NCLEX-RN Renal, Urinary, & Reproductive systems.

A client is admitted to the hospital for acute gastritis and ascites secondary to alcoholism and cirrhosis. For which condition is it most important for the nurse to assess this client? Blood in the stool

Erosion of blood vessels may lead to hemorrhage, a life-threatening situation further complicated by decreased prothrombin production, which occurs with cirrhosis. Although food intolerances should be identified, there is no immediate threat to life. Although increased intraabdominal pressure because of ascites may precipitate nausea, there is no immediate threat to life. Hourly urine output measurements are unnecessary.

During an examination of a client with kidney dysfunction, the nurse finds the presence of glucose in the urine. Which nursing intervention is beneficial for this client? Reporting this finding to the primary healthcare provider

The presence of glucose in the urine is an abnormal finding that requires further assessment. Therefore, the nurse should report this finding to the primary healthcare provider. The nurse should not administer oral fluids or hypoglycemic medication without instructions from the primary healthcare provider.

The student nurse is collecting a clean-catch midstream urine specimen from a client suspected of urinary tract infection. After reviewing the results, the head nurse instructs the student nurse to repeat the procedure. Which finding in the urinalysis report supports the head nurse's instruction? 10 4 organisms/mL

The reference interval 10 3 to 10 5 organisms/mL is usually not diagnostic and usually requires the test to be repeated. Therefore, the finding 10 4 organisms/mL supports the head nurse's instruction. The finding of 10 2 organisms/mL usually indicates no infection. A value greater than 10 5 organisms/mL indicates infection. The findings of 10 6 organisms/mL and 10 8 organisms/mL indicate infection and do not require repetition of the test.

The nurse assists an elderly client in squirting warm water over the perineum. Which outcome indicates effective nursing care? The client will not have a tendency to retain urine.

The renal system undergoes age-related changes in elderly clients. A tendency to retain urine is a physiologic change that can result in urine stasis. Assisting the client in squirting warm water over the perineum will help to initiate voiding in the client. Thus when the client does not have a tendency to retain urine, this finding is an effective outcome. Discouraging excessive fluid intake for two to four hours before the client goes to bed reduces nocturia. Providing thorough perineal care after each voiding will help to prevent bladder infections. Responding quickly to the client's indication of the need to void will help to reduce urinary stress incontinence.

The nurse is providing education to a client with calculi in the calyces of the right kidney. The client is scheduled to have the calculi removed. Which information should the nurse include in the teaching? After surgery, there will be a small incision in the right flank area.

If the calculi are in the renal pelvis, a percutaneous pyelolithotomy is performed. The calculi are removed via a small flank incision which will be evident in the right flank area. The calculi can be removed without damage to the ureter. Transurethral removal of large ureteral and renal calculi can be performed using ureteroscopic ultrasonic lithotripsy. Placement of a suprapubic catheter usually is unnecessary unless there is damage to the ureter during the procedure.

A client with cancer of the bladder is admitted to the hospital for diagnostic tests to determine the extent of the disease. While the nurse is caring for the client, the client asks, "If they remove my bladder, how will I be able to urinate?" Which is the best response by the nurse? "I know you're upset, but there are alternatives to removing your bladder."

If the entire bladder is removed, an opening (stoma) is created to allow urine to be emptied into a bag. The kidneys are still producing the urine, so dialysis is not indicated. Telling the client it will be normal is not answering the client's question. Waiting for test results does not answer the client's question.

A client is admitted to the hospital with urinary retention, and an indwelling urinary catheter is prescribed by the primary healthcare provider. What should the nurse do to help prevent the client from developing a urinary tract infection? Maintain the prescribed hydration

Promoting hydration maintains urine production that flushes the bladder, thereby preventing urinary stasis and possible infection. Although assessing urine specific gravity may help identify a urinary tract infection, it will not prevent it. Although collecting a weekly urine specimen for culture and sensitivity may help identify a urinary tract infection, it will not prevent it. The collection bag is emptied once every shift unless the bag is full and needs to be emptied sooner.

The nurse is caring for a client who has been diagnosed with glomerulonephritis. Which initial urinary finding supports this diagnosis? Proteinuria

Protein in the urine (proteinuria) and hematuria (blood in the urine) are classic manifestations of the onset of glomerulonephritis because of the increased permeability of the vascular bed in the kidneys. Suppression of urine formation (anuria) is not an initial manifestation of glomerulonephritis; oliguria may be present. Pain or burning on urination (dysuria) is indicative of cystitis, not glomerulonephritis. Excessive urination (polyuria) does not occur as an initial change with glomerulonephritis; polyuria and nocturia may occur later with chronic glomerulonephritis, when the renal structures are destroyed.

A rubella vaccination is ordered for a client. Which statement made by the client is cause for concern? "I have been trying to conceive a baby for a few months."

Rubella infection is a cause for concern in women of childbearing age because it increases the risk of congenital abnormalities in a developing fetus. However, the client should not be given the rubella vaccine if already pregnant because it could affect the fetus. The client can be given the rubella vaccine if they are in child-bearing age, with the precautionary instruction to avoid conception for at least three months after vaccination. The nurse should give the rubella vaccination to the client who has not previously had rubella in childhood. This is because the client's body will not have developed antibodies against rubella and needs the vaccination. A client who is planning to get married by the next year should be encouraged to receive rubella vaccination to eliminate risk of developing the infection.

The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis results. Which urinary finding should the nurse conclude needs to be reported to the primary healthcare provider? Presence of large proteins

The glomeruli are not permeable to large proteins such as albumin or red blood cells (RBCs), and it is abnormal if albumin or RBCs are identified in the urine; their presence should be reported. The urine can be acidic; normal pH is 4.0 to 8.0. Glucose and bacteria should be negative; these are normal findings.

After a prostatectomy, a client's plan of care will include the prevention of postoperative deep vein thrombosis. Which nursing goal will best achieve prevention? Increase velocity of the venous return.

Because venous stasis is the major predisposing factor of pulmonary emboli, venous flow velocity should be increased through activity. Increasing the coagulability of the blood can lead to the development of deep vein thrombosis. Effectiveness of internal respiration and oxygen-carrying capacity of the blood will not affect the prevention of deep vein thrombosis.

The nurse is teaching about pneumaturia to a coworker. Which statement should the nurse include in the teaching plan? "It is passage of urine containing gas."

Pneumaturia is characterized by the passage of urine containing gas that occurs with fistula connections between the bowel and bladder. Burning sensation on urination constitutes the stinging pain in the urethral area. Oliguria is the presence of a diminished amount of urine during a given time. Stress incontinence is involuntary urination with increased abdominal pressure, such as during sneezing or coughing.

A nurse is caring for a male client who is scheduled for a dilation of the urethra. Which structure surrounding the male urethra should the nurse include in a teaching program when explaining the procedure? Prostate gland

The prostate gland is shaped like a ring, with the urethra passing through its center. The epididymis lies along the top and sides of the testes. The seminal vesicles are on the posterior surface of the bladder. The bulbourethral gland lies below the prostate.

The nurse is explaining the physiologic reasons for taking vitamin D and calcium supplements to a client with renal failure. Which statement made by the nurse is appropriate? "There will be a decrease in the active metabolite of vitamin D in your body."

Renal failure results in decrease in the active metabolite of vitamin D because inactive vitamin D gets activated in the liver followed by the kidneys. Food sources of vitamin D and sunlight contribute to an inactive form of the hormone in the body. Inactive vitamin D will decrease if foods rich in vitamin D are not consumed or exposure to sunlight is reduced. Conversion of skin cholesterol to vitamin D depends on the exposure to sunlight and not renal impairment. In renal failure, there is less active vitamin D and therefore less intestinal absorption of calcium.

A client is scheduled for a kidney ultrasound. Which instructions given by the nurse to the client would be most beneficial? Drink plenty of fluids. Do not urinate prior to the exam Lie flat and perfectly still during the test

A kidney ultrasound requires a full bladder. Asking the client to drink plenty of fluids will increase the volume of blood, thereby increasing the volume of urine collected in the urinary bladder. Because of this, the client should be advised not to urinate prior to the exam. A urinary catheter may be needed for a cystometrography test; this is performed to determine the bladder wall muscle functions. Eating foods rich in fiber is good for overall health, but has no effect on the kidney ultrasound. The ultrasound is performed by placing the client in the supine position, wherein the client lies flat with the abdomen exposed, but the client is draped.

The nurse is preparing a blood transfusion for a client with renal failure. Why does anemia often complicate renal failure? Decrease in erythropoietin

The hormone erythropoietin, produced by the kidneys, stimulates the bone marrow to produce red blood cells. In renal failure there is a deficiency of erythropoietin that often results in the client developing anemia. Therefore the nurse is instructed to administer blood. In renal failure, increased blood pressure is due to impairment of renal vasodilator factors and is not treated by administration of blood. Phosphate is retained in the body during renal failure, causing binding of calcium leading to done demineralization, not anemia. Increase in urinary sodium concentration and decrease in serum sodium concentration trigger the release of renin from the juxtaglomerular cells.

A nurse writes a goal of preventing renal calculi in a care plan for a client with paraplegia. Which information most likely caused the nurse to write this goal? Accelerated bone demineralization.

Calcium that has left the bones as a response to prolonged inactivity enters the blood and may precipitate in the kidneys, forming calculi. Increased fluid intake is helpful in preventing this condition by preventing urinary stasis. Calcium intake usually is limited to prevent the increased risk for calculi. Calculi may develop despite adequate kidney function; kidney function may be impaired by the presence of calculi and urinary tract infections associated with urinary stasis or repeated catheterizations.

A nurse is assessing the urine of a client with a urinary tract infection. For which characteristic should the nurse assess each specimen of urine? Clarity

Cloudy urine usually indicates drainage associated with infection. Viscosity is a characteristic that is not measurable in urine. Urinary glucose levels are not affected by urinary tract infections. Specific gravity yields information related to fluid balance.

A client with an ileal conduit is being prepared for discharge. As part of the discharge teaching, which instruction should the nurse include? Maintain fluid intake of least 2 L daily

High fluid intake flushes the ileal conduit and prevents infection and obstruction caused by mucus or uric acid crystals. Alcohol is not contraindicated with an ileal conduit. Using soap and water on the peristomal area helps prevent irritation from waste products. Notifying the primary healthcare provider if the stoma size decreases is not necessary because this is an expected response; as edema decreases, the stoma will become smaller.

The nurse observes a client with kidney failure has increased rate and depth of breathing. Which laboratory parameter does the nurse suspect is associated with this client's condition? Bicarbonate 15 mEq/L

An increased rate and depth of breathing is called Kussmaul respiration and occurs due to metabolic acidosis in clients with kidney disease. Serum bicarbonate level decreases in metabolic acidosis. The normal range of serum bicarbonate is 23-30 mEq/L. Therefore the bicarbonate value of 15 mEq/L is associated with Kussmaul respirations in the client. The normal serum potassium is 3.5-5 mEq/L. Therefore a potassium level of 8 mEq/L indicates hyperkalemia and is associated with changes in cardiac rate and rhythm. The normal range of hemoglobin is 12-16 g/dL in females and 14-18 g/dL in males. Therefore a Hgb of 10 g/dL indicates anemia; this is associated with fatigue, pallor, and shortness of breath. The normal range of serum phosphorous is 3-4.5 mg/dL. Therefore a phosphorous value of 7 mg/dL indicates hyperphosphatemia, which is associated with hypocalcemia and demineralization of bone.

A client who is 5 feet, 8 inches tall (173 cm) and weighs 220 lb (99.8 kg) is admitted to the hospital with ureteral colic, blood in the urine, and a blood pressure of 150/90 mm Hg. Which is the priority objective of nursing care for this client? Decrease pain

Sharp, severe pain (renal colic) radiating toward the genitalia and thigh is associated with ureteral distention and must be relieved. Weight loss is a long-term goal; reducing pain is the priority. Although the hematuria will be addressed, pain reduction is the priority. Although the client's hypertension will be addressed, pain reduction is the priority.

A client with the diagnosis of chronic kidney disease develops hypocalcemia. Which clinical manifestations should the nurse expect the client with hypocalcemia to exhibit?

3. Fractures 4. Osteomalacia 5. Eye calcium deposits Because of calcium loss from the bone, fractures, osteomalacia, and eye calcium deposits occur. Acidosis decreases calcium that binds to albumin, resulting in more ionized calcium (free calcium) in the blood. Lethargy and weakness are associated with hypercalcemia.

The nurse is reviewing the urinalysis reports of four clients with renal disorders. Which client's finding signifies the presence of excessive bilirubin? 1. Amber-yellow 2. Dark, smoky color 3. Yellow-brown to olive green 4. Orange-red or orange-brown

3 Client 3's urinalysis reports findings of the presence of yellow-brown to olive-green-colored urine which signifies excessive bilirubin. Client 1's urinalysis report findings of the presence of amber-yellow-colored urine signifies a normal finding. Client 2's urinalysis report findings of the presence of dark, smoky-colored urine signifies hematuria. Client 4's urinalysis report findings of orange-red or orange-brown-colored urine indicates the presence of phenazopyridine in the urine.

A nurse is caring for a client with acute kidney injury. Which findings should the nurse anticipate when reviewing the laboratory report of the client's blood level of calcium, potassium, and creatinine?Calcium: 7.6 mg/dL (1.9 mmol/L) Potassium 6.0 mEq/L (6.0 mmol/L) Creatinine: 3.2 mg/dL (194 mcmol/L)

A client with acute kidney injury will have a low calcium level, a high potassium level, and an elevated creatinine level.

A nurse is caring for a client who is scheduled to have a paracentesis. Immediately before the procedure, the nurse asks the client to void. What is the rationale for asking the client to void? A full bladder increases the danger of puncture during the procedure.

When the bladder contains large amounts of urine, it becomes distended and may push upward into the abdominal cavity, where it can be punctured accidentally during the paracentesis. Decreasing the intraabdominal pressure is not the rationale for emptying the bladder. The amount of fluid in the bladder has no relationship to ascites. Urea is present in blood and urine, not ascitic fluid.

The nurse is caring for a client who recently was diagnosed with urinary phosphate calculi. What should the nurse plan to teach this client to include in the diet? Pears

All fresh fruits are low in phosphate, which should be limited in a client with urinary phosphate calculi. Beef and fish contain phosphate; all protein foods are high in phosphate. Cheddar cheese is made with milk, which contains phosphate; dairy products are high in phosphorus.

What should the nurse monitor for when caring for a postoperative client who presents with 180 mL of urine in the urinary drainage bag from the past 8 hours? 1. Renal failure 2. liver cirrhosis 3. Diabete mellitus 4. Rheumatoid arthritis

1. Renal failure Post-surgical urine output should not be less than 30 mL per hour; urine output of less than that per hour indicates hypovolemia or renal failure. The client has urinated only 180 mL in the past 8 hours, which is less than 30 mL/hour. This indicates that the client may have renal failure. Liver cirrhosis causes scarring of the liver tissue, which may cause variceal bleeding and hepatic encephalopathy, but it is not associated with decreased urine output. Uncontrolled diabetes mellitus is manifested by frequent and excessive urination. Rheumatoid arthritis does not cause renal complications such as decreased urine output.

Which retrograde procedure involves the examination of the ureters and the renal pelvises? Pyelogram

A pyelogram is a retrograde examination of the ureters and the pelvis of both kidneys. A cystogram is a retrograde examination of the bladder. An urethrogram is a retrograde examination of the urethra. A voiding cystourethrogram is used to determine whether urine is flowing backward into the urethra.

A nurse is caring for a client with a ureteral calculus. Which are the most important nursing actions? Monitoring intake and output Straining the urine at each voiding Administering the prescribed analgesic

A urinary calculus may obstruct urine flow, which will be reflected in a decreased output; obstruction may result in hydronephrosis. Urine is strained to determine whether any calculi or calcium gravel is passed. Reduction of pain is a priority. A calculus obstructing a ureter causes flank pain that extends toward the abdomen, scrotum and testes, or vulva; the pain begins suddenly and is severe (renal colic). Fluids should be encouraged to promote dilute urine and facilitate passage of the calculi. Recording the blood pressure is not critical.

A client with a history of excessive alcohol use develops hepatic portal hypertension and an elevated serum aldosterone level. For which complications should the nurse assess this client? Sodium retention and fluid accumulation

Aldosterone, a corticosteroid, causes sodium and water retention and potassium excretion by the kidneys. Hypovolemia will not occur with increased aldosterone levels because sodium and water are retained. Potassium is excreted in the presence of aldosterone and therefore will not accumulate and cause dysrhythmias. Calcium is unaffected by aldosterone.

A client with acute kidney failure becomes lethargic and fatigued. Upon reviewing the client's medical record, which finding does the nurse determine is the most likely cause of this behavior? An increased BUN level

An increased blood urea nitrogen level, indicating uremia, is toxic to the central nervous system and causes fatigue and lethargy. Hyperkalemia is associated with muscle weakness, irritability, nausea, and diarrhea. Hypernatremia is associated with firm tissue turgor, oliguria, and agitation. Dehydration can cause fatigue, dry skin and mucous membranes, and rapid pulse and respiratory rates.

A nurse is counseling a woman who had recurrent urinary tract infections. Which factor should the nurse explain is the reason why women are at a greater risk than men for contracting a urinary tract infection? Proximity of the urethra to the anus.

Because a woman's urethra is closer to the anus than a man's, it is at greater risk for becoming contaminated. Urinary pH is within the same range in both men and women. Hormonal secretions have no effect on the development of bladder infections. The position of the bladder is the same in men and women

The nurse reviews the medical records of four male clients. Which client will the nurse assess most closely for developing prostate cancer? Black 55-year-old

Cancer of the prostate is rare before age 50 years but increases with age; black men develop cancer of the prostate more often and at an earlier age than white men. Black men develop prostate cancer more often than any other ethnic group. Asian American men have a lower incidence than white men.

Which is a primary glomerular disease? Chronic glomerulonephritis

Chronic glomerulonephritis is a primary glomerular disease. Diabetic glomerulopathy, hemolytic-uremic syndrome, and systemic lupus erythematosus (SLE) are secondary glomerular diseases.

Which structure is removed during circumcision of an infant? Prepuce

Circumcision involves removal of the prepuce, which is a skin folding over the glans. The glans is the tip of the penis. The epididymis is the internal structure that helps in the transportation and maturation of sperm. The vas deferens carries sperm from the epididymis to the ejaculatory duct.

A client arrives at a health clinic reporting hematuria, frequency, urgency, and pain on urination. Which diagnosis will the nurse most likely observe written in the client's medical record? Cystitis

Cystitis is an inflammation of the bladder that causes frequency and urgency of urination, pain on micturition, and hematuria. Chronic glomerulonephritis is a disease of the kidney that is associated with manifestations of systemic circulatory overload. Nephrotic syndrome is a condition of increased glomerular permeability characterized by severe proteinuria. Pyelonephritis is a diffuse, pyogenic infection of the pelvis and parenchyma of the kidney that causes flank pain, chills, fever, and weakness.

Twenty-four hours after a penile implant the client's scrotum is edematous and painful. What should the nurse do? Elevate the scrotum using a soft support.

Elevating the scrotum using a soft support increases lymphatic drainage, reducing edema and pain. Assisting the client with a sitz bath and applying warm soaks to the scrotum increase circulation to the area, intensifying edema and pain in this client. Preparing for an incision and drainage procedure is not indicated; scrotal swelling is caused by the trauma of surgery, not infection.

A client with ascites has a paracentesis, and 1500 mL of fluid is removed. For which immediate response is it most important for the nurse to monitor? Rapid, thready pulse

Fluid shifts from the intravascular compartment into the abdominal cavity, causing hypovolemia. A rapid, thready pulse, which is indicative of shock, is a compensatory response to this shift. Decreased peristalsis is not likely to occur in the immediate period. After a paracentesis, intravascular fluid shifts into the abdominal cavity, not into the lungs. Increase in temperature is not the priority; body temperature usually is not affected immediately; an infection will take several days.

A client scheduled for a hemicolectomy because of ulcerative colitis asks if having a hemicolectomy means wearing a pouch and having bowel movements in an abnormal way. Which is the best response by the nurse? "No, only part of the colon is removed and the rest reattached."

Hemicolectomy is removal of part of the colon with an anastomosis between the ileum and transverse colon; a colostomy is not necessary. With a colostomy the intestine opens on the abdomen, whereas in a hemicolectomy a portion of the intestine is resected and the ends reconnected. "Yes, but it will be temporary until the colitis is cured" is the description of a temporary colostomy; a cure occurs only when the entire colon is removed. A colostomy is done for a variety of reasons other than a tumor; a colectomy with a colostomy is only one intervention that may be used to treat a tumor.

A client has end-stage kidney disease and is admitted for a kidney transplant. Which information should the nurse share when teaching about the donor? Must have matching leukocyte antigen complexes

Human leukocyte antigen compatibility provides the most specific predictions of the body's tendency to accept or reject foreign tissue. Although ABO compatibility is necessary, the exact blood type is not. Being a member of the same family does not make for a better match unless the family member has matching leukocyte antigen complexes. Being a member of the same family may increase the possibility of a match, but there is no guarantee that a family member will match. Differences in body size do not cause rejection.

Which hormone is released in response to low serum levels of calcium? Parathyroid Hormone

If serum calcium levels decline, the parathyroid gland releases parathyroid hormone to maintain calcium homeostasis. Renin is a hormone released in response to decreased renal perfusion; this hormone is responsible for regulating blood pressure. Erythropoietin is released by the kidneys in response to poor blood flow to the kidneys; it stimulates the production of red blood cells. Atrial natriuretic peptide is produced by the right atrium of the heart in response to increased blood volume. This hormone then acts on the kidneys to promote sodium excretion, which decreases the blood volume.

The laboratory report of a client indicates that the urinary urea nitrogen levels are 9 g/24 hr. What does the nurse anticipate from this finding? The client has potential kidney damage.

Kidney damage or liver disease is suspected when the urea nitrogen is less than normal levels. The normal level of urea nitrogen in the urine ranges from 12 to 20 g/24 hr (0.43-0.71 mmol/24 hr). Normal kidneys are able to filter urea and other toxic byproducts of ammonia. An increased level of urea nitrogen is indicative of sepsis, dehydration, or high protein diet in the client.

Which electrolyte deficiency triggers the secretion of renin? Sodium

Low sodium ion concentration causes decreased blood volume, thereby resulting in decreased perfusion. Decreased blood volume triggers the release of renin from the juxtaglomerular cells. Deficiencies of calcium, chloride, and potassium do not stimulate the secretion of renin.

A nurse checking the perineum of a client with a radium implant for cervical cancer observes the packing protruding from the vagina. The nurse notifies the primary healthcare provider to have the packing removed. What is the primary reason that the packing needs to be removed immediately? The radioactive packing will injure healthy tissue.

Packing maintains a radium implant in its correct placement; correct placement minimizes the effect on healthy tissue. There should not be active bleeding with a radium implant; cellular sloughing is expected. Although exposure to the radioactive packing damages healthy tissue, it is not life threatening.

A client is admitted to the hospital with a diagnosis of severe chronic kidney disease. Which assessment findings should the nurse expect the client to exhibit? Paresthesias Hypertension

Paresthesias occur as a result of excess nitrogenous wastes, altered fluid and electrolytes, and altered regulatory functions. Nonfunctioning kidneys cause fluid retention that may result in hypervolemia and hypertension. Polyuria occurs because of extensive nephron damage and may occur in the early stage of kidney disease but not in the severe stage. Metabolic acidosis, not alkalosis, results from the inability to excrete hydrogen ions and retain bicarbonate. Widening pulse pressure occurs with increased intracranial pressure, not with kidney dysfunction.

A client is at high risk for developing ascites because of cirrhosis of the liver. How should the nurse assess for the presence of ascites? Percuss the client's abdomen and listen for dull sounds.

Percussing over the client's abdomen will produce a dull, not tympanic, sound if fluid is present. Respiratory distress occurs with ascites, but it is not an early sign; the client does not have ascites but is at risk for ascites at this time. Palpating the lower extremities assesses for dependent edema, not ascites. Ascites is fluid within the peritoneal cavity. Bowel sounds may be heard with developing ascites; when ascites is extensive, bowel sounds may diminish.

A nurse is caring for a client who had a kidney transplant. Which test is most important for the nurse to monitor to determine whether a client's newly transplanted kidney is working effectively? Serum Creatinine

Serum creatinine, a test of renal function, measures the kidneys' ability to excrete metabolic wastes; creatinine, a nitrogenous product of protein breakdown, is elevated in renal insufficiency. A renal scan will not provide information about the filtering ability of the transplanted kidney. Although intake and output will be monitored, this will not provide information about the ability of kidney to excrete metabolic wastes. The WBC count will not reflect functioning of a transplanted kidney.

After interacting with a client, a nurse finds that a 23-year-old client has never undergone a Papanicolaou (Pap) test. What should the nurse suggest to the client? Schedule a Pap test immediately

The Papanicolaou test (Pap test) is a cytologic study performed annually after the age of 21 years. The nurse should advise a 23-year-old client to undergo a Pap test immediately to rule out precancerous and cancerous cells within the client's cervix. Undergoing a Pap test during menses may interfere with laboratory analysis and results. A human papillomavirus test is performed every 5 years. Pap tests and human papillomavirus tests are recommended in clients between the ages of 30 and 65 years.

What is the action of the vasopressin hormone released from the client's posterior pituitary? Helps produce concentrated urine.

The action of the hormone vasopressin released from the posterior pituitary is to make the distal convoluted tubule and collecting duct permeable to water so as to maximize reabsorption and produce concentrated urine. The natriuretic hormones produced from cardiac ventricles cause tubular secretion of sodium. Aldosterone released from the adrenal cortex promotes potassium secretion and sodium reabsorption in the distal convoluted tubules and collecting duct.

What is the cup-like structure that collects a client's urine and is located at the end of each papilla? Calyx

The calyx is a cup-like structure that collects urine and is located at the end of each papilla. The outer surface of the kidney consists of fibrous tissue and is called the capsule. The renal cortex is the outer tissue layer. The renal columns are the cortical tissue that dip down into the interior of the kidney and separate the pyramids.

Which condition should be reported immediately to the primary healthcare provider? Body temperature of 102° F with vaginal discharge 48 hours after cervical biopsy

The client with cervical biopsy should immediately report to the primary healthcare provider if experiencing a body temperature of 102° F with vaginal discharge. This is because fever and vaginal discharge that develops 48 hours after cervical biopsy may be the signs of infection related to the procedure. The client should take pain relievers for pelvic pain after colposcopy. Light vaginal bleeding for 1 to 2 days following hysterosalpingogram is common. If the amount of bleeding increases or extends beyond 2 days, the healthcare provider should be notified. Light rectal bleeding for a few days is common after prostate biopsy.

After a transurethral vaporization of the prostate, the client returns to the unit with an indwelling urinary catheter and a continuous bladder irrigation. The client puts the call light on to report the need to urinate. What should the nurse do first? Assess that the tubing attached to the collection bag is patent.

The drainage tubing may be obstructed. Retained fluid raises bladder pressure, causing discomfort similar to the urge to void. The client's vital signs are not related to the complaint. Although the nurse may review the client's intake and output, it is not the priority. Whether urine is draining from the tubing at this point in time is significant. Although it is true that the balloon inflated in the bladder causes this feeling, the patency of the gravity system should be ascertained before determining the cause of the complaint.

What are the general manifestations associated with clients who have urinary system disorders? Excessive thirst Nausea and vomiting Elevated blood pressure

The general manifestations associated with urinary system disorders include excessive thirst, nausea and vomiting, and elevated blood pressure. The specific manifestations associated with urinary system disorders include facial edema and stress incontinence.

Which complications does the nurse expect in the client with a renal disorder who has a blood urea nitrogen (BUN)/creatinine ratio of 28? Fluid volume deficit Obstructive uropathy

The normal range of blood urea nitrogen (BUN)/creatinine ratio is 6 to 25. The BUN/creatinine ratio of 28 is a higher value than the normal; the client may have complications like fluid volume deficit and obstructive uropathy. A decrease in BUN levels indicates malnutrition and severe hepatic damage. Increased serum creatinine levels indicate kidney impairment.

Which phase of the woman's sexual response is characterized by elevation of the uterus? Plateau Phase

The plateau phase occurs after the excitation phase, and excitation is maintained through the plateau phase, wherein the vagina expands and the uterus is elevated. Therefore elevation of the uterus is a characteristic of the plateau phase of a woman's sexual response. The orgasmic phase is characterized by uterine and vaginal contractions. In the excitation phase, the clitoris is congested and vaginal lubrication increases. The resolution phase is characterized by returning to the preexisting state.

A client with end-stage kidney disease says to the nurse, "I heard that it is inevitable that I will need a kidney transplant. If so, which one of my kidneys will be removed?" Which is the best response by the nurse? "Neither of your kidneys will be removed unless they are infected."

The recipient's own kidneys are not removed unless a chronic infection is present. The primary healthcare provider will not decide which kidney is replaced, the most diseased kidney will not be removed, and the right kidney will stay because the kidneys are left in place; the new kidney is placed in the right lower quadrant.

When assessing a client during peritoneal dialysis, a nurse observes that drainage of the dialysate from the peritoneal cavity has ceased before the required volume has returned. What should the nurse instruct the client to do? Turn from side to side

Turning from side to side will change the position of the catheter, thereby freeing the drainage holes of the tubing, which may be obstructed. Drinking a glass of water and deep breathing and coughing do not influence drainage of dialysate from the peritoneal cavity. The position of the catheter should be changed only by the primary healthcare provider.

The nurse is caring for a client in the postanesthesia care unit. The client had a suprapubic prostatectomy for cancer of the prostate and has a continuous bladder irrigation (CBI) in place. Which primary goal is the nurse trying to achieve with the CBI? Prevent the development of clots in the bladder.

A continuous flushing of the bladder dilutes the bloody urine and empties the bladder, preventing clots. Fluid instilled into the bladder does not affect kidney function. Urinary output can be measured regardless of the amount of fluid instilled. The urinary retention catheter is not designed to exert pressure on the prostatic fossa.

What is the primary purpose of conducting a cystoscopy in a client with decreased and difficult urination? To ascertain the presence of urethral wall abnormality.

Cystoscopy is a procedure in which a cystoscope is used to visualize and examine the inner walls of the urinary bladder and ureter. The cystoscope is introduced into the client's ureter to detect the presence of urethral wall abnormalities or occlusions. Radiography or ultrasonography of the kidneys will enable visualization of the kidneys and therefore kidney size can be ascertained. A 24-hour urine test is performed to analyze the levels of various components in the urine and is recommended to ascertain the protein content in urine. The total amount of catecholamines excreted in urine can also be measured through 24-hour urine sample testing.

During percussion of the client's bladder, the primary healthcare provider hears sounds as high up as the umbilicus. While caring for this client, the nurse provides privacy, assistance, and voiding stimulants as needed. What other action should the nurse perform while caring for this client? Evaluate the client's history for anticholinergic therapy

Distention of the bladder occurs due to urine retention. A distended bladder can be percussed as high as the umbilicus. The other intervention that the nurse should perform is to evaluate the client's history for anticholinergic therapy because anticholinergic drugs promote urine retention. The nurse should provide privacy, assistance, and voiding stimulants, such as warm water over the perineum as needed. The nurse should carefully administer potentially nephrotoxic agents if the client has decreased glomerular filtration rate (GFR). The nurse should evaluate the client's history for steroid therapy if there is an increase in blood urea nitrogen (BUN) levels. The nurse should not administer nonsteroidal antiinflammatory drugs (NSAIDs) for urinary retention.

Which instruction would be most beneficial for an aging African-American client with hypertension? "Have an annual urinalysis

African-American clients have 20% less blood flow to the kidneys because of high sodium consumption. This causes anatomical changes in the blood vessels, thereby increasing the risk of kidney failure. Therefore instructing the client with hypertension to have an annual urine examination would be beneficial. If the client has protein in the urine, this is a sign of high blood pressure and can signify kidney damage. Checking the pulse daily poses no harm to the individual, but does not determine if the client has hypertension. Recording the blood pressure weekly is not a good indicator of an aging African-American client with hypertension. The client's blood pressure should be taken at least daily to determine if the client has problems. If the client has an eye-related problem, visiting an ophthalmologist should be suggested.

A client is scheduled for a transurethral resection of the prostate. What should the nurse tell the client to expect after surgery? "An indwelling urinary catheter is required for at least a day."

An indwelling urethral catheter is used, because surgical trauma can cause edema and urinary retention, leading to additional complications, such as bleeding. Urinary control is not lost in most cases; loss of control usually is temporary if it does occur. Sexually ability usually is not affected; sexual ability is maintained if the client was able to perform before surgery. A cystostomy tube is not used if a client has a transurethral resection; however, it is used if a suprapubic resection is done.

What are the functions of antidiuretic hormone (ADH)? Increasing arteriole constriction Increasing tubular permeability to water

Antidiuretic hormone (ADH), also known as vasopressin, is a hormone released from the posterior pituitary gland. ADH increases arteriole constriction and tubular permeability to water. Calcium balance is controlled by blood levels of calcitonin and the parathyroid hormone (PTH). Erythropoietin stimulates the bone marrow to make red blood cells. Aldosterone promotes the reabsorption of sodium in the distal convoluted tubule (DCT).

Tests reveal that a client has phosphatic renal calculi. The nurse teaches the client that the diet may include which food item? Apples

Apples are low in phosphate; fresh fruit is low in phosphorus. Chocolate contains more phosphate than apples. Rye bread contains more phosphate than apples. Cheese is made with milk, which contains phosphate and should be avoided. Dairy products are high in phosphorus.

A client comes to the emergency department because of minimal urinary output despite drinking adequate fluid. The client's blood pressure is 190/94 mm Hg. For what additional clinical manifestation associated with this data should the nurse assess the client? Weight gain

If urine is not being produced in the presence of an average daily intake, fluid will be retained and reflected in weight gain. Oliguria is decreased urinary output. One liter of fluid weighs 2.2 pounds (1 kg). Excess fluid contributes to an increase in circulating blood volume, causing hypertension. Thirst is associated with dehydration, not hypertension and oliguria. Urinary retention is unrelated to hypertension. Urinary retention is the inability to empty the bladder. Urinary hesitancy is an involuntary delay in initiating urination and is unrelated to hypertension and oliguria.

A 75-year-old male with a history of cancer of the prostate is admitted for a prostatectomy. The client's prostate specific antigen (PSA) levels have been increasing. This finding should prompt the nurse to include what in the client's plan of care? Handle the client gently when turning.

Increasingly elevated PSA levels may indicate a worsening of the client's condition with possible metastasis to the bone, increasing the risk of pathologic fractures; therefore handling must be gentle. Although measuring intake and output is necessary for any client with prostatic cancer because of the risk of bladder obstruction, it is not the priority for this client. Seizure precautions are not necessary; a PSA elevation indicates bone, not brain, involvement. Elevated PSA levels do not significantly affect the plasma pH.

The registered nurse is preparing to assess a client's renal system. Which statement by the nurse indicates effective technique? "I must first auscultate the client and then proceed to percussion and palpation."

Palpation and percussion can cause an increase in normal bowel sounds and hide abdominal vascular sounds. Therefore it is wise to perform auscultation prior to percussion and palpation during clinical assessment of the renal system. Palpation should be avoided if a client is suspected of having a tumor because it could harm the client. It is more important as part of clinical assessment of the renal system to listen for bruit by auscultating over the renal artery. Bruit indicates renal artery stenosis. The nontender areas should be examined prior to tender areas to avoid confusion regarding radiating pain from the tender area being percussed.

A sexually active client presents with a sore throat and a generalized rash. The client states that a chancre that had been present healed approximately 3 months ago. The physical assessment and the serologic test findings indicate a diagnosis of syphilis. Which stage should the nurse determine the client is in at this time? <p>A sexually active client presents with a sore throat and a generalized rash. The client states that a chancre that had been present healed approximately 3 months ago. The physical assessment and the serologic test findings indicate a diagnosis of syphilis. Which stage should the nurse determine the client is in at this time? Secondary

The client has secondary syphilis, which occurs 1 to 3 months after healing of the primary lesion and lasts for several weeks to as long as a year; it is the stage at which the individual is most infectious. Primary syphilis is the stage of initial infection and is characterized by the presence of a chancre, a painless lesion at the site of infection. Latent syphilis occurs after the secondary stage and before the late stage of syphilis; in latent syphilis the immune system is able to suppress the infection and there are no clinical signs and symptoms. Tertiary syphilis, also known as late syphilis, is the final stage of syphilis. At this stage it is a slowly progressive inflammatory disease that can involve many organs; the skin, brain, and heart can be affected.

During the postoperative period after surgery for a kidney transplant, the client's creatinine level is 3.1 mg/dL (260 mcmol/L). What should the nurse do first in response to this laboratory result? Assess for decreased urine output

The expected serum creatinine range is 0.7 to 1.4 mg /dL (62 to 124 mcmol/L). The nurse should obtain additional information that may indicate acute rejection; therefore, the nurse must first assess for decreased urine output and changes in vital signs. Once additional data are collected (e.g., urine output, current blood work reports) and the intravenous (IV) infusions are checked, the nurse should contact the primary healthcare provider, explain the situation, and implement further prescriptions. Eventually the nurse should ensure that proper infusion rates, along with IV medications, are being maintained after the client is first assessed for decreased urine output and for changes in vital signs. Current blood work reports should be obtained after the client is assessed for decreased urine output and changes in vital signs.

A client has undergone pelvic surgery and the nurse removes the catheter in a week according to instructions. In the follow up within several hours, which finding in the client indicates a need for reinsertion of catheter? Retention

The inability of the client to urinate in spite of the bladder being filled with urine is called retention. Generally clients who have undergone pelvic surgery and have the catheter removed experience urinary retention. The catheter should be reinserted if the client is unable to void. Anuria is the drastic decrease in urine output to less than 100 mL in a day and is a sign of end-stage kidney disease or acute kidney injury. Polyuria is anticipated in a client who is diagnosed with diabetes mellitus or insipidus, and the client eliminates large volumes of urine at a time. Incontinence or the loss of ability over voluntarily control of urination is a sign of conditions such as neurogenic bladder or bladder infection.

A nurse is caring for a client with end-stage renal disease who has a mature arteriovenous (AV) fistula. Which nursing care should be included in the client's plan of care? Auscultate for a bruit Palpate the site to identify a thrill Avoid drawing blood from the affected extremity.

The presence of a bruit indicates patency of the AV fistula. The presence of a vibration or thrill indicates patency of the AV fistula. Drawing blood is avoided to prevent damage to the AV fistula. An AV fistula is internal and is not irrigated. The AV fistula is under the skin and is not clamped.

The client is scheduled for an abdominal hysterectomy with a bilateral oophorectomy. As the nurse prepares to have the client sign the informed consent, the client asks how long she should wait to become pregnant. Which action should the nurse take? Call the primary healthcare provider immediately and hold preoperative medications.

The primary healthcare provider should be notified immediately that the informed consent is not going to be signed because the client does not appear to understand the procedure. Bilateral oophorectomy is removal of the ovaries, and pregnancy is not possible. The primary healthcare provider should also be informed that preoperative medication is being held until the situation is worked out. An informed consent involves the primary healthcare provider telling the client in understandable terms about the diagnosis, treatment, likely outcome, alternative treatments, and possible complications. If there are questions before signing the consent, the primary healthcare provider must be contacted to provide further explanation. The nurse should ensure that the client signing the consent understands its meaning and is signing voluntarily. Clients are unable to provide consent if they have received analgesia. Having the client sign the informed consent without understanding it is an unethical action. It is not within the nurse's role to explain the surgical procedure, and it is obvious by the question asked that the client does not have all the necessary information. Telling the client that she will be unable to become pregnant after the surgery is not the nurse's responsibility.

Which actions should the nurse perform while collecting subjective data from a client during a focused urinary assessment? Inquire about painful urination. Ask the client about changes in characteristics of urination.

While collecting subjective data from a client during the focused urinary assessment, the nurse should ask the client about painful urination and also about any changes in the characteristics of urination (diminished, excessive). This information indicates the presence or absence of urinary disorders. The nurse should palpate the abdomen for bladder distention or masses while collecting objective data during the physical examination. The blood, urea, nitrogen, and creatinine values are included in the objective diagnostic data. The nurse inspects the client's urinary meatus for inflammation or discharge while collecting objective data during the physical examination.