Week 2: Genitourinary Disorders

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 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.

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.

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 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 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 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 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 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.

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 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.

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.

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.

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.

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.

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.

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

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

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.

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.

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.

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.

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 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 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%.

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 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.

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.

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).

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.

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.

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.

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.

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.

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 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.

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.

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 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.

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 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 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.

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 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.

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 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 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.

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.