GENITOURINARY DISORDERS
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: You selected: dehydration. Incorrect Correct response: cardiac arrhythmia. Explanation: As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn't cause paresthesia (sensations of numbness and tingling). Dehydration doesn't occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. In the client with ARF, pruritus results from increased phosphates and isn't associated with hyperkalemia. (less)
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The nurse is developing an educational program about prostate cancer. The nurse should provide information about which of the following topics. Correct response: For all men, age 50 and older, the American Cancer Society recommends an annual rectal examination. Explanation: Most prostate cancer is adenocarcinoma and 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 recommends an annual rectal examination and blood PSA level for all men age 50 and older, or starting at age 40 if African American or if there is family history of prostate cancer. To help achieve optimal sexual function, give the client the opportunity to communicate his concerns and sexual needs. Regular sexual activity does not prevent cancer.
A client has undergone a cystectomy and an ileal conduit diversion. What should the nurse incorporate into the discharge instructions? Select all that apply. Correct response: • Drink at least 3,000 ml of fluid each day. • Avoid odor-producing foods, such as onions, fish, eggs, and cheese. Explanation: An adequate fluid intake aids in the prevention of urinary calculi and infection. Odor-producing foods can produce offensive odors that may impact the client's lifestyle and relationships. Lack of activity leads to urinary stasis, which promotes urinary calculi development and infection. Acidic urine helps prevent urinary tract infections. Tight clothing over the stoma obstructs blood circulation and urine flow.
A client returns to an intensive care unit after coronary artery bypass graft surgery, which was complicated by prolonged cardiopulmonary bypass and hypotension. After 3 hours in the unit, the client's condition stabilizes. However, the urine output has decreased despite adequate filling pressures. The nurse expects the physician to add which drug, at which flow rate, to the client's regimen? Correct response: Dopamine (Intropin), 3 mcg/kg/minute Explanation: This client is at high risk for acute prerenal failure secondary to decreased renal perfusion during surgery. To dilate the renal arteries and help prevent renal shutdown, the physician is likely to order dopamine at a low flow rate (2 to 5 mcg/kg/minute). Although this drug has mixed dopaminergic and beta activity when given at 5 to 10 mcg/kg/minute, the client is stabilized and thus doesn't need the beta effects from the higher flow rate — or the sympathomimetic effects of epinephrine. The dopaminergic effects of dopamine increase renal perfusion, contractility, and vasodilation. Dobutamine is used to increase cardiac output. Norepinephrine is a potent vasoconstrictor that shunts blood away from the kidneys to increase blood pressure.
A client undergoes a nephrectomy. In the immediate postoperative period, which nursing intervention has the highest priority? Correct response: Assessing urine output hourly. Explanation: After a nephrectomy, a specific aspect of immediate postoperative management includes monitoring urine output at least hourly. Monitoring blood pressure and encouraging the use of incentive spirometry are other important considerations, but because of the surgical disruption of the urinary system, urine output is a priority. Measurement of urine output should also include an estimation of the amount of urine drainage on the flank dressing.
Trichomoniasis; caused by a protozoan Although the client may not have symptoms, the classic symptom is a malodorous, yellow-green discharge.
A women with a uterus who takes unopposed estrogen has an increased risk of endometrial cancer. The addition of progesterone prevents the formation of endometrial hyperplasis.
Low fluid intake can predispose an individual to calculi formation due to the increased urine concentration. Other causes include repeated urinary tract infections, high doses of vitamin C or D, immobility, and large doses of calcium. A single episode of urinary tract infection is not as likely to lead to calculi formation as a routinely low fluid intake. Large doses of vitamin E do not cause renal calculi. A diet that contains the normal daily requirements of calcium will not be as likely to predispose most individuals to renal calculi as a decreased fluid intake.
During dialysis, the client has disequilibrium syndrome. The nurse should first? You selected: Slow the rate of dialysis. Correct Explanation: If disequilibrium syndrome occurs during dialysis, the most appropriate intervention is to slow the rate of dialysis. The syndrome is believed to result from too-rapid removal of urea and excess electrolytes from the blood; this causes transient cerebral edema, which produces the symptoms. Administration of oxygen and position changes do not affect the symptoms. It would not be appropriate to reassure the client that the symptoms are normal.
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? You selected: Scarlet fever Incorrect Correct response: Mumps Explanation: Mumps is the childhood infectious disease that most significantly affects male fertility. Chickenpox, measles, and scarlet fever don't affect male fertility.
Low fluid intake can predispose an individual to calculi formation due to the increased urine concentration. Other causes include repeated urinary tract infections, high doses of vitamin C or D, immobility, and large doses of calcium. A single episode of urinary tract infection is not as likely to lead to calculi formation as a routinely low fluid intake. Large doses of vitamin E do not cause renal calculi. A diet that contains the normal daily requirements of calcium will not be as likely to predispose most individuals to renal calculi as a decreased fluid intake.
Which of the following compensatory actions by the body would occur if a client were in respiratory acidosis?
Retention of HCO3- by the kidneys The compensatory mechanism for respiratory acidosis is the renal system. In respiratory acidosis, the kidneys will conserve HCO3 in an attempt to correct the acidosis. Excretion of HCO3 would exacerbate the body's acidosis. The lungs cannot compensate for a problem that arises in the respiratory system.
Renal stones found to be composed of uric acid; a low purine, alkaline diet milk, all fruits, tomatos, cereals, and corn, especially legumes and green vegetables. Gravy, chiken and liver are hig in purine.
Six hours after an abdominal hysterectomy, a client has a strong urge to void and voids 25ml; experiencing urine retention and needs to be catheterized Urinary control may not return for 6-8 hours after surgery owing to the effects of anesthesia and bladder manipulation during surgery. Urine retention is common; voiding a small amount of urine after surgery may indicative of urine retention.
Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the expected outcome of giving this drug? Correct response: Binding phosphate in the intestine. Explanation: 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.
To assess the client's renal status, the nurse should monitor which of the following laboratory tests? Select all that apply. You selected: • Serum blood urea nitrogen • Creatinine levels. Correct Explanation: Serum BUN and creatinine are the tests most commonly used to assess renal function, with creatinine being the most reliable indicator. Nonrenal factors may affect BUN levels as well as serum sodium and potassium levels. Arterial blood gases and hemoglobin are not used to assess renal status. Urinalysis is a general screening test.
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 of the following terms should the nurse use to document the client's condition? You selected: Vaginismus. Correct Explanation: The client is experiencing an involuntary contraction of the muscles surrounding the vaginal orifice; this should be documented as vaginismus. Dyspareunia is painful intercourse. Difficulty achieving orgasm is documented as orgasmic dysfunction. Abstention from sexual intercourse is documented as celibacy.
Which of the following would the nurse include in the teaching plan for a 32-year-old female client requesting information about using a diaphragm for family planning? You selected: Diaphragms should not be used if the client develops acute cervicitis. Correct Explanation: 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.
