Genitourinary - NCLEX
A female client reports to a nurse that she experiences a loss of urine when she jogs. The nurse's assessment reveals no nocturia, burning, discomfort when voiding, or urine leakage before reaching the bathroom. The nurse explains to the client that this type of problem is called:
Stress incontinence. (Stress incontinence is a small loss of urine with activities that increase intra-abdominal pressure, such as running, laughing, sneezing, jumping, coughing, and bending. These symptoms occur only in the daytime. Functional incontinence is the inability of a usually continent client to reach the toilet in time to avoid unintentional loss of urine. Reflex incontinence is an involuntary loss of urine at predictable intervals when a specific bladder volume is reached. Total incontinence occurs when a client experiences a continuous and unpredictable loss of urine.)
A client with a urinary tract infection is to take nitrofurantoin four times each day. The client asks the nurse, "What should I do if I forget a dose?" What should the nurse tell the client?
"Take the prescribed dose as soon as you remember it, and if it is very close to the time for the next dose, delay that next dose." (Antibiotics have the maximum effect when the level of the medication in the blood is maintained, and the client should take the medication as soon as possible after missing a dose. Because nitrofurantoin is readily absorbed from the gastrointestinal tract and is primarily excreted in urine, toxicity may develop by taking the dose too close to the time the next dose should be taken or doubling the dose. If possible, the client should not skip a dose, if one dose is missed. It is not necessary to contact the HCP as the dosage does not need to be adjusted. The nurse can coach the client to set a timer or use a pill container with timed doses so that the client does not forget to take the medication.)
A client with a urinary tract infection is ordered co-trimoxazole. The nurse should provide which medication instruction?
"Drink at least eight 8-oz (240 mL) glasses of fluid daily." (The nurse should instruct a client receiving a sulfonamide such as co-trimoxazole to drink at least eight 8-oz (240 mL) glasses of fluid daily to maintain a urine output of at least 1,500 ml/day. Otherwise, inadequate urine output may lead to crystalluria or tubular deposits. For maximum absorption, the client should take this drug at least 1 hour before or 2 hours after meals. No evidence indicates that antacids interfere with the effects of sulfonamides. To prevent a photosensitivity reaction, the client should avoid direct sunlight during co-trimoxazole therapy.)
A woman is using progestin injections for contraception. When does the nurse instruct the client to return for her next injection?
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.)
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." (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%.)
A 39-year-old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which client statement indicates effective teaching?
"My fallopian tubes will be tied off through a small abdominal incision." (Tubal ligation, a female sterilization procedure, involves ligation (tying off) or cauterization of the fallopian tubes through a small abdominal incision (laparotomy). Reversal of a tubal ligation is not easily done, and the pregnancy success rate after reversal is about 30%. After a tubal ligation, the client may engage in intercourse 2 to 3 days after the procedure.)
The client with acute renal failure asks the nurse, "Will my kidneys ever function normally again?" What should the nurse tell the client?
"You will continue to improve over a period of weeks." (The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. The client should be taught how to recognize the signs and symptoms of decreasing renal function and to notify the health care provider (HCP) if such problems occur)
The client asks the nurse, "Is it really possible to lead a normal life with an ileostomy?" Which action by the nurse would be the most effective to address this question?
Arrange for a person with an ostomy to visit the client preoperatively. (If the client agrees, having a visit by a person who has successfully adjusted to living with an ileostomy would be the most helpful measure. This would let the client actually see that typical activities of daily living can be pursued postoperatively. Someone who has felt some of the same concerns can answer the client's questions.)
A client with chronic renal failure is experiencing central nervous system (CNS) changes caused by uremic toxins. Which nursing approach would be most appropriate for addressing the changes?
Assess the client's mental status regularly. (Central nervous system changes include such symptoms as apathy, lethargy, and decreased concentration. Seizures and coma can also occur. The nurse should assess the client's level of consciousness at regular intervals and maintain client safety. Allowing the client to express feelings related to body image changes and restricting foods high in potassium and fluid intake are all appropriate activities, but they are not related to the central nervous system changes.)
A physician orders a single dose of trimethoprim/sulfamethoxazole by mouth for a client diagnosed with an uncomplicated urinary tract infection. The pharmacy sends three unit-dose tablets. The nurse verifies the physician's order. What should the nurse do next?
Call the hospital pharmacist and question the medication supplied. (The nurse should call the hospital pharmacy and question the medication supplied. The hospital pharmacist should be able to tell the nurse whether three tablets are necessary for the single dose or whether a dispensing error occurred. It isn't clear whether the three tablets are the single dose because they were packaged as a unit-dose. The physician's order was clearly written, so clarifying the order with the physician isn't necessary. Administering the tablets without clarification might cause a medication error.)
A client is diagnosed with pyelonephritis. Which nursing action is a priority for care now?
Ensure sufficient hydration. (The nurse should ensure the client has adequate hydration. A urinary catheter is discouraged because of the risk of urinary tract infection. Monitoring of the hemoglobin level is not necessary for clients with pyelonephritis.)
Which should be included in the client's plan of care during dialysis therapy?
Monitor the client's blood pressure. (Because hypotension is a complication associated with peritoneal dialysis, the nurse records intake and output, monitors vital signs, and observes the client's behavior. The nurse also encourages visiting and other diversional activities. A client on peritoneal dialysis does not need to be placed in a bed with padded side rails or kept on NPO status.)
When instructing a client about the proper use of condoms for pregnancy prevention, the nurse should include which instructions to ensure maximum effectiveness?
Place the condom over the erect penis before coitus.
Which steps should a nurse follow to insert a straight urinary catheter?
Prepare the client and equipment, create a sterile field, put on gloves, clean the urinary meatus, and insert the catheter until urine flows. (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.)
A nurse is providing instruction about peritoneal dialysis to a client. Which action warrants immediate action by the nurse?
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.)
Which factor would put the client at increased risk for pyelonephritis?
history of diabetes mellitus (A client with a history of diabetes mellitus, urinary tract infections, or renal calculi is at increased risk for pyelonephritis. Others at high risk include pregnant women and people with structural alterations of the urinary tract.)
A client who had a transurethral resection of the prostate (TURP) 1 day earlier has a three-way Foley catheter inserted for continuous bladder irrigation. Which of the following statements best explains why continuous irrigation is used after TURP?
To keep the catheter free from clot obstruction. (Continuous irrigation, usually consisting of sterile normal saline, is used after TURP to keep blood clots from obstructing the catheter and impeding urine flow. Antibiotics may be instilled in the bladder with the use of an irrigating solution, but this is not the primary reason for using continuous irrigation in TURP. The irrigating solution may secondarily help prevent bladder distention because it keeps the catheter from becoming obstructed.)
A female client with which condition would be at risk for increased severity of vulvovaginal candidiasis? Select all that apply.
Uncontrolled diabetes Immunosuppression due to cancer HIV (Women with underlying medical conditions, such as uncontrolled diabetes and HIV infection or cancer-causing immunosuppression, correlate with an increasing severity of candidiasis.)
A nurse is caring for a client diagnosed with ovarian cancer. Diagnostic testing reveals that the cancer has spread outside the pelvis. The client has previously undergone a right oophorectomy and received chemotherapy. The client now wants palliative care instead of aggressive therapy. The nurse determines that the care plan's priority nursing diagnosis should be:
acute pain. (Palliative care for the client with advanced cancer includes pain management, emotional support, and comfort measures.)
Which abnormal blood value would not be improved by dialysis treatment?
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.)
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?
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.)
Which factor would put the client at increased risk for pyelonephritis?
history of diabetes mellitus (A client with a history of diabetes mellitus, urinary tract infections, or renal calculi is at increased risk for pyelonephritis. Others at high risk include pregnant women and people with structural alterations of the urinary tract)
A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:
hyperkalemia. (Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. Administering glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels.)
The nurse is observing an unlicensed assistive personnel (UAP) give care to a client after gynecologic surgery. The nurse should intervene if the UAP:
massages the client's legs (Massaging the legs postoperatively is contraindicated because it may dislodge small clots of blood, if present, and cause even more serious problems. Ambulation, elasticized stockings, and moving the legs in bed all help reduce the risk of thrombophlebitis.)
The nurse has inserted an indwelling catheter in a male client. Which problem is prevented if the nurse tapes the catheter laterally to the thigh?
pressure at the penoscrotal angle (The primary reason for taping an indwelling catheter to the lateral aspect of the thigh of a male client is so that the penis is held in a lateral position is to prevent pressure at the penoscrotal angle. Prolonged pressure at the penoscrotal angle can cause a ureterocutaneous fistula. This position of the catheter does not prevent kinking in the urethra, accidental removal, or obstruction of the urine flow if the client turns.)
The nurse is assessing a client's data with primary glomerular disease. Which assessment data will the nurse expect to verify progression to nephrotic syndrome? Select all that apply.
proteinuria diffuse edema hypoalbuminemia
The nurse is assessing a client's data with primary glomerular disease. Which assessment data will the nurse expect to verify progression to nephrotic syndrome? Select all that apply.
proteinuria diffuse edema hypoalbuminemia (The nurse will see proteinuria, diffuse edema, and hypoalbuminemia with nephrotic syndrome. Hypertension and elevated serum cholesterol are associated with nephrotic syndrome.)
Validate the client's understanding of the material frequently.
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.)
The correct procedure for collecting a urine specimen from an indwelling catheter is to:
remove urine from the drainage tube with a sterile needle and syringe and place urine from the syringe into the specimen container. (
A nurse is planning to administer a sodium polystyrene sulfonate enema to a client with a potassium level of 6.2 mEq/L. Correct administration and the effects of this enema should include having the client
retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. (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.)
The nurse is assessing a young adult who thinks he has a sexually transmitted infection. When obtaining a health history, what sign or symptom would lead the nurse to suspect gonorrhea
urethral discharge (Urethritis is usually the initial clinical manifestation of gonorrhea in men. The symptoms include a profuse, purulent discharge and dysuria. Complications are uncommon, but they include prostatitis and sterility.)
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 (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 male client is diagnosed with a chlamydial infection. Azithromycin 1 g is prescribed. The supply of azithromycin is in 250-mg tablets. How many tablets should the nurse administer? Record your answer using a whole number.
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A nulliparous client tells the nurse that during her last pelvic examination, the health care provider said that her uterus was in a severe retroverted position. The nurse determines that the client may experience which complication?
difficulty conceiving a child (Severe retroversion or anteversion may lead to infertility or difficulty conceiving a child because these positions can block the deposition or migration of sperm. The normal position of the uterus is tipped slightly forward.)
The nurse gives a pamphlet that describes Kegel exercises to a client with stress incontinence. Which statement indicates that the client has understood the instructions contained in the pamphlet?
"I can do these exercises sitting up, lying down, or standing. (The client can perform the Kegel exercises anytime in any position listed. Pelvic muscles, not the abdominal muscles, should be contracted during these exercises. The client can learn to identify these muscles by urinating and stopping the flow. To be most effective, the exercises should be performed at least twice a day for a total of 10 minutes a day. If performed regularly, the client should begin to note changes after about 6 weeks.)
A client has undergone a cystectomy and an ileal conduit diversion. What should the nurse include in the discharge instructions? Select all that apply.
Drink at least 3,000 mL of fluid each day. Avoid odor-producing foods, such as onions, fish, eggs, a
A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client's discharge teaching plan?
Increase daily fluid intake to at least 2 to 3 L. (A 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)
The nurse is teaching the client with an ileal conduit how to prevent a urinary tract infection. Which measure would be most effective?
Maintain a daily fluid intake of 2,000 to 3,000 mL. (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.)
Prior to administering continuous renal replacement therapy (CRRT) on November 7 the nurse assesses the client's shint and the dialysate. While assessing the dialysate the nurse notes that the color is clear and the expiration date is November 6. What is the appropriate action by the nurse?
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 cliient 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?
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 school nurse is teaching a class about sexually transmitted infections (STIs). Which statement is correct regarding STIs?
STIs are most prevalent among teenagers and young adults. (STIs are most prevalent among teenagers and young adults, and nearly two thirds of all STIs occur in people younger than 25 years. The incidence of STIs is increasing due to multiple sex partners and sexual activity at a younger age. STIs affect men and women of all backgrounds and economic levels.)
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?
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.)
Which teaching approach for the client with chronic renal failure who has difficulty concentrating due to high uremia levels would be most appropriate?
Validate the client's understanding of the material frequently. (Uremia can cause decreased alertness, so the nurse needs to validate the client's comprehension frequently. Because the client's ability to concentrate is limited, short lessons are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videos because the client may not be able to maintain alertness during the viewing of the videos.)
A physician enters a computer order for a nurse to irrigate a client's nephrostomy tube every 4 hours to maintain patency. The nurse irrigates the tube using sterile technique. After irrigating the tube, the nurse decides that she can safely use the same irrigation set for her 8-hour shift if she covers the set with a paper, sterile drape. This action by the nurse is
inappropriate because irrigation requires strict sterile technique. (Irrigating a nephrostomy tube requires strict sterile technique; therefore, reusing the irrigation set (even if covered by a sterile drape) is inappropriate. Bacteria can proliferate inside the syringe and irrigation container. Although this procedure checks patency, it requires sterile technique to prevent the introduction of bacteria into the kidney)
During a clinic visit, the mother of an infant with hydrocele states that the infant's scrotum is smaller now than when he was born. After teaching the mother about the infant's condition, which statement by the mother indicates that the teaching has been effective?
"It seems like the fluid is being reabsorbed." (A hydrocele is a collection of fluid in the tunica vaginalis of the testicle or along the spermatic cord that results from a patent processus vaginalis. As fluid is being absorbed, scrotal size decreases. Elevation of the infant's bottom, massage, or keeping the infant quiet or in an infant seat would have no effect in promoting fluid reabsorption in hydrocele.)
The nurse is caring for a client diagnosed with genitourinary tuberculosis (TB). Which statement, made by the client, about genitourinary TB demonstrates an understanding?
"It's a late manifestation of respiratory tuberculosis." (Genitourinary TB is usually a late manifestation of respiratory TB and can occur if the disease spreads through the bloodstream from the lungs. Bacillus in the urine is infectious, and urine would be handled cautiously. A condom would be used during sex to prevent spread of the infection.)
A client with acute renal failure has the following laboratory results. Based on these findings, which of the following should the nurse administer?hemoglobin 9.2 g/dLblood urea nitrogen 22 mg/dLcreatinine 0.7 mg/dLpotassium 4.8 mEq/L
Erythropoietin (Erythropoietin assists in the production of red blood cells, which are low as evidenced by the hemoglobin level. All other laboratory values are within normal limits.)
A client is admitted to the hospital with a diagnosis of renal calculi. The client is experiencing severe flank pain and nausea; the temperature is 100.6° F (38.1° C). Which outcome would be a priority for this client?
Alleviation of pain (The priority nursing goal for this client is to alleviate the pain, which can be excruciating. Prevention of urinary tract complications and alleviation of nausea are appropriate throughout the client's hospitalization, but relief of the severe pain is a priority. The client is at little risk for fluid and electrolyte imbalance.)
A client who had transurethral resection of the prostate (TURP) 2 days earlier has lower abdominal pain. What should the nurse do first?
Assess the patency of the urethral catheter. (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 client undergoes cystoscopy with bladder biopsy. After the procedure, which assessment is most appropriate for the nurse to make?
Assess urine for excessive bleeding. (After cystoscopy with biopsy, the nurse would assess for excessive hematuria, which might indicate hemorrhage caused by the biopsy. Catheters are not routinely inserted after cystoscopy. The nurse would not assess for bladder distention unless the client was having difficulty voiding. Urine cultures are not routinely ordered after cystoscopy.)
A client with end-stage renal failure has an internal arteriovenous fistula in the left arm for vascular access during hemodialysis. What should the nurse instruct the client to do?
Avoid sleeping on the left arm. Wear wrist watch on the right arm. Assess fingers on the left arm for warmth. (The nurse instructs the client to protect the site of the fistula. The client should avoid pressure on the involved arm such as sleeping on it, wearing tight jewelry, or obtaining BP. The client is also advised to assess the area distal to the fistula for adequate circulation, such as warmth and color. When the client is hospitalized, the nurse posts a sign on the client's bed not to draw blood or obtain BP on the left side; the client is also instructed to be sure that none of the health care team members do so.)
The nurse is planning care for a client with stress incontinence. What goal is realistic for the nurse to establish with the client?
Decrease the number of incontinence episodes. (The primary goal of nursing care is to decrease the number of incontinence episodes and the amount of urine expressed in an episode. Behavioral interventions (e.g., diet and exercise) and medications are the nonsurgical management methods used to treat stress incontinence. Without surgical intervention, it may not be possible to eliminate all episodes of incontinence. Helping the client adjust to the incontinence is not treating the problem. Clients with stress incontinence are not prone to the development of urinary tract infection.)
A client comes to the emergency department reporting sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site?
Kidney (The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation.)
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 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.
Which teaching approach for the client with chronic renal failure who has difficulty concentrating due to high uremia levels would be most appropriate?
Validate the client's understanding of the material frequently. (Uremia can cause decreased alertness, so the nurse needs to validate the client's comprehension frequently. Because the client's ability to concentrate is limited, short lessons are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videos because the client may not be able to maintain alertness during the viewing of the videos.)
A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important?
increasing fluid intake to 3 L/day (Acute pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both kidneys. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. Pyelonephritis may result from procedures that involve the use of instruments (such as catheterization, cystoscopy, and urologic surgery) or from hematogenic infection. The most important nursing intervention is to increase fluid intake to 3 L/day. Doing so helps empty the bladder of contaminated urine and prevents calculus formation.)
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important?
limiting fluid intake (During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.)
The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate?
low-protein, low-sodium, low-potassium (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.)
A nurse is assessing a client with nephrotic syndrome. The nurse should assess the client for which condition?
massive proteinuria (Nephrotic syndrome is characterized by massive proteinuria caused by increased glomerular membrane permeability. Other symptoms include peripheral edema, hyperlipidemia, and hypoalbuminemia. Because of the edema, clients retain fluid and may gain weight. Hematuria is not a symptom related to nephrotic syndrome.)
When educating a female client with gonorrhea, what should the nurse emphasize? In women, gonorrhea:
may not cause symptoms until serious complications occur. (Many women do not seek treatment because they are unaware that they have gonorrhea. They may be symptom-free or have only very mild symptoms until the disease progresses to pelvic inflammatory disease. Dysuria and vaginal bleeding are not present in gonorrhea. Gonorrhea can lead to very serious complications. It can be cured with the proper treatment.)
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 (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.)
A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:
notify the physician about cloudy or foul-smelling urine. (The nurse should instruct the client to report the presence of foul-smelling or cloudy urine to the physician. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal because of residual stone products. Hematuria is common after lithotripsy.)
