Genitourinary Disorders
A middle-aged male client comes to the clinic for an evaluation of difficulty urinating and nocturia. His father died from prostate cancer. He asks the nurse what he can do to ensure early detection of this disease. What question will the nurse ask next?
"Do you have a digital rectal examination and prostate-specific antigen tests yearly?"
A client who is recovering from transurethral resection of the prostate (TURP) experiences urinary incontinence and has decreased the fluid intake because of the incontinence. What is the nurse's best response to the client?
"Drink eight glasses of water a day, and urinate every 2 hours."
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."
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'll need to get a urine culture when I am finished taking the pills."
A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?
"Increase your fluid intake to 2 to 3 L per day."
The nurse is explaining hemodialysis to a student nurse. What statement leads the nurse to determine that additional teaching is needed?
"It will extract the client's red blood cells."
The nurse is caring for a client diagnosed with genitourinary tuberculosis (TB). Which statement, made by the client, about genitourinary TB demonstrates an understanding?
"It's a late manifestation of respiratory tuberculosis."
A 65-year-old male client with erectile dysfunction (ED) asks the nurse, "Is all this just in my head? Am I crazy?" What should the nurse tell the client?
"More than 50% of the cases are attributed to organic causes."
Which instruction would a nurse include in the discharge teaching for a client who has an ileal conduit?
"Mucous in the pouch is expected."
A client who is to have a vaginal radium implant tells the nurse she is concerned about being radioactive. What should the nurse tell the client?
"The radioactive material is controlled and stays with the source; once the material is removed, no radioactivity will remain."
After trying for a year to conceive, a couple consults a fertility specialist. When obtaining a history from the husband, which question should the nurse ask?
"What childhood immunizations and illnesses did you have?"
A nurse is attending a seminar at the local senior center. The nurse knows the presenter has a good understanding of genitourinary changes in the elderly when the presenter makes which statement?
"You should leave a light on in your bathroom at night."
A client is admitted for a transurethral resection of the prostate (TURP). Preoperative teaching will include which information?
"You will return from surgery with a catheter in your bladder and fluid flowing into and out of it continuously."
A client reports having difficulty voiding to the nurse. What question(s) will the nurse ask the client? Select all that apply.
-"Are you waking up in the middle of the night to void?" -"How much fluids are you drinking in the late evenings?" -"What are your usual voiding patterns?"
A client with chronic renal failure who receives hemodialysis twice a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? Select all that apply.
-Have limited amounts of fluids only when thirsty. -Keep all dialysis appointments. -Eat smaller, more frequent meals.
The nurse is assigned the care of a client with acute renal failure and hypernatremia. Which actions can be delegated to the unlicensed assistive personnel (UAP)? Select all that apply.
-Obtain and monitor vital signs. -Oral care every 4 hours.
A nurse is discharging a client diagnosed with a urinary tract infection. Which information should the nurse include in the discharge teaching? Select all that apply.
-Take all antibiotics as prescribed. -Avoid coffee, tea, and alcohol.
When teaching a client with a urinary tract infection about taking a prescribed antibiotic for 7 days, the nurse should tell the client to report which symptom(s) to the health care provider (HCP)? Select all that apply.
-blood in the urine -rash -fever above 100° F (37.8° C)
A young adult client tells the nurse they have a slight yellow vaginal discharge. The nurse should tell the client to contact their health care provider (HCP) if they have which additional symptom(s)? Select all that apply.
-vaginal discharge that has a fishy odor -abdominal pain -a temperature above 101ºF (38.3ºC)
A child with nephrosis is placed on prednisone. The dose is 2 mg/kg per day to be administered in two divided doses. The child weighs 25 lb (11.3 kg). How many milligrams will the child receive at each dose? Record your answer using one decimal place.
11.3
Which woman is at greatest risk for bacterial vaginosis?
28-year-old who is sexually active
A woman is using progestin injections for contraception. When does the nurse instruct the client to return for the next injection?
3 months
A competent client has refused all medications despite being taught and understanding the rationales for the medications. The client states, "I don't want to take those pills anymore." What is the nurse's next action?
Accept the client's right to refuse medications at this time, and document the refusal.
A client reports left calf pain after undergoing a renal arteriogram through the left femoral artery. What intervention will the nurse perform first?
Assess peripheral pulses in the left leg.
Eight hours after an abdominal hysterectomy, the client has not voided and says to the nurse, "I don't think I can urinate."What should the nurse do first?
Assess the client's bladder.
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.
A client undergoes a nephrectomy. In the immediate postoperative period, which nursing intervention has the highest priority?
Assess urine output hourly.
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.
A client with acute pyelonephritis receives a prescription for co-trimoxazole P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the ordered regimen?
Bacteria are absent on urine culture.
The nurse is planning care for a client with stress incontinence. What goal is realistic for the nurse to establish with the client?
Decrease the number of incontinence episodes.
A client receiving total parenteral nutrition (TPN) is ordered to undergo a 24-hour urine test for creatinine clearance. Which actions should the client take to initiate this collection?
Discard the first morning void, then continue the collection for exactly 24 hours.
A client has a temperature of 98.6° F (37° C) prior to dialysis and 100° F (37.7° C) post dialysis. What is the appropriate nursing action?
Document the finding as the only action.
The nurse advises a client diagnosed with a chlamydial infection to inform sexual partners of the infection. The client refuses, stating, "This is my business, and I am not telling anyone. Besides, chlamydia does not cause any harm like the other sexually transmitted infections." What is the nurse's best response?
Educate the client about chlamydia and why it is important to inform past and current sexual contacts.
A client had an intravenous pyelogram (IVP) 1 hour ago. What should the nurse include in the client's plan of care?
Encourage adequate fluid intake.
A client is diagnosed with pyelonephritis. Which nursing action is a priority?
Ensure sufficient hydration.
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 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 Cancer Society and the Canadian Cancer Society recommend an annual rectal examination.
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.
The nurse is teaching a client with an ileal conduit how to prevent a urinary tract infection. Which measure would be most effective?
Maintain a daily fluid intake of 68 to 101 oz (2000 to 3000 mL.).
The nurse is caring for a client who had a closed renal biopsy. Which should the nurse include in the care plan after the biopsy?
Maintain the client on strict bed rest in a supine position for 6 hours.
Two weeks after being diagnosed with a streptococcal infection, a client develops fatigue, a low-grade fever, and shortness of breath. The nurse auscultates bilateral crackles and observes jugular vein distention. Urinalysis reveals red and white blood cells and protein. After the physician diagnoses poststreptococcal glomerulonephritis, the client is admitted to the medical-surgical unit. Which immediate action should the nurse take?
Monitor patient blood pressure.
A nurse is caring for an 8-year-old female with multiple, chronic urinary tract infections. While the nurse helps the child's parent provide morning care, the child states, "My uncle doesn't clean me that way." The parent becomes visibly upset and gives the girl a stern warning not to discuss the matter. What is the priority action for the nurse?
Notify the nursing supervisor and the authorities of the possibility of abuse.
Prior to administering continuous renal replacement therapy (CRRT) on November 7, the nurse notes that the dialysate is clear and the expiration date is November 6. What is the appropriate action by the nurse?
Obtain new dialysate.
The nurse is planning care for a client with a catheter. What action(s) should the nurse take to prevent a catheter-associated urinary tract infection? Select all that apply.
Provide perineal care at least once a day. Maintain a closed drainage system. Encourage the client to drink 101 oz (3000 mL) fluids daily.
A client has experienced excessive losses of bicarbonate and has subsequently developed an acid-base imbalance. How will this lost bicarbonate be replaced?
Renal tubular cells will generate new bicarbonate.
A nurse is caring for a client diagnosed with acute kidney injury with an indwelling urinary catheter. The nurse notes that the total urine output for the previous 24 hours is 35 ml. What action should the nurse perform first?
Scan the client's bladder to determine if residual volumes are present.
The nurse is observing an unlicensed assistive personnel (UAP) give care to a client after gynecologic surgery. When should the nurse discuss the care with the UAP?
The UAP massages the client's legs.
A client asks the nurse to explain the meaning of their abnormal Papanicolaou (Pap) test result of atypical squamous cells. The nurse should tell the client that an atypical Pap test means that what has occurred?
The cells could cause various conditions and help identify a problem early.
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.
During a routine physical examination, a male client informs the nurse that he frequently participates in anal intercourse with his sexual partner. What education is important for the nurse to include with health teaching?
The client should wear a condom during anal intercourse.
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.
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.
A client who had a transurethral resection of the prostate (TURP) 1 day earlier has a three-way Foley catheter inserted for continuous bladder irrigation. Which of the following statements best explains why continuous irrigation is used after TURP?
To keep the catheter free from clot obstruction.
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.
The nurse is helping a client obtain a midstream urine specimen. What should the nurse tell the client to do?
Void directly into the sterile specimen container after voiding a small amount into the toilet.
A client is at risk for acute pyelonephritis. The nurse should instruct the client about which health promotion behavior that will be most effective in preventing pyelonephritis?
Wash the perineum with warm water and soap, cleaning from front to back.
A nurse receives the assignment of clients for the shift. Following the report, which client should the nurse see first?
a client 3 days after a kidney transplant with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L after dialysis
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)
A client comes to the emergency department reporting severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis?
acute pain
A nurse is caring for a client diagnosed with ovarian cancer. Diagnostic testing reveals that the cancer has spread outside the pelvis. The client has previously undergone a right oophorectomy and received chemotherapy. The client now wants palliative care instead of aggressive therapy. The nurse determines that the care plan's priority nursing diagnosis should be:
acute pain.
A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?
assessing present voiding patterns
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 101 fl oz (3030 mL) of fluids daily
The nurse is teaching a client with erectile dysfunction (ED) to alter their lifestyle. Which change should the nurse recommend?
avoid alcohol
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 regularly?
blood pressure
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
A client with renal insufficiency is admitted to the hospital with pneumonia. The client is being treated with gentamicin. Which laboratory value should be closely monitored?
blood urea nitrogen (BUN)
The nurse is planning for home care with a client after transurethral resection of the prostate (TURP). What should the nurse tell the client about the dribbling of urine after this surgery?
can persist for several months.
A client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for:
cardiac arrhythmia.
A client with chronic kidney disease (CKD) has a blood urea nitrogen (BUN) of 100 mg/dL, serum creatinine of 6.5 mg/dL, potassium of 6.1 mEq/L, and lethargy. What is the priority nursing assessment?
cardiac rhythm
A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis?
corticosteroids use
The nurse receives the preoperative blood work report for a client who is scheduled to undergo surgery. Which laboratory finding should the nurse report to the surgeon and anesthesiologist?
creatinine, 2.6 mg/dL (230 µmol/L)
To treat a urinary tract infection, a client is ordered sulfamethoxazole-trimethoprim. The nurse should teach the client that sulfamethoxazole-trimethoprim is most likely to cause which adverse effect?
diarrhea
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.
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
A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?
foul-smelling discharge from the penis
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
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
A 45-year-old female client has stress incontinence. Which data from the client's history contributes most to the client's incontinence?
history of three full-term pregnancies
A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:
hyperkalemia.
A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important?
increasing fluid intake to 3 L/day
A client comes to the emergency department reporting sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site?
kidney
A nurse is assessing a client with nephrotic syndrome. The nurse should assess the client for which condition?
massive proteinuria
When educating a female client with gonorrhea, the nurse should emphasize which information?
may not cause symptoms until serious complications occur.
A client diagnosed with cancer of the cervix in situ is scheduled to have a conization. Which is a priority during the first 24 postoperative hours?
monitoring vaginal bleeding
A client with suspected renal dysfunction is scheduled for excretory urography. The nurse reviews the client history for conditions that may warrant changes in client preparation. Normally, the client should be mildly hypovolemic (fluid depleted) before excretory urography. Which history finding calls for the client to be well hydrated?
multiple myeloma
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.
A client with a testicular malignancy undergoes a radical orchiectomy. What should the nurse assess the client for during the immediate postoperative period?
pain
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
A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first?
pulse
The correct procedure for collecting a urine specimen from an indwelling catheter is to:
remove urine from the drainage tube with a sterile needle and syringe and place urine from the syringe into the specimen container.
A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is
renal calculi.
A nurse is planning to administer a sodium polystyrene sulfonate enema to a client with a potassium level of 6.2 mEq/L. Correct administration and the effects of this enema should include having the client
retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.
A 30-year-old client is being treated for epididymitis. What information should the nurse include in the teaching plan about the likely cause of epididymitis?
sexually transmitted infection
A client is diagnosed with a calcium oxalate urolithiasis. The nurse will need to clarify the teaching if the client chooses which menu items?
spinach
A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal?
transurethral resection of the prostate (TURP)
Which clinical finding should a nurse look for in a client with chronic renal failure?
uremia
The nurse is assessing a young adult male client who has pain when urinating. The client states they think they have a sexually transmitted infection. When obtaining a health history, the nurse should ask the client if they are experiencing which symptom?
urethral discharge
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, what should the nurse determine the client is experiencing?
urine retention
A 20-year-old female client says, "I feel that my vaginal opening constricts whenever I am about to have intercourse. I seem to have no control over it." Which term should the nurse use to document the client's condition?
vaginismus
To prevent recurrence of cystitis, the nurse should plan to encourage a female client to include which measure in their daily routine?
wearing cotton underpants
