Week 2: Genitourinary Disorders

The nurse collects a urine specimen from a client for a culture and sensitivity analysis. What should the nurse do to preserve the specimen?

Send it to the laboratory immediately. A specimen for culture and sensitivity should be sent to the laboratory promptly so that a smear can be taken before organisms start to grow in the specimen.

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.

A 19-year-old unmarried college student who is approximately 8 weeks pregnant asks the nurse, "If I have an abortion in the next 2 or 3 weeks, how will it be done?" The nurse instructs the client that at this gestational age, an abortion is usually performed by which technique?

dilatation and curettage When the gestation is less than 13 weeks, an elective abortion is usually performed by the dilatation and curettage method. Menstrual extraction, or suction evacuation, is the easiest method, but it is used only when the client is between 5 and 7 weeks' gestation. Dilatation and vacuum extraction is used when clients are between 12 and 16 weeks' gestation. Saline induction, used for clients between 16 and 24 weeks' gestation, involves instillation of a hypertonic saline solution into the amniotic sac to initiate expulsion. Oxytocin infusion may also be used with saline induction.

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 Documenting the expiration date is important but administering outdated dialysate is a cliient safety issue so obtaining new dialysate is a higher priority.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however, regardless of the color or clarity, new dialysate should be obtained versus administration of the outdated dialysate.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 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?

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.

Which measure is likely to provide the most relief from the pain associated with renal colic?

administering morphine During episodes of renal colic, the pain is excruciating. It is necessary to administer opioid analgesics such as morphine to control the pain. Application of heat, encouraging high fluid intake, and limitation of activity are important interventions, but they will not relieve the renal colic pain.

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 client is to take sulfamethoxazole-trimethoprim for a urinary tract infection. Which statement indicates that the client knows how to correctly take the medication?

"I will need to get a urine culture when I am finished taking the pills." After completing the drug therapy, it will be necessary to obtain a urine culture to accurately determine the effectiveness of the antibiotic.It is possible for symptoms to be relieved, but bacteria to still be present in the urine. The client should complete the full course of prescribed therapy and not stop taking the drug because symptoms have disappeared.The client should increase fluid intake, not decrease it, in order to dilute the urine and keep the urinary tract flushed.If the client still has symptoms after taking all the prescribed pills, the client needs to return to the health care provider for follow-up care. It is likely that another antibiotic needs to be prescribed as the organism may not have been sensitive to sulfamethoxazole-trimethoprim.

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 client has renal colic due to renal lithiasis. What is the nurse's first priority in managing care for this client

Administer an opioid analgesic as prescribed. If infection or blockage caused by calculi is present, a client can experience sudden severe pain in the flank area, known as renal colic. Pain from a kidney stone is considered an emergency situation and requires analgesic intervention. Withholding fluids will make urine more concentrated and stones more difficult to pass naturally. Forcing large quantities of fluid may cause hydronephrosis if urine is prevented from flowing past calculi. Straining urine for small stones is important, but does not take priority over pain management.

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. 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 couple is inquiring about vasectomy as a permanent method of contraception. Which teaching statement would the nurse include in the teaching plan?

Another method of contraception is needed until the sperm count is 0." Another method of contraception is needed until all sperm has been cleared from the body. The number of ejaculates for this to occur varies with the individual, and laboratory analysis is required to determine when that has been accomplished. Vasectomy is considered a permanent sterilization procedure and requires microsurgery for anastomosis of the vas deferens to be completed. Studies have shown that there is no connection between cardiac disease in males and vasectomy. There is no need for follow-up after verification there is no sperm in the system.

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 ovaries are not generally removed during a tubal ligation. An oophorectomy involves removal of one or both ovaries.

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.

The nurse is creating a medication list and notes that the client takes saw palmetto. What should the nurse assess next?

"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 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 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.

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." 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 with marked oliguria is ordered a test dose of 0.2 g/kg of 15% mannitol solution intravenously over 5 minutes. The client weighs 132 lb (60 kg). How many grams would the nurse administer? Record your answer as a whole number.

12 First, convert the client's weight from pounds to kilograms:132 lb ÷ 2.2 lb/kg = 60 kg.Then, to calculate the number of grams to administer, multiply the ordered number of grams by the client's weight in kilograms:0.2g/kg X 60 kg = 12 g.

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. One of the most common reasons for failure of this contraceptive is lack of adherence to the appointment schedule for injections every 3 months.

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?

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 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:

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." ntercourse is not contraindicated in cystitis. Voiding immediately after intercourse flushes bacteria from the urethra, which should help prevent recurrence.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 nurse is admitting an older female client to the gynecology surgical unit. When the nurse asks the client what medication she is taking at home, the client responds that she is taking a little red pill in the morning and a white capsule at night for her blood pressure. What should the nurse do next

Ask a family member to bring the medications from home in the original vials for proper identification and administration times. It is critical for medication safety to know the name, dosage, and times of administration of the medication taken at home. The family should bring the medication bottles to the hospital. The nurse should document the medication on the medical record from the bottles to ensure accuracy before the medication is prescribed and administered. The pharmacist is a helpful resource, but the safest way to identify the medication is in its original container. It is not safe to assume the client could correctly identify the medications from a drug book. The medication regimen may have changed since the record 2 years ago.

A nurse is preparing a client for an intravenous pyelography. Which action is the priority?

Assess allergies to iodine. The nurse should assess this client for allergies to iodine because the dye used in an intravenous pyelography is iodine based, and the client could potentially have a life-threatening reaction to the dye. The nurse should obtain vital signs before the client receives the procedure and assess the client's last bowel movement, but these actions are not the priority. Urine output should be monitored and documented.

An older adult client diagnosed with end-stage renal disease (ESRD) presents with fluid volume excess. Which nursing intervention is the priority?

Assess the client's lung sounds. All interventions are important for the client with fluid volume excess, but airway takes priority. Fluid volume excess can lead to fluid in the lungs causing respiratory difficulty

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 sitz bath would not relieve bladder spasms that are caused by an obstructed catheter.

A client undergoes cystoscopy with bladder biopsy. After the procedure, which assessment is mostappropriate 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 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. 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 end-stage renal failure has an internal arteriovenous fistula in the left arm for vascular access during hemodialysis. What should the nurse instruct the client to do? Select all that apply.

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.

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.

The client is scheduled for an intravenous pyelogram (IVP) to determine the location of the renal calculi. Which action would be most important for the nurse to include in pretest preparation?

Check the client's history for allergy to iodine. A client scheduled for an IVP should be assessed for allergies to iodine and shellfish. Clients with such allergies may be allergic to the IVP dye and be at risk for an anaphylactic reaction. Adequate fluid intake is important after the examination. Bladder spasms are not common during an IVP. Bowel preparation is important before an IVP to allow visualization of the ureters and bladder, but checking for allergies is most important.

The nurse assesses a client's outflow is less than the inflow during a peritoneal dialysis exchange. What actions will the nurse use to increase peritoneal dialysis outflow? Select all that apply.

Check the level of the drainage bag. Check the peritoneal dialysis system for kinks. Reposition the client to a side lying. The nurse will check the level of the drainage bag and the peritoneal dialysis system for kinks to try and increase client outflow by ensuring catheter flow by gravity. Repositioning the client to the side will also increase outflow by adjusting the catheter. If the nurse adds more dialysate, the client will only have more peritoneal fluid. The nurse will notify the health care provider if positioning and ensuring catheter flow have not worked.

The nurse is caring for a client with nephropathy. The health care provider orders a 24-hour urine collection. Which actions are necessary to ensure proper collection of the specimen? Select all that apply.

Collect the urine in a preservative-free container and keep on ice. Encourage daily amounts of fluids. Discard the initial voiding but save all others for 24 hours. All urine for a 24-hour urine collection must be saved in a container with no preservatives and refrigerated or kept on ice. Normal fluid amounts or an increase in fluids is encouraged. The first urine voided at the beginning of the collection is discarded, not the last. A self-report of weight may not be accurate and it is typically not documented on the container. It is not necessary to have an indwelling urinary catheter inserted for urine collection.

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?

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.

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

Control the amount of protein intake to 59 to 70 g/day. Hemodialysis clients have their protein requirements individually tailored according to their postdialysis weight. The protein requirement is 1.0 to 1.2 g/kg body weight per day. Hence, for a 59-kg weight, the amount of protein will be 59 to 70 g/day. Sodium should be restricted to 3 g/day. The client should obtain sufficient calories; if calories are not supplied in adequate amount, the body will use tissue protein for energy, which will lead to a negative nitrogen balance and malnutrition. Fluid intake needs to be restricted. The fluid amount is restricted to 500 to 700 mL plus the urine output.

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 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.

When auscultating an arteriovenous (AV) fistula, a bruit is noted. What is the appropriate action by the nurse?

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.

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

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.

After an intravenous pyelogram (IVP), the nurse should include which measure in the client's plan of care?

Encourage adequate fluid intake. After an IVP, the nurse should encourage fluids to decrease the risk of renal complications caused by the contrast agent. There is no need to place the client on bed rest or administer a laxative. An IVP would not cause hematuria.

A client has a ureteral catheter in place after renal surgery. What should the nurse do to provide safe care of the ureteral catheter?

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.

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

Expect blood in your urine in the first couple of days following the procedure." Transurethral resection of the prostate (TURP) is a common surgical procedure used to treat male clients with benign prostate enlargement. The surgery commonly results in blood from the surgery in the urine for the first few days, and the client should not be concerned; the urine will become clear within 2 to 3 days. Central venous access is not expected for this type of surgery. Peripheral IV access can be expected. Clients are instructed to anticipate hospitalization for 1 to 3 days. Because the procedure is performed transurethrally (via the urethra), there is no outward incision.

client who has a urinary diversion tells the nurse, "This urinary pouch is embarrassing. Everyone will know that I'm not normal. I don't see how I can go out in public anymore." What is an appropriate goal for the nurse to set with this client?

Express fears about the urinary diversion. It is normal for clients to express fears and concerns about the body changes associated with a urinary diversion. Allowing the client time to verbalize concerns in a supportive environment and suggesting that she discuss these concerns with people who have successfully adjusted to ostomy surgery can help her begin coping with these changes in a positive manner. Although the client may be anxious about this situation and may be feeling worthless, the underlying problem is a disturbance in body image. There are no data to indicate that the client does not know how to care for the urinary diversion.

A nurse is assessing a client in the recovery room who has had a vaginal hysterectomy. Which assessment finding should the nurse bring to the healthcare provider's immediate attention?

Foley catheter draining urine at 10 mL/hour A complication of vaginal hysterectomy would be injury to the ureters resulting in decreased urinary output. The other findings are normal and expected after a vaginal hysterectomy.

The nurse is developing an educational program about prostate cancer. The nurse should provide information about which topic?

For all men, age 50 and older, the American and Canadian Cancer Societies recommend an annual rectal examination. Most cases of prostate cancer are adenocarcinomas. An adenocarcinoma is palpable on rectal examination because it arises from the posterior portion of the gland. Although the PSA is not a perfect screening test, the American Cancer Society and the Canadian Cancer Society recommend an annual rectal examination and blood PSA level for all men age 50 years and older, or starting at age 40 years if the client is of African descent, or if there is family history of prostate cancer. A colonoscopy is performed to diagnose colon cancer, not prostate cancer. Regular sexual activity does not prevent cancer of the prostate.

A 39-year-old female client has been experiencing intermittent vaginal bleeding for several months. Her health care provider (HCP) tells her that she has uterine fibroids and recommends an abdominal hysterectomy. When the client expresses fear about the surgery, what should the nurse do?

Give the client opportunities to express her fears. The best approach for a client who is fearful about having surgery is to allow the client opportunities to express her fears. Open-ended questions should elicit the client's individual and specific fears. This then gives the nurse the opportunity to provide clarification, information, and support and possibly to offer other resources. The other actions are not supportive and deny the client the opportunity to express her feelings.

Which nursing action is most appropriate for a client who has urge incontinence?

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.

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

I'll ask any future partners if they have ever been diagnosed with genital herpes." Clients with genital herpes should inform their partners of the disease to help prevent transmission, and the client should be advised to ask future partners about their health history. Spermacides are a form of birth control and do not prevent genital herpes. The notion that genital herpes is only transmittable when visible lesions are present is false. According to the Centers for Disease Control and Prevention, long-term monogamous relationships help prevent the spread of herpes, but the client is protected only if the partner is infection-free at the beginning of the relationship. Anyone not already in a long-term, monogamous relationship, regardless of current health status, should follow safer-sex practices.

A nurse is inserting a urinary catheter into a client who is extremely anxious about the procedure. How should the nurse instruct the client to best facilitate the catheter insertion?

Inhale and exhale deeply during insertion. When inserting a urinary catheter, the nurse can facilitate insertion by asking the client to deeply inhale and exhale during the insertion. Breathing deeply will relax the urinary sphincter. Drinking fluids prior the procedure will not help with relaxation. Kegel exercises are done to enhance muscle control after a catheter is removed. The washing of the perineum will not help with insertion and relaxation.

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

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

Which action would be most appropriate for preventing urinary tract infections in an elderly female client?

Instruct the client to avoid tight-fitting underwear. To prevent urinary tract infections, clients should be encouraged to wear loose-fitting, cotton underwear to decrease the formation of a warm, moist environment.Clients should void whenever they feel the urge or at least every 4 to 6 hours during the day.An indwelling catheter increases the risk of a urinary tract infection.Prophylactic antibiotics are typically not used for urinary tract infections unless the client has experienced repeated episodes within 1 year.

Sulfamethoxazole/trimethoprim has been prescribed for a client who has a urinary tract infection. What should the nurse do when administering sulfonamides?

Instruct the client to drink at least eight glasses of water a day. The client who is taking sulfadiazine should be instructed to drink at least eight glasses of water a day to prevent the development of crystalluria. Sulfadiazine should be taken on an empty stomach with a full glass of water. It does not require that the client's urine output be measured and does not affect the color of the urine.

A client is having peritoneal dialysis. During the exchange, the nurse observes that the solution draining from the client's abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. What clinical judgment should the nurse make about the blood-tinged drainage?

It indicates abdominal blood vessel damage. Because the client has a permanent catheter in place, blood-tinged drainage should not occur. Persistent blood-tinged drainage could indicate damage to the abdominal vessels, and the health care provider (HCP) should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too-rapid infusion of the dialysate can cause pain, not blood-tinged drainage.

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.

After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an I.V. infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output?

It's an abnormal finding that requires further assessment. The drop in urine output to less than 30 ml/hour is abnormal and requires further assessment. The reduction in urine output may be caused by an obstruction in the urinary catheter tubing or deficient fluid volume from blood loss. The client's nothing-by-mouth status isn't the cause of the low urine output because the client is receiving I.V. fluid to compensate for the lack of oral intake. Ambulation promotes urination; however, the client should produce at least 30 ml of urine/hour

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.

A client recovering from an abdominal hysterectomy has pain in her right calf. What should the nurse do next?

Measure the circumference of both calves and note the difference. After abdominal pelvic surgery, the client is especially prone to thrombophlebitis. Measuring calf circumference can help detect edema in the affected leg. The calf should not be rubbed or palpated because a clot could be loosened and travel to the lungs as a pulmonary embolism. Homan's sign, which is calf pain on dorsiflexion of the foot when the leg is raised, is sometimes associated with thrombophlebitis. Having the client flex and extend the leg does not provide useful assessment data; the leg will not change color when raised and lowered.

Which instruction would a nurse include in the discharge teaching for a client who has an ileal conduit?

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.

The nurse is teaching a client about foods and fluid options to prevent the reoccurrence of urinary calculi. Which statement(s) by the client indicate further teaching is required? Select all that apply.

My favorite seafood lobster is no longer a meal option." "I will eat dried fruits and nuts for an afternoon snack." Eating a diet that's high in protein, sodium, and sugar may increase the risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much salt in a diet increases the amount of calcium the kidneys must filter and significantly increases the risk of kidney stones. Dried fruits and nuts, soda, coffee, tea, and ice cream are foods and beverages that are high in substances that cause calculi. Not drinking enough water each day can increase the risk of kidney stones

The nurse is planning care for an obese female client. The client experiences dribbling urine when she coughs, sneezes, and changes positions. The nurse should instruct the client to promote urinary health by encouraging which actions? Select all that apply.

Participate in a weight loss program. Perform muscle-strengthening exercises (Kegel exercises). Use adult diapers as needed. The goal is to promote health in this client who has stress incontinence. Participating in a weight loss program or support group may decrease the intra-abdominal pressure contributing to the incontinence. Participating in swimming, bicycling, or low-impact exercise is beneficial to weight loss. Kegel exercises are helpful in developing muscle control. Wearing adult diapers will absorb leaked urine and prevent excoriation. Clients with urinary stress incontinence are encouraged to avoid drinks with caffeine and alcohol. Perineal care is essential to prevent skin breakdown, but the client does not require a Foley or straight catheter at this time.

During rounds, a client admitted with gross hematuria asks the nurse about the physician's diagnosis. To facilitate effective communication, what should the nurse do?

Provide privacy for the conversation. Providing privacy for the conversation is a form of active listening, which focuses solely on the client's needs. Asking why the client is concerned, changing the subject, or giving advice tends to block therapeutic communication.

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

Report the finding to the healthcare provider. Peritonitis is the most common and serious complication of peritoneal dialysis. The first sign of peritonitis is cloudy dialysate drainage fluid that should be immediately reported to the healthcare provider. Flushing the catheter could enhance the development of an abdominal infection. The client receiving peritoneal dialysis is in renal failure and most likely is on a fluid restriction. Additional fluids will not affect the presence of cloudy dialysate. It is beyond the nurse's scope of practice to instill an additional liter of dialysate. This action could alter the client's fluid and electrolyte balance

A client is prescribed alfuzosin for benign prostatic hyperplasia (BPH). What should the nurse teach the client?

Rise slowly from a supine position. First-dose phenomenon, which is a severe and sudden drop in blood pressure after the administration of the first dose of an alpha-adrenergic blocker, can cause clients to fall or pass out. All clients must be warned about this adverse effect before they take their first dose of an alpha blocker. Orthostatic hypotension can occur with any dose of an alpha blocker, and clients must be warned to get up slowly from a supine position. The client needs to consult with the healthcare provider if the heart rate falls below 60/bpm. There is no fluid restriction with this medication. A dry cough is a side effect of an ACE inhibitor.

A client who is receiving continuous renal replacement therapy (CRRT) suddenly begins to deteriorate. What is the appropriate sequence of interventions by the nurse? All options must be used.

Stop the CRRT and notify the healthcare provider. Clamp and disconnect the blood lines. Scrub the hub of the catheter with disinfectant pad. Flush each catheter lumen. Cap the lumens with sterile caps. Continue to monitor client status. When a client receiving CRRT shows signs of clinical deterioration, the nurse should stop the CRRT and notify the healthcare provider. The CRRT is stopped to prevent further CRRT-related deterioration in the client. The nurse notifies the healthcare provider so that appropriate measures can be initiated. Then the nurse should clamp and disconnect the blood lines.The hubs of the catheter should be scrubbed with disinfectant pad to prevent infection and then each catheter lumen flushed to maintain patency. The lumens should then be capped with a sterile cap and the nurse should continue to monitor the client's status.

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?

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 about to admit a client to the medical surgical unit directly from the healthcare provider's office. Upon assessment, the nurse notes that the client has significant periorbital edema. Laboratory values indicate the presence of proteinuria and hypoproteinemia. Which action is the nurse's priority?

Strict intake and output assessment and documentation Symptoms are highly suggestive of glomerulonephritis. Clients require strict intake and output are generally placed on a high protein diet. Monitoring of laboratory values is good nursing practice overall, but not the priority with this diagnosis. Ambulation is not the priority, as client requires rest.

A client's catheter is removed 4 days after a transurethral resection of the prostate (TURP). He is experiencing urinary dribbling. What should the nurse do?

Teach the client Kegel exercises. After TURP, sphincter tone is poor, resulting in dribbling or incontinence. Kegel exercises can increase sphincter tone and decrease dribbling. Voiding every hour will not prevent dribbling or improve sphincter tone. It may take up to 12 months for urinary continence to be regained. Dribbling is not a sign of a urinary tract infection.

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. 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%.

When the nurse is conducting a preoperative interview with a client who is having a vaginal hysterectomy, the client states that she forgot to tell her surgeon that she had a total hip replacement 3 years ago. Why should the nurse communicate this information to the perioperative nurse?

The client should not have her hip externally rotated when she is positioned for the procedure The nurse should notify the surgery department and document the past surgery in the medical record in the preoperative notes so that the client's hip is not externally rotated and the hip dislocated while she is in the lithotomy position. The prosthesis should not be a problem as long as the perioperative nurse places the return electrode away from the prosthesis site. The perioperative nurse will inform the rest of the team, but the primary reason to inform the perioperative nurse is related to safe positioning of the client. The surgeon should enter this information on the client's medical record at this time.

A nurse is preparing the plan of care for a client with neurogenic flaccid bladder. Which outcome is appropriate for this client?

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.

A client diagnosed with end stage renal disease (ESRD) is receiving peritoneal dialysis. Which assessment data warrants immediate nursing intervention?

The dialysate instilled into the client was 1500 mL and 1500 mL was removed. The purpose of peritoneal dialysis is to remove excess water and electrolytes from the body. Output should be greater than input. Normal effluent is clear or straw colored. Mild back pain is expected as large amounts of fluid are instilled into the abdomen. The client receiving peritoneal dialysis does not have a graft and there is no bruit to be assessed.

A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact?

The left kidney usually is slightly higher than the right one. The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4??) long, 5 to 5.8 cm (2? to 2¼?) wide, and 2.5 cm (1?) thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae.

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.

An unlicensed assistive personnel (UAP) tells the nurse, "I think the client is confused. He keeps telling me he has to void, but that's not possible because he has a catheter in place that is draining well." What should the nurse tell the UAP?

The urge to void is usually created by the large catheter, and he may be having some bladder spasms." The indwelling urinary catheter creates the urge to void and can also cause bladder spasms. The nurse should ensure adequate bladder emptying by monitoring urine output and characteristics. Urine output should be at least 30 to 50 mL/h. A plugged catheter, imagining the urge to void, and confusion are less likely reasons for the client's problem.

A nurse is obtaining a health history from a male senior citizen. The client states that he is having urinary hesitancy, slight dysuria, and dribbling. He denies reports of hematuria. Identify the area where the nurse anticipates the primary cause of the urinary dysfunction.

The walnut-sized prostate gland lies beneath the bladder and surrounds the urethra. When the prostate gland becomes enlarged, which commonly occurs as a male ages, urination becomes affected as the prostate gland narrows the passage of urine through the urethra.

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

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

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.

On the second day following an abdominal hysterectomy, a client reports she has had three brown, loose stools in moderate amount. The morning medications include an order for 100 mg of docusate sodium daily or as needed. What should the nurse do next?

Withhold the medication, and document the client's report of loose stools. The nurse should withhold administering docusate sodium, a stool softener, and document that the woman has had loose stools. The nurse is responsible for assessing contraindications and adverse effects of medications, and administering the medication when the client already has loose stools is unsafe. The assessment should also include auscultation of bowel sounds and inquiry about gas pains, but the stool softener should still be withheld.

The nurse is developing a community health education program about sexually transmitted infections. Which information about women who acquire gonorrhea should be included

Women with gonorrhea are usually asymptomatic. Many women who acquire gonorrhea are asymptomatic or experience mild symptoms that are easily ignored. They are not necessarily more reluctant than men to seek medical treatment, but they are more likely not to realize they have been affected. Gonorrhea is easily transmitted to all women and can result in serious consequences, such as pelvic inflammatory disease and infertility.

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 when your sperm count indicates 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.

Which woman is at greatest risk for bacterial vaginosis?

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.

A registered nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients. Which client's care will the nurse safely delegate to the UAP?

a client diagnosed with renal calculi who is encouraged to ambulate four times daily The ambulation of the client diagnosed with renal calculi may safely be delegated to the UAP. The registered nurse should care for the clients with a suprapubic catheter draining burgundy-colored urine. The client returning from anesthesia unit requires assessment, and assessment is not within the scope of practice for the UAP. The UAP would also not be permitted to perform bladder irrigation.

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

a hard prostate, localized or diffuse On digital rectal examination, key signs of prostate cancer are a hard prostate, induration of the prostate, and an irregular, hard nodule. Accompanying symptoms of prostate cancer can include constipation, weight loss, and lymphadenopathy. Abdominal pain usually does not accompany prostate cancer. A boggy, tender prostate is found with infection (e.g., acute or chronic prostatitis).

A client had a cystoscopy to remove a renal stone. Which laboratory data warrants immediate intervention by the nurse?

a white blood cell count of 14,000 mm/dL (14.00 x 109/L) The high white blood cell count signals infection and needs to be treated immediately. Microscopic hematuria may be related to trauma from the procedure and is not cause for alarm. The creatinine and calcium levels are normal.

The nurse explains to the client the importance of drinking large quantities of fluid to prevent cystitis. How much fluid should the nurse tell the client to drink?

at least 3,000 mL of fluids daily Instructions should be as specific as possible, and the nurse should avoid general statements such as "as much as possible." A specific goal is most useful. A mix of fluids will increase the likelihood of client compliance. It may not be sufficient to tell the client to drink twice as much as or 1 L more than she usually drinks if her intake was inadequate to begin with.

A client with stress incontinence asks the nurse what kind of diet to follow at home. The nurse should recommend that the client:

avoid alcohol and caffeine. Clients with stress incontinence should be encouraged to avoid alcohol and caffeine products because both are bladder stimulants.The client should not decrease fluid intake.Increasing the intake of fruit juice may be desirable but will not affect the episodes of incontinence.There is no need to avoid milk products.

The nurse should teach the client with erectile dysfunction (ED) to alter his lifestyle by doing which?

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.

Aluminum hydroxide gel is prescribed for the client with chronic renal failure to take at home. What is the expected outcome of this drug?

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.

When teaching the client with a urinary tract infection about taking a prescribed antibiotic for 7 days, the nurse should tell the client to report which symptoms to the health care provider (HCP)? Select all that apply.

blood in the urine rash fever above 100° F (37.8° C) The nurse should instruct the client to report signs of adverse reaction to the antibiotic or indications that the urinary tract infection is not clearing. Blood in the urine is not an expected outcome, rash is an adverse response to the antibiotic, and an elevated temperature indicates a persistent infection. These signs should be reported to the HCP. Cloudy urine can be expected during the first few days of antibiotic treatment. Mild nausea is a side effect of antibiotic therapy, but it can be managed with eating small, frequent meals. Urinating every 3 to 4 hours or more is expected, particularly if the client is increasing the fluid intake as directed.

A client with benign prostatic hypertrophy (BPH) is being treated with terazosin 2 mg at bedtime. What should the nurse tell the client to monitor on a regular basis?

blood pressure Terazosin is an antihypertensive drug that is also used in the treatment of BPH. The client should monitor his blood pressure to ensure he does not develop hypotension, syncope, or orthostatic hypotension. The client should be instructed to change positions slowly. Terazosin does not cause glycosuria, restlessness, or changes in the heart rate.

A client has nephrotic syndrome. To aid in the resolution of the client's edema, the health care provider prescribes 25% albumin. In addition to an absence of edema, the nurse should evaluate the client for which expected outcome?

blood pressure elevation Albumin is a colloid that remains in the intravascular space, pulling fluid out of the intracellular and interstitial space. The client with nephrotic syndrome loses excessive amounts of protein, mainly albumin, in the urine. Because fluid is drawn into the intravascular space, blood pressure will increase. Crackles in the lung bases and cerebral edema are signs of circulatory overload or fluid volume excess. When edema is present in lower extremities, the skin feels cool to the touch unless an infection is present.

A client returns to the intensive care unit after coronary artery bypass graft surgery, which was complicated by a prolonged cardiopulmonary bypass and hypotension. After 3 hours in the unit, the client's condition stabilizes. Which assessment finding indicates a potential complication related to this occurrence?

blood urea nitrogen level (BUN) of 40 mg/dL The BUN is elevated and indicative of renal hypo-perfusion and damage related to the prolonged bypass and hypotension. The other findings are expected following surgery but require monitoring.

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 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.

A nurse is conducting a healthy-living workshop with a group of female college students. Which method of contraception should the nurse recommend as a means of preventing both pregnancy and sexually transmitted infections?

condoms Coitus interruptus, oral contraceptives, and IUDs provide no protection against STIs, while condoms provide significant (but imperfect) protection against both pregnancy and STIs.

A client undergoing long-term peritoneal dialysis at home is currently experiencing a reduced outflow from the dialysis catheter. To determine if the catheter is obstructed, what should the nurse ask the client about experiencing recently?

constipation Constipation may contribute to reduced urine outflow in part because peristalsis facilitates drainage outflow. For this reason, bisacodyl suppositories can be used prophylactically, even without a history of constipation. Diarrhea, vomiting, and flatulence typically do not cause decreased outflow in a peritoneal dialysis catheter.

A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans?

cottage cheese-like discharge The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of Trichomonas vaginalis. Gray-white discharge and a fishy odor are signs of Gardnerella vaginalis.

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

decreased abdominal girth Fluid accumulates in the abdomen and interstitial spaces owing to hydrostatic pressure changes. Increased abdominal fluid is evidenced by an increase in abdominal girth. Therefore, decreased abdominal girth is a sign of reduced fluid in the third spaces and tissues. When fluid accumulates in the abdomen and interstitial spaces, the child does not feel hungry and does not eat well. Although increased caloric intake may indicate decreased intestinal edema, it is not the best and most accurate indicator of fluid retention. Increased respiratory rate may be an indication of increasing fluid in the abdomen (ascites) causing pressure on the diaphragm. Heart rate usually stays in the normal range even with excessive fluid volume.

A male client has been diagnosed as having a low sperm count during infertility studies. After giving instructions about causes of low sperm counts, the nurse determines that the client needs further instructions when the client says low sperm counts may be caused by which health problem?

decreased body temperature Increased, not decreased, body temperature resulting from occupations or infections can contribute to low sperm counts caused by decreased sperm production. Heat can destroy sperm. Varicocele, an abnormal dilation of the veins in the spermatic cord, is an associated cause of a low sperm count. The varicosity increases the temperature within the testes, inhibiting sperm production. Frequent use of saunas or hot tubs may lead to a low sperm count. The temperature of the scrotum becomes elevated, possibly inhibiting sperm production. Endocrine imbalances (thyroid problems) are associated with low sperm counts in men because of possible interference with spermatogenesis.

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 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.

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

diarrhea Trimethoprim-sulfamethoxazole is most likely to cause diarrhea. Nausea and vomiting are other common adverse effects. This drug rarely causes anxiety, headache, or dizziness.

Two days after a herniorrhaphy, the client reports that his scrotum is swollen and painful. To promote comfort, the nurse should instruct the client to

elevate the scrotum and place ice bags on the area intermittently. A swollen, painful scrotum after herniorrhaphy is relatively common. Elevating the scrotum, as on a rolled towel, and intermittently placing ice bags on the area are helpful.Applying an abdominal binder will have no effect on the scrotal swelling.Applying a truss is unlikely to promote comfort when the scrotum is swollen.Having the client lie on his side with a pillow between his legs will not elevate the scrotum; therefore, this will not help reduce swelling and discomfort.

A client receiving dialysis directs profanities at the nurse and then abruptly hangs his head and pleads, "Please forgive me. Something just came over me. Why do I say those things?" The nurse interprets this as which finding?

emotional lability This type of behavior illustrates emotional lability, which is a readily changeable or unstable emotional affect. Neologism is using a word when it can have two or more meanings, or a play on words. Confabulation involves replacing memory loss by fantasy to hide confusion; it is unconscious behavior. Flight of ideas refers to a rapid succession of verbal expressions that jump from one topic to another and are only superficially related.

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?

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 who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl (70mmol/L). The most therapeutic pharmacologic intervention would be to administer

epoetin alfa. Chronic renal failure diminishes the production of erythropoietin by the kidneys and leads to a subnormal Hb level. (Normal Hb level is 13 to 18 g/dl in men and 12 to 16 g/dl in women.) An effective pharmacologic treatment for this is epoetin alfa, a recombinant erythropoietin. Because the client's anemia is caused by a deficiency of erythropoietin and not a deficiency of iron, administering ferrous sulfate would be ineffective. Neither filgrastim, a drug used to stimulate neutrophils, nor enoxaparin (low-molecular-weight heparin) will raise the client's Hb level.

The client is six hours post-open hysterectomy. Intravenous fluids are infusing at 125 mL/hr, urinary catheter has drained 170 mL since surgery, and the client reports pain as a 3 out of 10. What is the nurse's priority concern?

fluid balance All abdominal surgery clients have a potential for fluid volume deficit. Post-op urine output should be at least 30 mL/hr; the output of 170 mL in six hours is slightly under this minimally accepted amount. Pain is sufficiently treated. Although the nurse does need to determine if the catheter is functioning properly, this investigation is related to the priority concern of decreased urine ouput. Incisional healing is an ongoing concern but not a priority at this time.

A client with prostate cancer is treated with a luteinizing hormone-releasing hormone agonist and antagonist goserelin. What symptom should the nurse instruct the client to expect while receiving this treatment?

flushing Goserelin is used to decrease testosterone production in men to slow or stop the production of cancer cells. A common side effect is flushing or hot flashes. Changes in blood pressure, tenderness of the scrotum, and dramatic changes in secondary sexual characteristics should not occur.

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

A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse states that many members of the health care team (including a mental health practitioner) will see the client. A mental health practitioner should be involved in the client's care to:

help the client cope with the anxiety associated with changes in body image. Many clients who undergo surgery for creation of an ileal conduit experience anxiety associated with changes in body image. The mental health practitioner can help the client cope with these feelings of anxiety. Mental health practitioners don't evaluate whether the client is a surgical candidate. None of the evidence suggests that urinary diversion surgery, such as creation of an ileal conduit, places the client at risk for suicide. Although evaluating the need for mental health intervention is always important, this client displays no behavioral changes that suggest intervention is necessary at this time.

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

high purine 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.

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 history of hypertension may put the client at risk for kidney damage, but not kidney infection. Intake of large quantities of cranberry juice and a fluid intake of 2,000 mL/day are not risk factors for pyelonephritis.

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.

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.

Six hours after undergoing an abdominal hysterectomy, a client has a strong urge to void and voids 25 mL into the bedpan. Based on these data, the nurse determines that the client:

is experiencing urine retention and needs to be catheterized. Urinary control may not return for 6 to 8 hours after surgery due to the effects of anesthesia and bladder manipulation during surgery. Urine retention is common; voiding a small amount of urine after surgery may be indicative of urine retention. The nurse should further assess for bladder distention by palpating and percussing the bladder and should intervene with catheterization as appropriate.Fluid status is closely monitored in the operating room, and it is unlikely that the client is dehydrated.An urge to void usually indicates a full bladder, and the client should not be asked to wait and try later. Leaving the bladder distended can stretch the bladder muscle, thus making it more difficult to void.While voiding in small amounts is a symptom of urinary tract infection, it is much more likely that anesthesia, pain, and manipulation during surgery are preventing complete bladder emptying.

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

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.

Which client is at highest risk for developing a urinary tract infection?

man with an indwelling urinary catheter Indwelling catheters are considered to be a major contributor to nosocomial infections. Any client with an indwelling catheter is at high risk for developing a urinary tract infection. A history of previous births does not necessarily predispose a client to urinary tract infections. Clients with a history of renal calculi are not necessarily at risk for developing urinary tract infections unless the renal calculi recur. Clients with diabetes mellitus are at a higher risk for developing urinary tract infections, but this risk can be decreased by maintaining good control over blood glucose 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.

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.

A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. The physician orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 ml. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of:

microorganism transfer. Bladder ultrasonic scanning, a noninvasive way of calculating the amount of urine in the bladder, reduces the risk of transferring microorganisms into the bladder. Use of a straight catheter to measure residual urine increases the transfer of microorganisms into the bladder, and increases, rather than reduces, client discomfort. A bladder ultrasonic scan doesn't reduce the risk of prostate irritation or incorrect urine output values.

A client with a history of chronic cystitis comes to an outpatient clinic with signs and symptoms of this disorder. To prevent cystitis from recurring, the nurse recommends maintaining an acid-ash diet to acidify the urine, thereby decreasing the rate of bacterial multiplication. On an acid-ash diet, the client must restrict which beverage?

milk A client on an acid-ash diet must avoid milk and milk products because these make the urine more alkaline, encouraging bacterial growth. Other foods to avoid on this diet include all vegetables except corn and lentils; all fruits except cranberries, plums, and prunes; and any food containing large amounts of potassium, sodium, calcium, or magnesium. Cranberry and prune juice are encouraged because they acidify the urine. Coffee and tea are considered neutral because they don't alter the urine pH.

A client is admitted with fever and flank pain and is diagnosed with pyelonephritis. What is a prioritynursing intervention in a client with this disorder?

monitoring laboratory values, especially WBCs Pyelonephritis generally causes fever, chills, flank pain, nausea, vomiting, increased white blood cells, pyuria, bacteriuria, and hematuria. As such, the nurse should be monitoring laboratory values, especially white blood cell count for trends, and to observe if antibiotic therapy is effective. Urine is strained if renal calculi are suspected. Specific gravity values and a 24-hour urine collection are not consistent with the treatment of pyelonephritis.

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.Hourly vital signs and strict bed rest are unnecessary unless complications develop.Electrolyte imbalance is not anticipated with this procedure.

After trying for a year to conceive, a couple consults an infertility specialist. When obtaining a history from the husband, the nurse asks about childhood infectious diseases. Which childhood infectious disease most significantly affects male fertility?

mumps Mumps is the childhood infectious disease that most significantly affects male fertility. Chickenpox, measles, and scarlet fever don't affect male fertility.

A client has been prescribed allopurinol for renal calculi that are caused by high uric acid levels. Which symptoms indicate the client is experiencing adverse effect of this drug? Select all that apply

nausea rash bone marrow depression Common adverse effects of allopurinol include gastrointestinal distress, such as anorexia, nausea, vomiting, and diarrhea. A rash is another potential adverse effect. A potentially life-threatening adverse effect is bone marrow depression. Constipation and flushed skin are not associated with this drug.

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis disequilibrium syndrome. Which assessment is the priority?

neurological status Clients experiencing dialysis for the first time often have confusion and even seizures and should be monitored closely. Vital signs and laboratory values are important assessments but do not specifically address dialysis disequilibrium syndrome. Pain in the flank region is not associated with dialysis.

A client with chronic renal failure is experiencing metabolic acidosis. The client most likely requires:

no treatment. The metabolic acidosis of chronic renal failure usually produces no symptoms and requires no treatment.

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.

The nurse is interviewing a client with newly diagnosed syphilis. In order to prevent the spread of the disease, the focus of the interview should include which approach?

obtaining a list of the client's sexual contacts An important aspect of controlling the spread of sexually transmitted diseases (STDs) is obtaining a list of the sexual contacts of an infected client. These contacts, in turn, should be encouraged to obtain immediate care. Many people with STDs are reluctant to reveal their sexual contacts, which makes controlling STDs difficult. Increasing clients' knowledge of the disease and reassuring clients that their records are confidential can motivate them to seek treatment, which does help to control the spread of the disease, but it is not as critical as information about the client's sexual contacts.

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?

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 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.

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

prevent the development of ketosis. High-carbohydrate foods meet the body's caloric needs during acute renal failure. Protein is limited because its breakdown may result in accumulation of toxic waste products. The main goal of nutritional therapy in acute renal failure is to decrease protein catabolism. Protein catabolism causes increased levels of urea, phosphate, and potassium. Carbohydrates provide energy and decrease the need for protein breakdown. They do not have a diuretic effect. Some specific carbohydrates influence urine pH, but this is not the reason for encouraging a high-carbohydrate, low-protein diet. There is no need to reduce demands on the liver through dietary manipulation in acute renal failure.

A client is scheduled for a renal arteriogram. No allergies are recorded in the client's medical record, and the client is unable to provide allergy information. During the arteriogram, the nurse should be alert for which assessment finding that may indicate an allergic reaction to the dye used?

pruritus he nurse should be alert for pruritus, which may indicate a mild anaphylactic reaction to the arteriogram dye. The client would have an increased respiratory rate. Nausea would be more likely with a food allergy or intolerance and would not be associated with a reaction to the dye. Psoriasis is a chronic condition triggered by a hyperimmune response.

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

pulse An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. In addition to assessing the client's pulse, the nurse should place the client on a cardiac monitor because an arrythmia can occur suddenly. The client's blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also may delay assessing respirations and temperature because these aren't affected by the serum potassium level.

Which laboratory value supports a diagnosis of pyelonephritis?

pyuria Pyelonephritis is diagnosed by the presence of pyuria, leukocytosis, hematuria, and bacteriuria. The client exhibits fever, chills, and flank pain. Myoglobinuria is seen with any disease process that destroys muscle. Ketonuria indicates a diabetic state. Because the client with pyelonephritis typically has signs of infection, the WBC count is more likely to be high rather than low

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 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.

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. 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 client is scheduled to undergo transurethral resection of the prostate. The procedure is to be done under spinal anesthesia. What should the nurse assess the client for after surgery?

respiratory paralysis If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal anesthesia is used, the client is likely to develop respiratory paralysis. Artificial ventilation is required until the effects of the anesthesia subside. Seizures, cardiac arrest, and renal shutdown are not likely results of spinal anesthesia.

A client receiving total parenteral nutrition is ordered a 24-hour urine test. When initiating a 24-hour urine specimen, the collection time should

start after a known voiding. When initiating a 24-hour urine specimen, have the client void, then start the timing. The collection should start on an empty bladder. The exact time the test starts isn't important but the test is commonly started in the morning.

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 nurse is providing inservice education for staff members about evidence collection after sexual assault. The educational session is successful when staff members focus their initial care on which step?

supporting the client's emotional status The teaching session is successful when staff members focus first on supporting the client's emotional status. Next, staff members should gain consent to perform the pelvic examination, perform the examination, and collect evidence, such as semen if present.

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 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.

The nurse is working the night shift and needs to collect urine from four clients for routine urinalysis. Which client collection can be delegated to the unlicensed assistive personnel (UAP)?

the client ordered a voided urine The UAP can collect a urine sample from a client who voids the specimen since no additional education is needed. The UAP cannot teach clients about how to catheterize or obtain a sterile specimen, the RN must teach the client these processes themselves. This is because sterile technique must be observed and this necessitates additional education.

Which client will the nurse prioritize to assess first?

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 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 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.

Following an incisional approach to an abdominal hysterectomy, the nurse should assess the client for:

thrombophlebitis. Clients who have had major pelvic surgery are especially at risk for developing thrombophlebitis postoperatively. Extensive manipulation of the pelvic organs and removal of lymph glands can lead to edema, stasis, and circulatory congestion.Ascites, peripheral edema, and hypostatic pneumonia are not complications that would be specifically anticipated after pelvic surgery.

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 human immunodeficiency virus (HIV) infection Women with underlying medical conditions, such as uncontrolled diabetes and HIV infection or cancer-causing immunosuppression, correlate with an increasing severity of candidiasis. Hypertension and asthma are not related to immunosuppression or complicated candidiasis.

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

uremia Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)

urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. The nurse should report which finding to the health care provider (HCP)?

urine output: 20 mL/h The decrease in urine output may reflect inadequate renal perfusion and should be reported immediately. Urine output of 30 mL/h or greater is considered acceptable. A slight elevation in temperature is expected after surgery. Peristalsis returns gradually, usually the second or third day after surgery. Bowel sounds will be absent until then. A small amount of serosanguineous drainage is to be expected.

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation?

urine pH of 3.0 Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal and requires further investigation. Urine specific gravity normally ranges from 1.002 to 1.035, making this client's value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, with color ranging from pale yellow to deep amber.

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.

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 client has an ileal conduit. Which solution will be useful to help control odor in the urine collecting bag after it has been cleaned?

vinegar A distilled vinegar solution acts as a good deodorizing agent after an appliance has been cleaned well with soap and water. If the client prefers, a commercial deodorizer may be used. Salt solution does not deodorize. Ammonia and bleaching agents may damage the appliance.

The nurse should tell a client who is to obtain a midstream urine specimen to:

void directly into the sterile specimen container after voiding a small amount into the toilet. To collect a midstream urine specimen, the client voids directly into a sterile specimen container after voiding a small amount into the toilet.The initial urine voided flushes contaminants out of the urethra and is not saved.The client does not need to empty the bladder. After enough urine has been collected for the specimen, the remainder of the urine may be voided into the toilet, bedpan, or urinal.Cleansing of the urethral meatus is done before obtaining the specimen

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 nurse is caring for a male client with gonorrhea. The client asks how he can reduce his risk of contracting another sexually transmitted disease (STD). The nurse should instruct the client to:

wear a condom every time he has intercourse. Wearing a condom during intercourse considerably reduces the risk of contracting STDs. Asking all potential sexual partners if they have an STD; considering intercourse safe if his partner has no visible discharge, lesions, or rashes; and limiting the number of sexual partners won't reduce the risk of contracting an STD to the extent wearing a condom will. A monogamous relationship also reduces the risk of contracting STDs.

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

weight loss. Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?

white blood cell (WBC) count of 20,000/mm3 (0.02 L) 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.