GI & GU
A nurse is teaching a client with a surgically repaired undescended testis about testicular self-examination (TSE). Which instructions should be included in the teaching? Select all that apply. A. Perform the examination during a warm bath or shower B. Perform the examination monthly on the same day C. Report if one testis is slightly larger than the other D. Report if there is a hard mass over the testis E. Use both hands to feel each testis separately
A, B, D, E Testicular cancer is common form of cancer in men age 15-35. Instruction for TSE: Perform TSE monthly on the same day, Perform TSE while taking a warm shower or bath as warm temperatures will relax the scrotal tissue and make the testis hang lower in the scrotum, use both hands to feel each testis separately, palpate each testicle gently using the thumb and two fingers, check for normal egg-shaped and movable with a smooth surface. Findings that should be reported Painless, hardened lumps on testes. scrotal swelling or heaviness, dull ache in the pelvis or scrotum.
The nurse reinforces teaching about self-management strategies for a client with urge incontinence. Which of the following statements indicate that teaching has been effective? Select all that apply. A. I am going to join a walking program to lose excess weight. B. I may have dry mouth as a side effect from the oxybutynin. C. I really need caffeine to get myself going in the morning. D. I should perform Kegel exercises several times daily. E. I will void every 2 hours until I am having fewer accidents.
A, B, D, E Weight loss helps reduce the pressure on the pelvic floor, Anticholinergic meds - dry mouth is a frequent adverse effect, Avoid bladder irritants, and bladder training.
The nurse assesses a client peritoneal dialysis. Which assessment finding are most important for the nurse to report to the health care provider? Select all that apply. A. Cloudy outflow B. Low-grade Fever C. Oliguria D. Pruritus E. Tachycardia
A, B, E Cloudy outflow, low-grade fever, and tachycardia are symptoms for peritonitis. Bloody Effluent = intestinal perforation or the client is menstruating and Brown Effluent = Fecal contamination from perforation. Oliguria = acute or chronic kidney failure. Pruritus = common for patients with kidney failure
The nurse is caring for a client with multiple renal calculi. Which nursing intervention should be included in the plan of care? Select all that apply. A. Administer analgesics at regularly scheduled intervals B. Encourage fluid intake of up to 3 L/day C. Instruct client to stay on bed rest D. Provide massage to the client's flank E. Strain all urine for the presence of stones
A, B, E Patient management for Renal calculi are analgesics at scheduled intervals, rehydration unless contraindicated, and ambulation to facilitate the passage of calculi. Strain all urine to retrieve stones that the client may pass; collect to determine their composition and direct the plan of care. Avoid immobilization it causes kidney stones and massage therapy to prevent further renal colic.
The nurse is caring for a client who received extracorporeal shock wave lithotripsy with ureteral stent placement for treatment of a kidney stone. Which discharge instructions provided by the nurse are appropriate? Select all that apply. A. Contact your health care provider if you develop a fever or chills. B Except for using the bathroom, you should stay on bed rest for the next 48 hours. C. Increase your fluid intake to help flush out the kidney stone fragments. D. It is common to have some blood in the urine up to 24 hours after this procedure E. You may develop some bruising on your back or on the side of your abdomen
A, C, D, E Extracorporeal shock wave is a noninvasive procedure that uses high-energy acoustic shock waves to break up the kidney stones into smaller fragments that can be excreted in the urine. temporary ureteral stents are often placed during the procedure to facilitate the passage of the stone fragments and prevent occlusion of the ureter. Client should be instructed to: Increase fluid intake, expect some bruising and pain of the back and/or flank of the affected side, blood in urine in the first 24 hours, report any signs of infection. Ambulation is encouraged to help with the passage of the stone fragments.
The nurse assesses a client who is 2 days postoperative breast reconstruction surgery. The client has 2 closed-suction Jackson Pratt bulb drains in place. There is approximately 10 mL of serosanguineous fluid in each one. One hour later, the nurse notices the bulbs are full of bright red drainage and measures a total output of 200 mL. What is the nurse's priority action? A. Notify the health care provider B. Open the collection bulb to release excessive negative pressure. C. Record the amount in the output record as wound drainage D. Reposition the client on the right side.
A. Although it depends on the client and type of surgical procedure, about 80-120 mL of serosanguineous or sanguineous drainage per hour during the first 24 hours after surgery can be expected. Priority action is to notify the provider due to the change in type and amount of drainage after the first 24 hours following surgery.
The nurse assesses a client with benign prostatic hyperplasia. Which client statement requires further assessment? A. I have a burning Sensation when I urinate. B. I have been trying some dribbling after i Finish urinating. C. I missed 3 days of finasteride while on a trip last week. D. I was awakened 3 times last night by the need to urinate.
A. BPH affects male patients age >50. Symptoms include urinary urgency, frequency, hesitancy, dribbling urine after voiding, nocturia, and urinary retention. Patients with BPH have an increased risk for urinary retention because of incomplete bladder emptying and urine retention. Symptoms of UTI are a burning sensation with urination and cloudy/foul-smelling urine.
The nurse is caring for a 78-year-old client with a urinary tract infection (UTI). Which assessment finding would be most concerning and require immediate follow-up by the nurse? A. Confusion B. Presbyopia C. Temperature 100.2 F (37.8 C) D. White Blood Cell (WBC) Count 12,000/mm^3
A. Confusion is not a normal finding in an elder adult so it is required further evaluation. All other symptoms are in result of the UTI.
The nurse educator is completing a staff education conference about prenatal carrier screening. Which statement by a participant indicates a correct understanding of the genetic inheritance for cystic fibrosis? A. Both parents must be carriers of the abnormal gene for offspring to have the disorder B. Female offspring are most often affected by the inheritance pattern of cystic fibrosis C. If the female partner is a carrier, only male offspring will have the disorder. D. The inheritance pattern for cystic fibrosis does not skip generations
A. Cystic fibrosis follows an autosomal recessive inheritance pattern, meaning that offspring must receive two abnormal genes. Any gender can be affected because the disorder is not sex-linked.
The nurse is teaching self-care management to a client experiencing an outbreak of genital herpes. Which statement by the client indicates a need for further teaching? A. I will be sure we use condoms during intercourse as long as I have lesions. B. I will not touch the lesions to prevent spreading the virus to other parts of my body. C. I will use a hair dryer on cool setting to dry the lesions after taking a shower. D. I will use warm running water and mild soap without perfumes to wash the area.
A. Management strategies focus on disease spread and pain relief. Patients should avoid any sexual activity when lesions are present. Transmission is still possible even after the outbreak is resolved they should use condoms. Should keep the area clean and dry, avoid perfumed soaps and bubble baths, Proper hand hygiene and avoid touching the lesions, sitz baths and oatmeal baths provide comfort and relief.
A client with diabetes mellitus is admitted to the surgical unit after a vaginal hysterectomy. The client received 6 units of regular insulin subcutaneously and metoprolol 50 mg by mouth in the post-anesthesia care unit. Which statement by the unlicensed assistive personnel would require immediate action by the nurse? A. I changed the client's perineal pad 3 times in the last 2 hours. B. I have been encouraging the client to exercise the legs while in bed. C. I thought you should know the client voided 500 ml of straw-colored urine. D. I just took the client's vital sign, which are blood pressure 108/60 mm Hg, Pulse 58, and respirations 12.
A. Nurse should monitor the patient after recovering from a vaginal hysterectomy and saturates more than one perineal pad in an hour. Encourage leg exercises to promote circulation and prevent DVT. Metoprolol slows the heart rate; if the HR is lower than 60 before medication is given should be withheld and contact the provider. Monitor for excessive bleeding, urinary retention, backache, decreased urinary output, Signs, and symptoms of DVT.
After reviewing the urinalysis report data on a client, which question is most appropriate for the nurse to ask? Urinalysis Color: amber, Specific gravity: 1.031, RBC: None, WBC: Rare, Protein: None, Glucose: Absent A. Do you have a family history of diabetes? B. Do you have any burning or difficulty urinating? C. Have you suffered any recent kidney trauma? D. what has your fluid intake been for the last 24 hours?
A. The urinalysis reveals the client is dehydrated. Color indicates urine concentration, Specific gravity evaluates the ability of the kidneys to concentrate solutes in the urine (Nomal-1.003-1.030). Cause of increased specific gravity include fluid deficit.
A 14-year-old is seen in the Sextually Transmitted Disease (STD) outpatient department and diagnosed with gonorrhea. The client tell the nurse of having sexual relations with only a 19-year-old partner. What is the best response by the nurse? A. "Has your partner been evaluated and treated by a health care provider?" B. "I have to report your situation to local law enforcement." C. "One of your parents will need to consent to your treatment." D. "You should use a condom when you have sex."
A. To avoid reinfection with gonorrhea it is essential that the client's partner be tested and treated. The nurse should counsel the patient to the importance of the evaluation and treatment of the partner. Client should avoid any sexual activity till the treatment is completed and no longer have symptoms.
A client who was discharged following a prostatectomy 6 days ago calls he clinic and reports passing some small blood slots and experiencing a decreased urinary stream. What is the nurse's best response? A. Please come to the clinic to be evaluated by the health care provider. B. Those symptoms are normal in the first week following surgery. C. Try to bear down as if having a bowel movement. D. You should increase your daily fluid intake.
A. Up to 36 hours after the surgery small blood clots may occur, they should not impair the urine stream. Consistent passage of clots after this time would be considered a complication. Signs of complications after discharge should be evaluated by the health care provider.
The nurse is reviewing the history of four female clients. The nurse should recommend a Pap test to screen for cervical cancer in which client? A. 17-year-old who reports being sexually active for 2 years and uses condoms B. 26- year-old whose last pap test screening at age 21 was negative C. 51-year-old who had a hysterectomy with cervix removal for benign reasons and whose previous pap tests were negative D. 72-year-old with a history of regular pap test screening whose previous pap tests were negative
B. Cervical cancer is typically in Age >21 regardless of age at onset of sexual activity. Women as 21-29 should be screened with Pap testing every three years. A patient with history of negative pap test they can discontinue screening at age 65 or older or if cervix is removed of unrelated to cervical cancer.
The nurse preparing an educational seminar on sexually transmitted infections for female college students should advise that which 2 infections are leading causes of pelvic inflammatory disease and infertility? A. Genital herpes and HIV B. Gonorrhea and Chlamydia C. Human Papillomavirus and Syphilis D. Yeast and trichomoniasis
B. Gonorrhea and chlamydia can lead to PID and Infertility. The use of condoms is recommended to prevent contracting the disease. Annual screenings is recommended for sexually active females age <25.
A client suffering from bladder prolapse and subsequent stress urinary incontinence has discussed treatment options with the health care provider (HCP). The nurse evaluates that the client understands support pessary use when the client makes which statement? A. After the pessary is surgically placed, I'll experience bladder discomfort for several weeks. B. I can remain sexually active while my pessary is in place. C. I need to schedule weekly appointments to have the pessary removed and replaced D. I should report any vaginal discharge to my HCP immediately.
B. Patients with a pessary can remain sexually active. The patient can remove and insert the pessary themselves. Clients can remove it weekly, nightly, and before intercourse. If the patient can not remove the pessary regularly, removal by an HCP at 2-3 months intervals.
Which nursing instruction is the highest priority when teaching a 38-year-old female client newly diagnosed with stress incontinence? A. Coaching related to Kegel exercises B. Importance of voiding every 2 hours C. Minimizing caffeine and alcohol D. Use of incontinence pads and pessary
B. The priority for a patient newly diagnosed with stress is preventing skin breakdown and UTI through bladder training. Teach to empty the bladder every 2 hours when awake and 4 hours at night. Interventions for for stress incontinence include: bladder training, pelvic floor exercises, lifestyle modifications, and incontinence products.
The nurse is caring for a client with an ileal conduit. While assisting the client in removing the external pouch, the nurse observes that the stoma appears bluish grey. What is the nurse's best action? A. Administer an antibacterial agent and assess for further signs of infection B. Document the findings and continue to monitor for changes C. Measure the stoma and apply a larger pouching device D. Report the finding to the health care provider (HCP) immediately
D. A healthy stoma should be pink to brick-red and moist, indicating vascularity and viability. If the stoma is dusky or any shade of blue, should suspect impaired perfusion and contact HCP immediately. It is considered a medical emergency.
The nurse is caring for a 72-year-old client with a history of renal calculi and diabetes mellitus who was admitted for acute pyelonephritis. The nurse assesses shaking chills, temperature of 101.2 F, and flank pain. Which of the following is the priority nursing intervention? A. Administer intravenous antibiotics B. Check baseline serum creatinine level C. Have the client strain all urine D. Obtain blood an urine cultures
D. Blood and urine culture should be obtained prior to starting antibiotic treatments. When the causative agent is identified antibiotic should be given immediately to prevent sepsis.
The nurse is reinforcing instructions to a client being discharged from the clinic with a diagnosis of acute prostatitis. Which statement by the client indicates an understanding of the instructions? A. Having sex will make the infection worse. B. I enjoy iced tea, so I will drink more to stay hydrated. C. I should Take ciprofloxacin until I feel better. D. I should take docusate to prevent straining.
D. Management of prostatitis includes antimicrobial and anti-inflammatory medications. Should instruct the client to: Hydrate with clear fluids avoid caffeinated beverages it can exacerbate the symptoms, Complete antibiotic treatments, Sexual intercourse or masturbation to reduce discomfort with the use of Prophylactic barrier, Reduce straining, and Take sitz baths.
The nurse is conducting a pain assessment on a client with dysuria. Which pain description is most likely associated with pyelonephritis? A. Constant; increased by pressure over the suprapubic area B. Dull and continuous; occasional spasms over the suprapubic area C. Dull flank pain; extending toward the umbilicus D. Excruciating; sharp flank pain radiating to the groin
D. Pyelonephritis causes flank pain that is experienced in the back at the costovertebral angle and may spread to the umbilicus. The pain is excruciating, sharp, and radiates to the groin.
A 28-year-old client is seeking advice from the nurse about not been able to conceive the client is discourage and states the she had been "trying to get pregnant for 4 months." Which statement by the nurse is best? A. adoption or surrogacy are options for those who are unable to conceive. B. Consider talking to your health care provider about fertility-enhancing medications that can help you conceive more quickly. C. There is no cause for concern unless you haven't been able to conceive for 1 year. D. Using an over-the-counter urine ovulation detector kit to time sexual intercourse may improve your chances of conceiving"
D. Teaching clients about menstrual cycle physiology may increase fertility awareness and improve their chances of achieving pregnancy sooner. The ovulation predictor kit detects the surge of LH that precede ovulation so that clients can time sexual intercourse during their "fertile window"
The nurse prepares a client for discharge following a vasectomy. The client asks, "When can I have sexual intercourse with my wife without using a condom?" What us the best response by the nurse? A. Discontinue alternative birth control after at least 5 ejaculations. B. There is no need to use alternative birth control following today's procedure. C. Use alternative birth control for 6 months following today's procedure. D. Use alternative birth control until cleared by the healthcare provider.
D. Vasectomy is permanent male sterilization. The procedure should not affect the ability to ejaculate, amount and consistency of fluid, or other physiological mechanisms. Sperm is still produced but absorbed by the body. After the procedure it can take several month to get rid of the remaining sperm, should follow up with provider for semen sample and clear the patient.
The emergency nurse plans care for a female victim of sexual assault. Which of the following interventions should the nurse include in the care plan? Select all that apply. A. Determine if the victim has douched or had a bath or shower since the incident B. Educate the victim regarding the need for a pelvic examination C. Obtain the date of the last menstrual period and current method of birth control D. Perform head-to-toe assessment of injuries and document injury locations E. provide prescribed prophylactic antibiotic medication for sexually transmitted infection
A, B, C, D, E Priority nursing actions for sexual assault victims: Determined if the patient has bathed, showered, or douched; Educate on pelvic exam to identify injuries and collect evidence; Date of last menstrual period and birth control method to identify risk for pregnancy, Perform head-to-toe assessment, and provide prophylactic therapies.
The nurse gathers a health history from a 58-year-old male client with acute urinary retention. Which of the following questions should the nurse ask to aid in assessing for benign hyperplasia? Select all that apply. A. Do you feel the need to urinate again immediately after urinating? B. Do you have strain to begin your stream of urine? C. How often do you engage in sexual intercourse? D. Is your stream of urine weak or intermittent? E. is your stream of urine weak or intermittent?
A, B, D, E BPH symptoms are: Urinary retention, sensation of incomplete emptying or increased urgency to void, Straining or difficulty initiating voiding, Weak or intermittent urine stream, and Frequent voiding.
The nurse is caring for several clients in a gynecology clinic. Which of the following clients are at increased risk for developing breast cancer? Select all that apply. A. 24-year-old client whose sister had breast cancer at age 38 B. 32-year-old client with mutations of the breast cancer 1 and 2 (BRCA1, BRCA2) genes C. 45-year-old client whose menstrual period began at age 17 D. 56-year-old client who is postmenopausal and gained 50 lb (22.7kg) in the last 5 years E. 65-year-old client who has been taking estrogen and progestin pills for the last 15 years for vasomotor symptoms
A, B, D, E Risk factors that increase a client's risk for developing breast cancer: FIrst degree, biological relative with a history of breast cancer, Inheriting the mutation gene of breast cancer 1 or 2, Gaining excessive weight in the postmenopausal years, and menopausal hormone therapy for >5years is can stimulate tumor growth.
The emergency department nurse cares for 5 clients. Which of the following clients below are at risk for developing metabolic acidosis? Select all that apply. A. 25-year-old client with claustrophobia who was stuck in an elevator for 2 hours. B. 36-year-old with food poisoning and severe diarrhea for the past 3 days. C. 40-year-old client with 3-day history of chemotherapy-induced vomiting. D. 75-year-old client with pyelonephritis and hypotension. E. 82-year-old client due for hemodialysis with clotted arteriovenous shunt.
B, D, E Metabolic acidosis is due to increased production or retention of acid or the depletion of bicarbonate via the kidneys or GI tract. Common causes are GI bicarbonate Losses (diarrhea), Ketoacidosis, Lactic acidosis, Renal Failure, and Salicylate toxicity.
A sexually active female client has had 3 urinary tract infection (UTI) in 12 months. Which instructions should the nurse include in teaching the client how to prevent UTI recurrence? Select all that apply. A. Douche with a water and vinegar solution after intercourse B. Increase daily intake of fluids C. Use a spermicidal contraceptive jelly D. Use fragrance-free perineal deodorant products E. Void immediately after intercourse F. Wear underwear with a cotton crotch
B, E, F Encourage the patient to implement the following interventions: Take all antibiotics as prescribed, Increase fluid intake, Wipe front to back, Avoid synthetic fabrics, and void after sexual intercourse. Avoid douching and use feminine perineal products = it can increase the risk for infection, alter PH and normal flora. Avoid spermicidal contraceptive jelly = suppress the production of protective vaginal flora.
The charge nurse is making rounds and should immediately intervene when making which observation? A. A new nurse is using gentle pressure to flush a kidney pelvis catheter with 5 ml of fluid B. A nursing assistant id hanging a urinary drainage bag on the back of the wheelchair when transporting a client C. Indwelling urinary catheter is taped to a male client's inner thigh D. Total oral intake in 24 hours for a client with a urinary diversion device is 2.800 ml
B.
A client diagnosed with end-stage renal disease comes to the dialysis clinic for treatment. Which actions should the nurse take to prepare the client for hemodialysis? Select all that apply. A. Administer subcutaneous heparin to decrease clotting during dialysis. B. Administer the client's morning doses of carvedilol and lisinopril C. Check the client's medical records to determine the last post-dialysis weight D. Obtain a set of client vital signs and the clients current weight E. Palpate the fistula in the client's arm for a thrill and auscultate for a bruit
C, D, E Prior to dialysis treatment, the nurse should assess the client's fluid status, vascular access, and vital signs. IV heparin is added to the blood to prevent clotting. Many medications are taken after dialysis to prevent the removal. IF patient is given blood pressure medications the patient can be prone to hypotension and after they can have uncontrolled hypertension. If a fistula is functioning properly it can be palpated and a bruit can be heard during auscultation.
The nurse is caring for a client with suspected pelvic inflammatory disease (PID). When the nurse is obtaining the client's health history, which of the following questions would provide pertinent data about the client's risk factors for PID? Select all that apply. A. Are you currently taking oral contraceptive? B. At what age did you experience your first menstrual cycle C. Do you engage in sexual intercourse with multiple partners? D. Have you ever been diagnosed with a sexually transmitted infection? E. Have you recently had an abortion or pelvic surgery?
C, D, E Risk factors for Pelvic inflammatory disease: Multiple sexual partners, history of chlamydia or gonorrhea, history of pelvic inflammatory disease, Partner with an STI, Lack of consistent barrier contraception use, Age 15-25, and recent abortion or pelvic surgery. PID is when bacteria from the genitalia travel to the cervix and causes infection in the female reproductive organs and pelvic cavity. Symptoms include pelvic or lower abdominal pain, menstrual irregularities or increase menstrual cramps, painful intercourse, fever, and abnormal vaginal discharge.
