary floor. A new graduate is starting the first day on the unit. An agency nurse and an experienced nurse are also present. The charge nurse should assign the new graduate nurse to the care of which client? client who had an ileal conduit 3 days ago middle-aged client who had a kidney transplant 3 days ago elderly client just admitted for an acute stroke middle-aged stable client with bladder cancer awaiting surgery

middle-aged stable client with bladder cancer awaiting surgery The charge nurse should assign the new nurse to the middle-aged client newly diagnosed with bladder cancer awaiting surgery, as this client has a condition common to the genitourinary floor and is of low acuity and stable. The charge nurse should assign the agency nurse to the client who had an ileal conduit. That condition has lesser acuity. The charge nurse should assign the experienced nurse to the most acute clients: the middle-age kidney-transplant recipient.

A client who had transurethral resection of the prostate (TURP) 2 days earlier has lower abdominal pain. What should the nurse do first? Have the client use a sitz bath for 15 minutes. Assess the patency of the urethral catheter. Administer an oral analgesic. Auscultate the abdomen for bowel sounds.

Assess the patency of the urethral catheter. 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. Auscultating the abdomen for bowel sounds would be appropriate after patency of the catheter has been established. The nurse should assess for bladder spasms before administering an analgesic. A sitz bath would not relieve bladder spasms that are caused by an obstructed catheter.

When providing client teaching about continuous bladder irrigation following prostate surgery, what should the nurse tell the client? "The fluid drips into the bladder at a slow rate to prevent the effects of overhydration and hyponatremia." "The catheter is clamped off approximately 4 hours after returning to the nursing unit." "The catheter is disconnected from the drainage tubing one time per shift to enable manual irrigation of the bladder." "The purpose of the irrigation is to keep bladder drainage clear and to prevent the formation of blood clots in the bladder."

"The purpose of the irrigation is to keep bladder drainage clear and to prevent the formation of blood clots in the bladder." Continuous bladder irrigation (CBI) is performed when urinary surgery (typically prostate surgery) results in hematuria. It is accomplished using an indwelling Foley catheter with three lumens. One port is for the balloon, a second port allows irrigant inflow, and a third port enables outflow. The purpose of the irrigation is to achieve and maintain clear outflow and to prevent clot formation within the bladder. Manual irrigation is used as an intermittent type of bladder irrigation and is not the same as CBI. CBI involves irrigation of the bladder; it is not an intravascular infusion. The rate is often initially fast to achieve a clear outflow. Stopping and clamping the irrigant inflow is done only under a health care provider's (HCP's) direction and is typically not expected until at least 1 day following the procedure.

When determining the volume of replacement fluid that is to be administered during continuous renal replacement therapy (CRRT), what should the nurse subtract from the total fluid loss? Select all that apply. nasogastric drainage fluid in collection device client's fluid intake past 24 hours client's fluid intake in past hour prescribed net fluid loss

prescribed net fluid loss client's fluid intake in past hour The nurse determines the total fluid loss by adding together fluid in the collection device from the previous hours and any blood loss, emesis, or nasogastric drainage in the past hour. This is the total fluid loss. From this the nurse should subtract the client's prescribed net fluid loss and fluid intake in the past hour. This gives the volume of replacement fluid to infuse.