Genitourinary Disorders

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. The prostate-specific antigen (PSA) test is reliable for detecting the presence of prostate cancer. Regular sexual activity promotes the health of the prostate gland, which prevents cancer. Men over 50 should have a colonoscopy.

For all men, age 50 and older, the American Cancer Society and the Canadian Cancer Society recommend an annual rectal examination. Explanation: 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 a family history of prostate cancer. A colonoscopy is performed to diagnose colon cancer, not prostate cancer. Regular sexual activity does not prevent cancer of the prostate.

A 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? cystic fibrosis myasthenia gravis gout multiple myeloma

multiple myeloma Explanation: Fluid depletion before excretory urography is contraindicated in clients with multiple myeloma, severe diabetes mellitus, and uric acid nephropathy — conditions that can seriously compromise renal function in fluid-depleted clients with reduced renal perfusion. If these clients must undergo excretory urography, they should be well hydrated before the test. Cystic fibrosis, gout, and myasthenia gravis don't necessitate changes in client preparation for excretory urography.

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. Abnormal viral cells were found in the test. Cancer cells were found in the smear. The Pap smear alone is not very important diagnostically because there are many false-positive results.

The cells could cause various conditions and help identify a problem early. Explanation: The Pap test 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 test 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%.

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 the risk factors for this disease? "Exposure to dyes used to color fruits and vegetables increases the risk for polycystic kidney disease." "Drinking alcohol daily allows the kidneys to develop cysts." "There is a higher incidence of polycystic kidney disease among blood relatives." "Secondhand smoke puts you at greater risk for developing cysts."

"There is a higher incidence of polycystic kidney disease among blood relatives." Explanation: 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 secondhand smoke promote the 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 nurse is caring for a client in renal failure who fell and sustained a head injury. The nurse is educating the client on the upcoming computed tomography (CT) scan of the brain requiring radiopaque dye. Which statement by the nurse is correct? "Blood will be drawn and analyzed before the test to ensure your kidneys can remove the dye." "It is important to lie still for 2 hours during the scan as movement can interfere with the results." "Flushing, itching, shortness of breath, and dizziness after injection of the dye is common." "Your hearing aids may stay in during the scan so you can accurately hear the instructions."

"Blood will be drawn and analyzed before the test to ensure your kidneys can remove the dye." Explanation: The radiopaque dye used in CT scans is filtered by the kidneys and then excreted from the body. If a client has renal impairment the kidneys may be unable to filter this dye. Therefore, a creatinine blood test is completed prior to the scan to ensure appropriate kidney function. Although it is important to remain still during this scan, a brain CT takes approximately 30 minutes. Instructing the client to lie still for 2 hours is unnecessary. Feeling flushed and warm after receiving the radiopaque dye is common; however, shortness of breath, pruritus, and dizziness can be signs of an allergic reaction. Metal objects such as hearing aids, piercings, and other jewelry are not allowed in the CT scan

A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs) about prevention. What statement indicates the client understands the teaching? "I should wipe from back to front." "I should empty my bladder after eating a meal." "I should take at least 1,000 mg of vitamin C each day." "I should take a tub bath at least 3 times per week."

"I should take at least 1,000 mg of vitamin C each day." Explanation: The client demonstrates understanding of teaching when she states that she should take vitamin C each day. Increasing vitamin C intake to at least 1,000 mg per day helps acidify the urine, decreasing the amount of bacteria that can grow. The client should wipe from front to back to avoid introducing bacteria from the anal area into the urethra. The client should shower, not bathe, to minimize the amount of bacteria that can enter the urethra. The client should increase her fluid intake, and void every 2 to 3 hours and completely empty her bladder. It is not sufficient to empty the bladder only after eating a meal. Holding urine in the bladder can cause the bladder to become distended, which places the client at further risk for UTIs.

A client with benign prostatic hypertrophy is being transferred from the emergency department to a surgery unit. Which information should be included in the report from the nurse in the emergency department to the nurse responsible for admitting the client? "The client is very cooperative. The client is comfortable now that their bladder has been emptied. They have no ill effects from catheterization." "The client was catheterized, and 1100 mL of urine was obtained. The urine appeared cloudy, and a specimen was sent to the laboratory." "A urine specimen was obtained from the client and sent to the laboratory for analysis." "The client was in the emergency department for 3 hours because of bladder distention. The client is fine now but is being admitted as a possible candidate for surgery."

"The client was catheterized, and 1100 mL of urine was obtained. The urine appeared cloudy, and a specimen was sent to the laboratory." Explanation: A report about the client's condition should be as clear, pertinent, and concise as possible. It should be free of subjective information that could be interpreted differently by different caregivers. The report mentioning that a specimen was sent to the laboratory does not indicate how much urine had been drained from the client's bladder and how the urine appeared. The report describing the client as cooperative is subjective and provides only limited client data. The report that mentions that the client was in the emergency department for 3 hours does not mention the treatment provided.

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 an early manifestation of an autoimmune disorder." "It isn't infectious, and I can't pass it from one person to another." "I can't pass it sexually to my partner." "It's a late manifestation of respiratory tuberculosis."

"It's a late manifestation of respiratory tuberculosis." Explanation: Genitourinary TB is usually a late manifestation of respiratory TB and can occur if the disease spreads through the bloodstream from the lungs. Bacillus in the urine is infectious, and urine would be handled cautiously. A condom would be used during sex to prevent spread of the infection.

A client who weighs 207 lb (94.1 kg) is to receive 1.5 mg/kg of gentamicin sulfate intravenously three times each day. How many milligrams of medication should the nurse administer for each dose? Round to the nearest whole number. mg

141 Explanation: Each of the 3 daily doses is 1.5 mg/kg. The client weighs 94.1 kg. Multiply 1.5 mg/kg/dose × 94.1 kg = 141.15 mg/dose, which rounds to 141 mg/dose.

A client has nephropathy. The health care provider (HCP) prescribes a 24-hour urine collection for creatinine clearance. Which action is necessary to ensure proper collection of the specimen? Request a prescription for the insertion of an indwelling urinary catheter. Inform the client to discard the last voided specimen at the conclusion of urine collection. Collect the urine in a preservative-free container and keep it on ice. Obtain a self-report of the client's weight before beginning the collection of urine.

Collect the urine in a preservative-free container and keep it on ice. Explanation: All urine for creatinine clearance determination must be saved in a container with no preservatives and refrigerated or kept on ice. The first urine voided at the beginning of the collection is discarded, not the last. A self-report of weight may not be accurate. It is not necessary to have an indwelling urinary catheter inserted for urine collection.

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? Start with the first voiding of the day and then continue for exactly 24 hours. Discard the first morning void, then continue the collection for exactly 24 hours. Begin at 0800 and then continue until 0759 on the following day. Start immediately after initiation of TPN and then continue for exactly 24 hours.

Discard the first morning void, then continue the collection for exactly 24 hours. Explanation: Evidence-based practice (EBP) dictates that the nurse should start the test after the first morning void, but this first void should be discarded. The other choices are not correct.

THE PATIENT HAD AN INTRAVENOUS PYELOGRAM (IVP) 1 HOUR AGO. WHAT SHOULD THE NURSE INCLUDE IN THE PATIENT'S PLAN OF CARE? a)MAINTAIN BED REST b)ENCOURAGE ADEQUATE FLUID INTAKE c)ASSESS FOR HEMATURIA ADMINISTER A LAXATIVE

Encourage adequate fluid intake. Explanation: After an IVP, the nurse should encourage fluids to decrease the risk for 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.

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 a normal finding associated with the client's nothing-by-mouth status. It's a normal finding caused by blood loss during surgery. It's an abnormal finding that will correct itself when the client ambulates. It's an abnormal finding that requires further assessment.

It's an abnormal finding that requires further assessment. Explanation: 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.

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? Encourage activity as tolerated. Monitor patient blood pressure. Place the client on a sheepskin, and monitor for increasing edema. Provide a high-protein, fluid-monitored diet.

Monitor patient blood pressure. Explanation: Blood pressure control is a priority assessment in clients with poststreptococcal glomerulonephritis. The blood pressure can be increased for up to 6 weeks after treatment. The nurse must provide a low-protein diet during the acute phase. The nurse must also closely monitor the client's fluid intake and output. Clients should be placed on bed rest to control hypertension and workload on the kidney. Although providing comfort measures (such as placing the client on a sheepskin) are important, this action isn't a priority.

The nurse collects a urine specimen from a client for a culture and sensitivity analysis. What should the nurse do to preserve the specimen? Store it in the refrigerator until it can be sent to the laboratory. Assign an unlicensed assistive personnel to take it to the laboratory as soon as possible. Send it to the laboratory immediately. Place it on counter for the next specimen pickup.

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

Which abnormal blood value would not be improved by dialysis treatment? hypernatremia decreased hemoglobin concentration elevated serum creatinine level hyperkalemia

decreased hemoglobin concentration Explanation: Dialysis has no effect on hemoglobin levels because some red blood cells are injured during the procedure; dialysis aggravates a low hemoglobin concentration and may contribute to anemia. Dialysis will clear metabolic waste products from the body and correct electrolyte imbalances.

A client has prostatic hypertrophy. When conducting a focused assessment of the client's ability to urinate, the nurse should expect which finding? painful urination difficulty starting the flow of urine increased force of the urine stream voiding at less frequent intervals

difficulty starting the flow of urine Explanation: Signs and symptoms of prostatic hypertrophy include difficulty starting the flow of urine, urinary frequency, and hesitancy, decreased force of the urine stream, interruptions in the urine stream when voiding, and nocturia. The prostate gland surrounds the urethra, and these symptoms are all attributed to obstruction of the urethra resulting from prostatic hypertrophy. Nocturia from incomplete emptying of the bladder is common. Straining and urine retention are usually the symptoms that prompt the client to seek care. Painful urination is generally not a symptom of prostatic hypertrophy.

After undergoing an abdominal hysterectomy, a client has gas pains. Which nursing action would most likely relieve the gas pains? helping the client walk providing extra warmth offering the client a hot beverage applying a snugly fitting abdominal binder

helping the client walk Explanation: The discomfort associated with gas pains is likely to be relieved when the client ambulates. The gas will be more easily expelled with exercise. The anesthesia, analgesics, and immobility have altered normal peristalsis. Peristalsis will be stimulated by exercise. Offering a hot beverage, providing extra warmth, and applying an abdominal binder are not recommended and could aggravate the discomfort of postoperative gas pains.

A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important? increasing fluid intake to 3 L/day using an indwelling urinary catheter to measure urine output accurately encouraging the client to drink cranberry juice to acidify the urine administering a sitz bath twice per day

increasing fluid intake to 3 L/day Explanation: Acute pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both kidneys. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. Pyelonephritis may result from procedures that involve the use of instruments (such as catheterization, cystoscopy, and urologic surgery) or from hematogenic infection. The most important nursing intervention is to increase fluid intake to 3 L/day. Doing so helps empty the bladder of contaminated urine and prevents calculus formation. Administering a sitz bath would increase the likelihood of fecal contamination. Using an indwelling urinary catheter could cause further contamination. Encouraging the client to drink cranberry juice to acidify urine is helpful but isn't the most important intervention.

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 maintaining strict bed rest monitoring vital signs hourly maintaining electrolyte balance

monitoring vaginal bleeding Explanation: Uncontrolled vaginal bleeding is the priority concern during the first 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 28-year-old client is diagnosed with acute epididymitis. What should the nurse assess the client for when conducting a focused assessment? severe tenderness and swelling in the scrotum foul-smelling urine foul-smelling ejaculate burning and pain during urination

severe tenderness and swelling in the scrotum Explanation: Epididymitis causes acute tenderness and pronounced swelling of the scrotum. Gradual onset of unilateral scrotal pain, urethral discharge, and fever are other key signs. Epididymitis is occasionally, but not routinely, associated with urinary tract infection. Burning and pain on urination and foul-smelling ejaculate or urine are not classic symptoms of epididymitis.

A client is diagnosed with a calcium oxalate urolithiasis. The nurse will need to clarify the teaching if the client chooses which menu items? banana coffee spinach liver

spinach Explanation: Spinach is high in calcium oxalate. Bananas contain potassium, liver contains purines, and coffee irritates the stomach; however, they do not contain calcium oxalate.

Which clinical finding should a nurse look for in a client with chronic renal failure? polycythemia hypotension uremia metabolic alkalosis

uremia Explanation: 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 has renal colic due to renal lithiasis. What is the nurse's priority in managing care for this client? Request the central supply department to send supplies for straining urine. Encourage the client to drink at least 17 oz (500 mL) of water each hour. Administer an opioid analgesic as prescribed. Do not allow the client to ingest fluids.

Administer an opioid analgesic as prescribed. Explanation: 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.

Which action has the highest priority in the care of a client with chronic renal failure? Apply corticosteroid creams to relieve itching. Maintain a low-sodium diet. Measure abdominal girth daily. Achieve pain control with analgesics.

Maintain a low-sodium diet. Explanation: It is appropriate for the client to be on a low-sodium diet to help decrease fluid retention. Dry skin and pruritus are common in renal failure. Lotions are used to relieve the dry skin, and antihistamines may be used to control itching; corticosteroids are not used. Pain is not a major problem in chronic renal failure, but analgesics that are excreted by the kidneys must be avoided. It is not necessary to measure abdominal girth daily because ascites is not a clinical problem in renal failure.

A client is voiding small amounts of urine every 30 to 60 minutes. What should the nurse do first? Encourage an increased fluid intake. Palpate for a distended bladder. Catheterize the client for residual urine. Obtain a urine specimen for culture.

Palpate for a distended bladder. Explanation: When a client voids frequent, small amounts, the nurse should suspect that the client is retaining urine. Palpating for a distended bladder is the first assessment that the nurse should perform to verify this suspicion. Obtaining a prescription to catheterize for residual urine may be appropriate as a follow-up activity. Obtaining a urine specimen for culture is not a first priority. The nurse would not encourage an increased fluid intake until further assessment of the situation is completed.

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? encouraging the client to increase the time between voidings restricting fluid intake to reduce the need to void establishing a predetermined fluid intake pattern for the client assessing present voiding patterns

assessing present voiding patterns Explanation: The guidelines for initiating bladder retraining include assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

A client is admitted to the recovery room after cystoscopy with biopsy. Before discharging the client, what should the nurse determine? The client has: no pain. emptied the bladder. no blood in the urine. had a bowel movement.

emptied the bladder. Explanation: The nurse should verify that the client has voided before discharge to evaluate bladder function. Bowel function is not expected to be affected by this procedure. There may not be a need for pain medication immediately after the procedure and before discharge, but the nurse should assess the client's pain status and inform the client about the use and side effects of the medication. It is normal for the client to have hematuria because of the procedure.

A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important? using an indwelling urinary catheter to measure urine output accurately administering a sitz bath twice per day encouraging the client to drink cranberry juice to acidify the urine increasing fluid intake to 3 L/day

increasing fluid intake to 3 L/day Explanation: Acute pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both kidneys. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. Pyelonephritis may result from procedures that involve the use of instruments (such as catheterization, cystoscopy, and urologic surgery) or from hematogenic infection. The most important nursing intervention is to increase fluid intake to 3 L/day. Doing so helps empty the bladder of contaminated urine and prevents calculus formation. Administering a sitz bath would increase the likelihood of fecal contamination. Using an indwelling urinary catheter could cause further contamination. Encouraging the client to drink cranberry juice to acidify urine is helpful but isn't the most important intervention.

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? ureter bladder kidney urethra

kidney Explanation: The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation.

The nurse is reading the nurse's note from the previous shift to evaluate the client with a risk for impaired skin integrity due to fluid volume excess. Which aspects would demonstrate this improvement? Foot of bed elevated 30 degrees for peripheral edema. Presence of urine output that is amber in color. Client statement of thirst and request for the cup of water. Ambulation to the bathroom without noted dyspnea.

Ambulation to the bathroom without noted dyspnea. Explanation: The client would have ambulation without dyspnea as a sign of improvement with fluid volume excess. Amber urine is a sign of a continued imbalance of fluid volume and the client's response of thirst is likely due to fluid restriction, not an indication of improvement. The foot of bed elevation would be a treatment and not a sign of improvement with fluid volume excess.

The nurse is providing preoperative instructions to a client who is having a transurethral resection of the prostate (TURP). What should the nurse tell the client? "Expect blood in your urine in the first couple of days following the procedure." "You will be taught care of the incision and suture line before your discharge home." "Plan on being in the hospital anywhere from 5 to 7 days following the procedure." "You will have a central venous access inserted just before the procedure."

Expect blood in your urine in the first couple of days following the procedure." Explanation: 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 intravenous 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 correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? acidic basic neutral alkaline

acidic Explanation: Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals acidic urine pH. A pH above 7.0 is considered an alkaline or basic solution. A pH of 7.0 is considered neutral.

A client is scheduled for hemodialysis three times a week. The nurse is explaining complications to the client. Which complications are related to hemodialysis treatments? Select all that apply. nausea and vomiting hypotension leg cramps hypertension bleeding

bleeding leg cramps hypotension Explanation: Bleeding, leg cramps, and hypotension are hemodialysis complications. Nausea/vomiting and hypertension are related to the kidney failure.

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? white blood cell (WBC) count blood urea nitrogen (BUN) sodium level alkaline phosphatase

blood urea nitrogen (BUN) Explanation: BUN and creatinine levels should be closely monitored to detect elevations caused by nephrotoxicity. Sodium level should be routinely monitored in all hospitalized clients. Alkaline phosphatase helps evaluate liver function. The WBC count should be monitored to evaluate the effectiveness of the antibiotic; it doesn't help evaluate kidney function.

The nurse is assessing a client with kidney failure. Which finding is concerning? increased blood pressure decreased urine output elevated body temperature increased urine specific gravity

decreased urine output Explanation: A sudden change in urine output is typical of acute renal failure. Most commonly, the initial change is greatly decreased urine output. Later in the course of acute renal failure, the client may have marked diuresis (nonoliguric failure). A high body temperature or sudden increase in blood pressure is not typically associated with acute renal failure. Urine specific gravity usually is within a low-normal range because the kidneys have difficulty concentrating urine.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? impaired urinary elimination activity intolerance toileting self-care deficit risk for infection

risk for infection Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, toileting self-care deficit, and activity intolerance may be pertinent but are secondary to the risk of infection.

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? penile lesion impotence urethral discharge scrotal pain

urethral discharge Explanation: Urethritis is usually the initial clinical manifestation of gonorrhea in men. The symptoms include a profuse, purulent discharge and dysuria. Complications are uncommon, but they include prostatitis and sterility. Impotence, scrotal pain, and penile lesions are not associated with gonorrhea.

The client asks the nurse, "Is it really possible to lead a normal life with an ileostomy?" Which action by the nurse would be the most effective to address this question? Arrange for a person with an ostomy to visit the client preoperatively. Tell the client to worry about those concerns after surgery. Notify the health care provider (HCP) of the client's question. Have the client talk with a member of the clergy about these concerns.

Arrange for a person with an ostomy to visit the client preoperatively. Explanation: If the client agrees, having a visit by a person who has successfully adjusted to living with an ileostomy would be the most helpful measure. This would let the client see that typical activities of daily living can be pursued postoperatively. Someone who has felt some of the same concerns can answer the client's questions. A visit from the clergy may be helpful to some clients but would not provide this client with the information sought. Disregarding the client's concerns is not helpful. Although the HCP should know about the client's concerns, this in itself will not reassure the client about life after an ileostomy.

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. Remind health care providers to draw blood from veins on the left side. Obtain blood pressure (BP) from the left arm. Avoid sleeping on the left arm. Assess fingers on the left arm for warmth. Wear a wristwatch on the right arm.

Avoid sleeping on the left arm. Wear a wristwatch on the right arm. Assess fingers on the left arm for warmth. Explanation: 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 the BP. The client is also advised to assess the area distal to the fistula for adequate circulation, such as warmth and color. When the client is hospitalized, the nurse posts a sign on the client's bed not to draw blood or obtain BP on the left side; the client is also instructed to be sure that none of the health care team members do so.

A client is diagnosed with pyelonephritis. Which nursing action is a priority? Stress the importance of the use of long-term antibiotics. Insert a urinary catheter. Ensure sufficient hydration. Monitor hemoglobin levels.

Ensure sufficient hydration. Explanation: The nurse should ensure the client has adequate hydration. A urinary catheter is discouraged because of the risk for urinary tract infection. Monitoring the hemoglobin level is not necessary for clients with pyelonephritis. Although antibiotics may be prescribed for long-term management and for chronic pyelonephritis, at this time the nurse should focus on helping the client maintain hydration.

The client has a continuous bladder irrigation after a transurethral resection. Which is a nursing goal related to maintaining the irrigation? Reduce incisional bleeding. Recognize signs of prostate cancer. Perform activities of daily living. Maintain catheter patency.

Maintain catheter patency. Explanation: 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.

Prior to administering continuous renal replacement therapy (CRRT), the nurse assesses the dialysate. The nurse notes that the solution has not expired; there are no particles in the solution; the solution is cloudy in appearance. What is the appropriate action by the nurse? Document the findings. Obtain new dialysate. Vary type of dialysate ordered. Administer the dialysate.

Obtain new dialysate. Explanation: Dialysate should be clear and without particles. If the solution is cloudy in appearance, the nurse should not administer the dialysate because this indicates that the integrity of the dialysate may be compromised. Documenting the findings is important but it is more important that the nurse obtain new dialysate as it is a client safety issue to administer dialysate with compromised integrity. Verifying the type of dialysate is also important, but it is more important that the nurse obtains new dialysate for client safety. Remediation:

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? Ask why the client is concerned about the diagnosis. Provide privacy for the conversation. Change the subject to something more pleasant. Give the client some good advice.

Provide privacy for the conversation. Explanation: 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 with chronic renal failure is receiving hemodialysis three times a week. What should the nurse do to protect the fistula? Start a second intravenous (IV) in the arm with the fistula. Maintain a pressure dressing on the shunt. Report the loss of a thrill or bruit on the arm with the fistula. Take the blood pressure in the arm with the fistula.

Report the loss of a thrill or bruit on the arm with the fistula. Explanation: The nurse must always auscultate for a bruit and palpate for a thrill in the arm with the fistula and promptly report the absence of either a thrill or bruit to the health care provider as it indicates an occlusion. The client should not have a pressure dressing on the shunt and should avoid wearing tight clothing or carrying heavy items such as a purse over the area of the shunt to avoid restricting blood flow in the shunt. No procedures such as IV access, blood pressure measurements, or blood draws are done on an arm with a fistula as they could damage the fistula.

A nurse is providing instruction about peritoneal dialysis to a client. Which action warrants immediate action by the nurse? The client prepares to connect the tubing using aseptic technique. The client keeps the dialysate cold until ready for use. The client empties the bladder before the infusion. The client inspects the effluent.

The client keeps the dialysate cold until ready for use. Explanation: 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 an indwelling urinary catheter is suspected of having a urinary tract infection. The nurse should collect a urine specimen for culture and sensitivity by wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle. draining urine from the drainage bag into a sterile container. clamping the tubing for 60 minutes and inserting a sterile needle into the tubing above the clamp to aspirate urine. disconnecting the tubing from the urinary catheter and letting the urine flow into a sterile container.

wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle. Explanation: Most catheters have a self-sealing port for obtaining a urine specimen. Antiseptic solution is used to reduce the risk of introducing microorganisms into the catheter. Tubing shouldn't be disconnected from the urinary catheter. Any break in the closed urine drainage system may allow the entry of microorganisms. Urine in urine drainage bags may not be fresh and may contain bacteria, giving false test results. When there's no urine in the tubing, the catheter may be clamped for no more than 30 minutes to allow urine to collect.

A client undergoes cystoscopy with bladder biopsy. After the procedure, which action should the nurse take first? Percuss the bladder for distention. Assess the patency of the Foley catheter. Assess urine for excessive bleeding. Obtain a urine specimen for culture.

Assess urine for excessive bleeding. Explanation: 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 prescribed after cystoscopy.

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. To instill antibiotics into the bladder. To prevent bladder distention. To control bleeding in the bladder.

To keep the catheter free from clot obstruction. Explanation: Continuous irrigation, usually consisting of sterile normal saline, is used after TURP to keep blood clots from obstructing the catheter and impeding urine flow. Antibiotics may be instilled in the bladder with the use of an irrigating solution, but this is not the primary reason for using continuous irrigation in TURP. The irrigating solution may secondarily help prevent bladder distention because it keeps the catheter from becoming obstructed

A client with an indwelling urinary catheter is suspected of having a urinary tract infection. The nurse should collect a urine specimen for culture and sensitivity by draining urine from the drainage bag into a sterile container. disconnecting the tubing from the urinary catheter and letting the urine flow into a sterile container. wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle. clamping the tubing for 60 minutes and inserting a sterile needle into the tubing above the clamp to aspirate urine.

wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle. Explanation: Most catheters have a self-sealing port for obtaining a urine specimen. Antiseptic solution is used to reduce the risk of introducing microorganisms into the catheter. Tubing shouldn't be disconnected from the urinary catheter. Any break in the closed urine drainage system may allow the entry of microorganisms. Urine in urine drainage bags may not be fresh and may contain bacteria, giving false test results. When there's no urine in the tubing, the catheter may be clamped for no more than 30 minutes to allow urine to collect.

The correct procedure for collecting a urine specimen from an indwelling catheter is to: open the spigot on the collecting bag and allow urine to empty into the specimen container. disconnect the drainage tube from the collecting bag and allow urine to flow from the tubing into the specimen container. remove urine from the drainage tube with a sterile needle and syringe and place urine from the syringe into the specimen container. disconnect the drainage tube from the indwelling catheter and allow urine to flow from the tubing into the specimen container.

remove urine from the drainage tube with a sterile needle and syringe and place urine from the syringe into the specimen container. Explanation: 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 develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? therapeutic index creatinine clearance liver function studies GI absorption rate

creatinine clearance Explanation: The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

The nurse is caring for a client with acute renal failure and edema. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? Select all that apply. Assess breath sounds. Remind the client that all urine is to be saved for intake and output measurement. Measure and record vital signs. Make sure the urinal is within the client's reach. Weigh the client every morning using the standing scale. Administer furosemide orally twice a day.

Make sure the urinal is within the client's reach. Remind the client that all urine is to be saved for intake and output measurement. Weigh the client every morning using the standing scale. Measure and record vital signs. Explanation: Administration of oral medications can be performed by a licensed nurse, and assessment of breath sounds requires additional education and skill development, such as in the scope of practice of the RN. All other actions are within the scope of practice for UAPs.

A client is diagnosed with genital herpes (herpes simplex virus type 2, or HSV-2). What information should the nurse give to the client about managing this health problem? Reducing stressful life events may decrease the incidence of herpetic outbreaks. Herpes is transmitted to partners only when lesions are weeping. Using occlusive ointments may decrease the pain from the lesions. There are no effective drug therapies to manage herpes symptoms.

Reducing stressful life events may decrease the incidence of herpetic outbreaks. Explanation: Managing stressful life events can decrease the incidence of outbreaks of HSV-2. Occlusive ointments should not be applied. Antiviral therapies will not cure herpes, but they can manage symptoms and decrease the incidence of outbreaks. Clients with HSV-2 should use condoms to prevent HSV transmission. Cells can be shed at other times, not only when the vesicles are weeping.

An older adult male client has been taking doxazosin 2 mg daily for 4 weeks for treatment of benign prostatic hypertrophy. The client reports feeling dizzy. What should the nurse do first? Report the symptoms to the health care provider. Test the client's urine for ketones. Review the client's other medications. Take the client's blood pressure lying, standing, and sitting.

Take the client's blood pressure lying, standing, and sitting. Explanation: Doxazosin is also used as an antihypertensive agent; the client may be experiencing orthostatic hypotension. The nurse should first take the client's blood pressure; later, the nurse can review other medications. Testing the urine for ketones would be appropriate if the client had diabetes mellitus. The client's report of symptoms should be reported to the health care provider with the blood pressure readings.

When instructing a client about the proper use of condoms for pregnancy prevention, the nurse should include which instructions to ensure maximum effectiveness? Obtain a prescription for a condom with nonoxynol 9. Withdraw the condom after sez when the penis is flaccid. Ensure that the condom is pulled tightly over the tip of the penis before sex. Place the condom over the erect penis before sex.

Place the condom over the erect penis before sex. Explanation: To ensure maximum effectiveness, the condom should always be placed over the erect penis before sex. Some couples find condom use objectionable because foreplay may have to be interrupted to apply the condom. The penis, covered by the condom, should be withdrawn before the penis becomes flaccid. Otherwise, semen may escape from the condom, providing an opportunity for possible fertilization. Rather than having the condom pulled tightly over the penis before sex, space should be left at the tip of the penis to allow the condom to hold the sperm. The client does not need a prescription for a condom with nonoxynol 9 because these are sold over the counter.