Genitourinary Disorders
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.
Which statements by a female client would indicate that she is at high risk for a recurrence of cystitis?
"I can go 8 to 10 hours without emptying my bladder."
After undergoing a total cystectomy and urinary diversion, a client has a Kock pouch (continent internal reservoir) in place. Which statement by the client indicates a need for further teaching?
"I'll have to wear an external collection pouch for the rest of my life."
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?
"Increase your carbohydrate intake."
The nurse is caring for a client with a cystectomy and ileal conduit (urostomy) for prior bladder cancer. Which statements by the client would indicate that teaching has been effective? Select all that apply.
"It is important to observe the color and odor of my urine." "Redness around the stoma should be reported to my physician." "I understand that I will need to consume adequate amounts of fluids each day."
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."
Which of the following is a priority nursing diagnosis for the client presenting with pelvic inflammatory disease?
Acute pain.
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.
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 (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?
Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl
The nurse receives a report of a serum potassium level on an infant of 5.4 mEq/L (5.4 mmol/L). What should the nurse do first?
Call the laboratory to see how the specimen was obtained.
The nurse assesses a client's outflow is less than the inflow during a peritoneal dialysis exchange. What actions will the nurse use to increase peritoneal dialysis outflow? Select all that apply.
Check the level of the drainage bag. Check the peritoneal dialysis system for kinks. Reposition the client to a side lying.
A client with benign prostatic hypertrophy has an elevated prostate-specific antigen (PSA) level. What should the nurse do next?
Determine if the prostatic palpation was done before or after the blood sample was drawn.
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.
Which nursing action is most appropriate for a client who has urge incontinence?
Have the client urinate on a timed schedule.
A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client's discharge teaching plan?
Increase daily fluid intake to at least 2 to 3 L.
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.
Which steps should a nurse follow to insert a straight urinary catheter?
Prepare the client and equipment, create a sterile field, put on gloves, clean the urinary meatus, and insert the catheter until urine flows.
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.
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.
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.
Which instructions should the nurse include in the teaching plan for a 30-year-old multiparous client who will be using an intrauterine device (IUD) for family planning?
Severe cramping may occur when the IUD is inserted.
A client comes to the emergency department reporting a sudden onset of sharp, severe, radiating pain in the lumbar and left flank regions. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. What is the nurse's priority action?
Strain all urine.
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.
The client is having peritoneal dialysis. During the exchange, the nurse observes that the flow of dialysate stops before all the solution has drained out. What should the nurse do next?
Turn the client from side to side.
The nurse is teaching the caregiver of an older adult client about urinary incontinence. What statement should the nurse make to the caregiver about urinary incontinence in the older adult?
Urinary incontinence has many causes and can often be improved with intervention.
A client with diabetes mellitus has had declining renal function over the past several years. Which diet regimen should the nurse recommend to the client on days between dialysis?
a low-protein diet with a prescribed amount of water
A client had a cystoscopy to remove a renal stone. Which laboratory data warrants immediate intervention by the nurse?
a white blood cell count of 14,000 mm/dL (14.00 x 109/L)
The most significant sign of acute renal failure is:
decreased urine output.
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 a urinary tract infection is ordered co-trimoxazole. The nurse should provide which medication instruction?
"Drink at least eight 8-oz (240 mL) glasses of fluid daily."
The nurse gives a pamphlet that describes Kegel exercises to a client with stress incontinence. Which statement indicates that the client has understood the instructions contained in the pamphlet?
"I can do these exercises sitting up, lying down, or standing."
The nurse is caring for a client with polydipsia and large amounts of urine with a specific gravity of 1.003. Which disorder is anticipated?
diabetes insipidus
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
A couple has completed testing and is a candidate for in vitro fertilization. The nurse is reviewing the procedure with them and realizes that further instruction is needed when the client makes which statement?
"The fertilization procedure can be done anytime during my cycle."
A nurse is caring for a client who is a hospital employee. The client is diagnosed with genital herpes and is being treated for a urinary tract infection (UTI). A coworker asks the nurse about how the client is doing. What is the nurse's best response?
"Would you like me to let the client know you said hello?"
A client with a new ileal conduit asks the nurse when he needs to wear his appliance. What should the nurse tell the client?
"You need to wear your appliance all the time."
The client with pyelonephritis asks the nurse, "How will I know whether the antibiotics are treating my infection?" What should the nurse tell the client?
"Your health care provider will take a urine culture."
A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis disequilibrium syndrome. Which assessment is the priority?
neurological status
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
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.
The nurse is instructing a client with an ileal conduit. What should the nurse instruct the client to do to prevent urine leakage when changing the appliance?
Insert a gauze wick into the stoma.
A client who is taking sildenafil has been prescribed tamsulosin. What is the nurse's best action?
Instruct the client to hold the sildenafil and contact the healthcare provider.
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.
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.
A client recovering from an abdominal hysterectomy has pain in her right calf. What should the nurse do next?
Measure the circumference of both calves and note the difference.
An 18-year-old female takes birth control pills and is sexually active with her boyfriend. She has a purulent vaginal discharge that is sometimes frothy. What nursing judgment should the nurse make about this finding?
sexually transmitted infection.
The client asks the nurse, "How did I get this urinary tract infection?" What should the nurse tell the client causes cystitis?
an ascending infection from the urethra
A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?
assessing present voiding patterns
A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation?
urine pH of 3.0
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)
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
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
The nurse is teaching an older adult with a urinary tract infection about the importance of increasing fluids in the diet. What puts this client at a risk for not obtaining sufficient fluids?
decreased ability to detect thirst
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should assess the client for which alteration in fluid and electrolyte balance?
decreased serum sodium level
A nulliparous client tells the nurse that during her last pelvic examination, the health care provider said that her uterus was in a severe retroverted position. The nurse determines that the client may experience which complication?
difficulty conceiving a child
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
A client with acute renal failure has the following laboratory results. Based on these findings, which of the following should the nurse administer? hemoglobin 9.2 g/dL blood urea nitrogen 22 mg/dL creatinine 0.7 mg/dL potassium 4.8 mEq/L
erythropoietin
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 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.
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 client has urge incontinence. When obtaining the health history, the nurse should ask the client about which factors that could precipitate incontinence?
loss of urine when coughing
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.
A client is admitted with fever and flank pain and is diagnosed with pyelonephritis. What is a priority nursing intervention in a client with this disorder?
monitoring laboratory values, especially WBCs
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 is to receive belladonna and opium suppositories, as needed, postoperatively after transurethral resection of the prostate (TURP). The nurse should give the client these drugs when he demonstrates signs of which symptom?
pain from bladder spasms
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
risk for infection
The nurse is teaching the client how to recognize infection in the shunt. What sign should the nurse tell the client to assess each day?
swelling at the shunt site
Which clinical finding should a nurse look for in a client with chronic renal failure?
uremia
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
A nurse preceptor is observing a new graduate nurse during care of a client in contact isolation. What action by the new graduate indicates the need for further teaching about handling the client's soiled linens?
uses alcohol gel to clean hands after removing gloves
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
A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:
weight loss.
The client will have an abdominal hysterectomy tomorrow. Which information will be mostimportant for the nurse to give to the client prior to admission to the hospital?
what she can eat and drink before admission
A client had a percutaneous nephrolithotomy to remove a kidney stone. The client is being discharged with drainage tubes from the kidney. What should the nurse instruct the client to do after the procedure? Select all that apply.
Avoid heavy lifting for 2 to 4 weeks. Report fever or chills to the health care provider (HCP). Go to the emergency department for bleeding from the drainage tubes.
