NURS 2207 GU/Men's Health Quiz

Which instructions would the nurse give to a client with renal calculi? Select all that apply. One, some, or all responses may be correct. 1. "Drink plenty of water." 2. "Have spinach soup every day." 3. "Substitute lemon juice for tea." 4. "Include high amounts of protein in the diet." 5. "Consume foods rich in omega-3 fatty acids."

ANS: 1, 3 Rationale: Renal calculi is the formation of kidney stones. Drinking plenty of water will keep the body hydrated and prevent further formation of stones. Tea contains caffeine, a diuretic, which causes dehydration. The client must be advised to replace tea with lemon juice. Spinach is rich in oxalates. Consuming spinach soup may aggravate the problem, due to the formation of oxalate crystals. Excessive consumption of proteins may precipitate uric acid stones. The use of proteins should not be encouraged. Foods rich in omega-3 fatty acids are beneficial in maintaining good health. However, the use of omega-3 fatty acids, specifically in the treatment, mitigation, or prevention of kidney stones, is not justified.

Which clinical manifestations would the nurse expect the client to report when experiencing renal calculi? Select all that apply. 1. Blood in the urine. 2. Irritability and twitching 3. Dry, itchy skin and pyuria 4. frequency and urgency of urination 5. Pain radiating from the kidney to a shoulder

ANS: 1, 4 Rationale: Hematuria is a common clinical manifestation of renal calculi. Frequency and a sense of urgency may occur because of irritation caused by the calculi; the most common expectation is sharp, severe pain. Irritability may occur because of discomfort; twitching does not occur. Pyuria may occur when infection is present; skin problems do not occur. Pain radiates from the flank to the groin area.

The nurse teaches a client with calcium-based renal calculi about foods that can be included in a low-calcium diet. The nurse concludes that the teaching is effective when the client selects which food items from the menu? Select all that apply. One, some, or all responses may be correct. 1. Baked chicken 2. Chocolate pudding 3. Salmon loaf with cheese sauce 4. Roast beef with mashed potatoes 5. Vanilla ice cream with chocolate syrup

ANS: 1, 4 Rationale: Baked chicken is relatively low in calcium. Roast beef and mashed potatoes have moderate amounts of calcium. Pudding is made with milk and is high in calcium. Cheese is high in calcium. Ice cream is made with milk and is high in calcium.

The laboratory values of a client with renal calculi reveal a serum calcium within expected limits and an elevated serum purine. Which type of stone composition is consistent with these laboratory values? 1. Cystine 2. Uric acid 3. Calcium oxalate 4. Magnesium ammonium phosphate

2. Uric acid Rationale: Purines are precursors of uric acid, which crystallizes. Cystine stones are caused by a rare hereditary defect resulting in defective absorption of cysteine in the gastrointestinal tract and kidneys (inborn error of cystine metabolism). Serum purine will not be elevated if the stone is composed of calcium oxalate. A struvite stone sometimes is called a magnesium ammonium phosphate stone and is precipitated by recurrent urinary tract infections.

Which information would the nurse provide about what the client can expect after surgery for a transurethral resection of the prostate? 1. "Urinary control may be permanently lost to some degree." 2. "An indwelling urinary catheter is required for at least a day." 3. "Your ability to perform sexually will be impaired permanently." 4. "Burning on urination will last while the cystostomy tube is in place."

2. "An indwelling urinary catheter is required for at least a day." Rationale: 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. Sexual 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.

The nurse writes a goal of preventing renal calculi in a care plan for a client who has paraplegia. Which information provides the rationale for selecting this goal? 1. High fluid volume intake 2. Increased calcium intake 3. Inadequate kidney function 4. Accelerated bone demineralization

4. Accelerated bone demineralization Rationale: 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.

After a transurethral resection of the prostate, the retention catheter is pulled taut and secured to the client's leg. The client reports a feeling of pressure and asks why this is necessary. Which rationale would the nurse include in a response to this question? 1. Prevents bleeding 2. Limits discomfort 3. Reduces bladder spasms 4. Promotes urinary drainage

1. Prevents bleeding Rationale: Pressure of the balloon against small blood vessels of the prostatic fossa causes them to constrict, thereby preventing bleeding. The taut catheter may cause discomfort or bladder spasms. The tautness of the catheter does not promote urinary drainage.

Which medication to treat osteoporosis would be contraindicated for a client who has a history of renal calculi? 1. Os-cal 2. Raloxifene 3. Ibandronate 4. Zoledronic acid

1. Os-cal Rationale: Os-cal (a calcium supplement) should not be prescribed to a client with osteoporosis with a history of urinary stones. Raloxifene may increase liver function test values and worsen hepatic disease. Ibandronate should not be prescribed to clients with gastric problems because of the risks of esophagitis and gastric ulcers. Zoledronic acid should not be prescribed to clients with poor oral hygiene because the medication may cause maxillary osteonecrosis.

The nurse is caring for several adolescent clients. Which are at increased risk for testicular cancer? Select all that apply. One, some, or all responses may be correct. 1. Client with infertility 2. Client with hemophilia 3. Client with liver disease 4. Client with cryptorchidism 5. Client with Klinefelter syndrome

ANS: 1, 4, 5 Rationale: Risk factors for testicular cancer include cryptorchidism, Klinefelter syndrome, and infertility. The client with liver disease may be at increased risk of gynecomastia. Hemophilia, a hematologic disorder, is not a risk factor for testicular cancer.

A client scheduled for a transurethral prostatectomy expresses concern about the effect the surgery will have on his sexual ability. Which information would the nurse share with the client? 1. The client may experience retrograde ejaculations. 2. The client may have a diminished sex drive. 3. The client will have prolonged erections after recovery. 4. The client will be impotent for the rest of his life.

1. The client may experience retrograde ejaculations. Rationale: Ejection of semen into the bladder instead of the urethra is common after a transurethral prostatectomy. The surgery should not interfere with the client's libido and will not cause prolonged erections. Impotence is not typical with the transurethral prostatectomy surgical approach; however, impotence may occur with the retroperitoneal surgical approach.

The health care provider prescribes finasteride for a client with benign prostatic hyperplasia (BPH). The client would like to take saw palmetto instead of the finasteride. Which information would the nurse provide to the client about this herbal supplement? 1. "Research has shown that saw palmetto is no better than a placebo." 2. "You can take both; saw palmetto doesn't require a prescription." 3. "The herbal supplement will relieve symptoms by altering the size of the prostate." 4. "Substituting saw palmetto is a good option to avoid all the bad side effects of finasteride."

1. "Research has shown that saw palmetto is no better than a placebo." Rationale: Rigorous research has demonstrated no significant difference between saw palmetto and a placebo. The health care provider must be consulted regarding the client's desire to change the prescribed therapy. Saw palmetto should be taken with food to limit gastrointestinal side effects. Saw palmetto does not alter the size of the prostate gland. Substituting something that is ineffective is not a good solution regardless of issues surrounding side effects.

Before a transurethral resection of the prostate (TURP), a client asks about what to expect postoperatively. Which response would the nurse provide? 1. "Your urine will be pink and free of clots." 2. "You will have an abdominal incision and a dressing." 3. "There will be an incision between your scrotum and rectum." 4. "There will be a urinary catheter and a continuous bladder irrigation."

4. "There will be a urinary catheter and a continuous bladder irrigation." Rationale: The presence of an indwelling urinary catheter and a continuous bladder irrigation are routine postoperative expectations after a TURP; they provide for hemostasis and urinary excretion. An abdominal incision and dressing are present with a suprapubic, not transurethral, prostatectomy. After a TURP, the client initially can expect hematuria and some blood clots; the continuous bladder irrigation keeps the bladder free of clots and the catheter patent. An incision between the scrotum and rectum is associated with a perineal prostatectomy, not a TURP.

When providing care for a client who had a nephrectomy secondary to renal cancer, which factor affects the client's ability to perform his or her postoperative deep breathing and coughing requirements? 1. Location of the client's surgical incision 2. Increased anxiety about the prognosis 3. Inflammatory process associated with surgery 4. Pulmonary congestion from preoperative medications

1. Location of the client's surgical incision Rationale: The location of the surgical site in relation to the diaphragm increases incisional pain when deep breathing or coughing. Anxiety about the prognosis should not interfere with the ability to deep breathe and cough, especially when encouraged by the nurse. Inflammatory changes will cause discomfort in the area of any incision but are not necessarily the prime factor preventing deep breathing after a nephrectomy. The client will need to cough and deep breathe if there is congestion in the lungs.

The client with a suprapubic prostatectomy for cancer of the prostate has continuous bladder irrigations (CBI) in place after surgery. Which primary goal is the nurse trying to achieve with the CBI? 1. Stimulate continuous formation of urine. 2. Facilitate the measurement of urinary output. 3. Prevent the development of clots in the bladder. 4. Provide continuous pressure on the prostatic fossa.

3. Prevent the development of clots in the bladder. Rationale: 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.

When performing presurgical teaching for a client pending a transurethral resection of the prostate (TURP), which statement would the nurse include? 1. "Urinary control may be permanently lost to some degree." 2. "An indwelling urinary catheter is required for at least 1 day." 3. "Your ability to perform sexually will be impaired permanently." 4. "Burning on urination will last while the cystostomy tube is in place."

2. "An indwelling urinary catheter is required for at least 1 day." Rationale: The primary health care provider will insert a three-way indwelling urethral catheter 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; the client maintains sexual ability if the client was able to perform sexually before surgery. The procedure does not use a cystostomy tube if a client has a transurethral resection; however, the provider does use a cystostomy tube for a suprapubic resection.

The nurse is caring for a client who has renal calculi secondary to hyperparathyroidism. Which type of diet would the nurse teach the client? 1. Low purine 2. Low calcium 3. High phosphorus 4. High alkaline ash

2. Low calcium Rationale: A low calcium intake is recommended. Calcium and phosphorus are components of these stones; foods high in calcium and phosphorus should be avoided. Low purine and high alkaline ash diets are indicated for clients with gout.

Which foods would the nurse teach a client to avoid when diagnosed with calcium oxalate renal calculi? Select all that apply. One, some, or all responses may be correct. 1. Milk 2. Tea 3. Liver 4. Spinach 5. Rhubarb

ANS: 2, 4, 5 Rationale: Tea, rhubarb, and spinach are high in calcium oxalate. Limiting oxalate-rich foods limits oxalate absorption and the formation of calcium oxalate calculi. Milk is an acceptable calcium-rich protein and is avoided with calcium stones, but not with oxalate stones. Liver is a purine-rich food and avoided with uric acid renal calculi or gout.

Which surgical procedure involves urinary diversion in which the ureters are transplanted to a resected section of the small intestines, with one end attached to the abdominal wall? 1. Cystostomy 2. Ileal conduit 3. Ureterosigmoidostomy 4. Cutaneous ureterostomy

2. Ileal conduit Rationale: An ileal conduit is the transplantation of the ureters into a resected portion of the ileum, which is then used to create a stoma on the abdominal wall for drainage of urine. Cystostomy is an opening into the bladder through the abdominal wall that allows urine to flow out. In ureterosigmoidostomy, the ureter is transplanted into the colon and urine is excreted through the rectum. In cutaneous ureterostomy, the ureter is transplanted through the abdomen and attached to the skin.

Which goal would the nurse establish when providing care for a client recovering from a transurethral resection of the prostate (TURP)? 1. Maintain patency of the cystostomy tube. 2. Prevent wound hemorrhage and infection. 3. Maintain patency of the indwelling catheter. 4. Prevent the abdominal dressing from draining.

3. Maintain patency of the indwelling catheter. Rationale: Indwelling catheter patency promotes bladder decompression, which prevents distention and bleeding; continuous flow of an irrigant limits clot formation and promotes hemostasis. Maintaining patency of the cystostomy tube is not associated with a TURP; a cystostomy tube is a catheter that is placed directly into the bladder through a suprapubic incision. No abdominal incision is made because the resection is performed via the urethra. Although hemorrhage and infection may occur, no wound is observed because the surgery was performed via the urethra.

The nurse shares the discharge instructions with a client who has prostate cancer. The client asks, "How much more blood will they need? Don't they have enough?" Which laboratory test would the nurse discuss the need to monitor throughout the course of the disease? 1. Albumin 2. Creatinine 3. Blood urea nitrogen (BUN) 4. Prostate-specific antigen (PSA)

4. Prostate-specific antigen (PSA) Rationale: The PSA is an indication of the presence of prostate cancer; the higher the level, the greater the tumor burden. The health care provider will monitor the PSA levels throughout the course of the disease and periodically thereafter. Albumin is a protein and an indicator of nutritional and fluid status. Creatinine and BUN levels indicate renal function and may elevate when blockage of the urethra occurs from an enlarged prostate, but the reports do not indicate metastasis or prostate cancer.

Which intervention would prevent urinary stasis and formation of renal calculi in an immobile client? 1. Increasing oral fluid intake to 2 to 3 L/day 2. Maintaining bed rest after discharge 3. Limiting fluid intake to 1 L/day 4. Voiding at least every hour

1. Increasing oral fluid intake to 2 to 3 L/day Rationale: Increasing oral fluid intake to 2 to 3 L/day, if not contraindicated, will dilute urine and promote urine flow, thus preventing stasis and complications such as renal calculi. Bed rest and limited fluid intake may lead to urinary stasis and increase the risk for the formation of renal calculi. Voiding at least every hour has no effect on urinary stasis and renal calculi.

Which information would the nurse include in the home care instructions for a client being discharged post-lithotripsy for renal calculi? 1. "Increase your intake of dairy products for 5 days." 2. "Drink at least 3 L of fluid daily for 4 weeks." 3. "Do not take any medications after this treatment." 4. "Call us back immediately if you observe any blood in your urine."

2. "Drink at least 3 L of fluid daily for 4 weeks." Rationale: Increasing fluid intake aids in the passage of fragments of the calculus that remain after the lithotripsy. Calcium is the major component of the most common type of calculus; the intake of dairy products, which are high in calcium, should be limited. The client will take antibiotics after the treatment and should complete the entire regimen. Hematuria (blood in the urine) after lithotripsy is an expected response and does not require notification.

A client with cancer of the prostate requests the urinal frequently but either does not void or voids in very small amounts. Which factor is the likely cause? 1. Edema 2. Dysuria 3. Retention 4. Suppression

3. Retention Rationale: An enlarged prostate constricts the urethra, interfering with urine flow and causing retention. When the bladder fills and approaches capacity, small amounts can be voided, but the bladder never empties completely. Edema does not cause the client to void frequently in small amounts. Dysuria is painful or difficult urination, which is not part of the client's responses. The urge to void is caused by stimulation of the stretch receptors as the bladder fills with urine; in suppression, little or no urine is produced.

A client is diagnosed with testicular cancer. Which treatment would be first? 1. Radiotherapy 2. Chemotherapy 3. Testicular biopsy 4. Radical inguinal orchiectomy

4. Radical inguinal orchiectomy Rationale: Treatment for testicular cancer may include a radial inguinal orchiectomy (a surgical removal of the diseased testicle). Radiotherapy and chemotherapy are usually implemented after an orchiectomy based on the stage of the tumor. A testicular biopsy is no longer recommended because it may cause the spread of malignant cells.

A client with invasive carcinoma of the bladder is scheduled for a cystectomy and an ileal conduit. The client expresses worries about the possibility of offensive odors associated with the urinary diversion. How would the nurse respond? 1. "Tell me more about your concerns." 2. "Products are available to limit this problem." 3. "This is a problem, but the surgery is necessary." 4. "Most people who have this surgery share this same concern."

1. "Tell me more about your concerns." Rationale: The response "Tell me more about what you are thinking" is an open-ended statement that focuses on the client's concerns and allows further verbalization of feelings. Although true, the response "This is a problem, but the surgery is necessary" may increase anxiety and cut off communication. The responses "Products are available to limit this problem" and "Most people who have this surgery share this same concern" move the focus away from the client and minimize the client's concerns.

To prevent the development of ureteral colic from renal calculi in the future, which strategy would the nurse include in the client's plan of care? 1. Instruct the client to drink at least 3 L of fluid daily. 2. Suggest interventions to decrease the serum creatinine level. 3. Establish a urinary output goal of 2000 mL per 24 hours. 4. Teach the client to exclude milk products from their diet.

1. Instruct the client to drink at least 3 L of fluid daily. Rationale: Increasing fluid intake dilutes the urine, and crystals are less likely to coalesce and form calculi. An elevated serum creatinine has no relationship to the formation of renal calculi. Calcium restriction is necessary only if calculi have a calcium phosphate basis. Producing only 2000 mL of urine per 24 hours is inadequate.

The nurse reviews the medical records of four male clients. Which client would the nurse note as having the highest risk for development of clinical manifestations related to prostate cancer? 1. African American 55-year-old 2. White 45-year-old 3. Asian 55-year-old 4. Hispanic 45-year-old

1. African American 55-year-old Rationale: Cancer of the prostate is rare before age 50 years but increases with age. African American men develop cancer of the prostate more often and at an earlier age than white men do. African American men develop prostate cancer more often than any other ethnic group. Asian American men have a lower incidence than white men do.

After a prostatectomy, the client reported the urinary catheter tubing pulled too tightly on the leg. The nurse observed the excessively taut indwelling catheter tubing and properly taped tubing to the thigh. Which action would the nurse implement? 1. Explain the tubing traction assists to control bleeding. 2. Adjust the catheter tubing tension to relieve the taut pressure. 3. Untape the urinary catheter and retape the catheter closer to the urinary meatus. 4. Assess the degree of tension on the catheter and contact the primary health care provider.

1. Explain the tubing traction assists to control bleeding. Rationale: Traction on the indwelling catheter pulls the balloon tight against the prostatic fossa, which promotes hemostasis. The nurse must insure maintenance of the catheter's tension until the primary health care provider determines there is no longer a risk of bleeding. There is not a need to notify the primary health care provider; pressure at the site is an expectation.

Which clinical manifestation would the nurse associate with benign prostatic hyperplasia? 1. Perineal edema 2. Urethral discharge 3. Flank pain radiating to the groin 4. Distention of the lower abdomen

4. Distention of the lower abdomen Rationale: Distention of the suprapubic area indicates the bladder is distended with urine and palpable. Perineal edema is not a clinical manifestation of urinary retention and benign prostatic hyperplasia. Urethral discharge typically relates to sexually transmitted infections and may indicate an infection, but not benign prostatic hyperplasia. The discharge would be associated with a urinary infection. Radiating flank pain may indicate renal calculi. Topics

A client has phosphate renal calculi. Which food item would the nurse teach the client to include regularly in the diet? 1. Apples 2. Chocolate 3. Rye bread 4. Cheddar cheese

1. Apples Rationale: 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.

Which response would the nurse use when a client scheduled for a transurethral incision of the prostate (TUIP) voices concern regarding impotence? 1. "It's understandable that you are worried; impotence is a very real possibility." 2. "I can understand your concern, but this procedure usually does not cause impotence." 3. "Most men worry about that ability; you should speak with your primary health care provider." 4. "You may be temporarily impotent, but normal functioning returns within a few months."

2. "I can understand your concern, but this procedure usually does not cause impotence." Rationale: The response "I can understand your concern, but this procedure usually does not cause impotence" recognizes the concern and provides accurate information that may reduce anxiety. The response "It's understandable that you are worried; impotence is a very real possibility" is inaccurate information; impotence usually does not result. The reply "Most men worry about that ability; you should speak with your primary health care provider" closes off communication and transfers responsibility to the primary health care provider. The reply "You may be temporarily impotent, but normal functioning returns within a few months" does not recognize feelings and provides inaccurate information; impotence rarely, if ever, occurs with this procedure.

Sildenafil is prescribed for a man with erectile dysfunction. Which side effects of this medication would the nurse mention in teaching? Select all that apply. One, some, or all responses may be correct. 1. Flushing 2. Headache 3. Dyspepsia 4. Constipation 5. Hypertension

ANS: 1, 2, 3 Rationale: Flushing is a common central nervous system response to sildenafil. Headache is a common central nervous system response to sildenafil. Dyspepsia is a common gastrointestinal response to sildenafil. Diarrhea, not constipation, is a common gastrointestinal response to sildenafil. Hypotension, not hypertension, is a cardiovascular response to sildenafil. It should not be taken with antihypertensives and nitrates because medication interactions can precipitate cardiovascular collapse.

The health care provider prescribes finasteride for a client with benign prostatic hyperplasia. Which information would the nurse provide to the client? 1. Male pattern baldness can occur. 2. Results can be expected in 4 to 6 weeks. 3. The medication relaxes the muscles in the bladder neck. 4. A condom should be worn during intercourse with a pregnant female.

4. A condom should be worn during intercourse with a pregnant female. Rationale: Contact with the semen of a client taking finasteride can adversely affect a developing male fetus in a pregnant woman. Finasteride helps prevent male pattern baldness. Results may take 6 to 12 months. Finasteride is used to shrink an enlarged prostate. Other medications, such as tamsulosin, relax the muscles in the prostate and bladder neck, making it easier to urinate.

A client who had a transurethral resection of the prostate (TURP) experiences dribbling after removal of the indwelling catheter. Which response to the client would the nurse use? 1. "I know you're worried, but the dribbling will go away in a few days." 2. "Increase your fluid intake and urinate at regular intervals." 3. "Limit your fluid intake and urinate when you first feel the urge." 4. "The catheter will have to be reinserted until your bladder regains its tone."

2. "Increase your fluid intake and urinate at regular intervals." Rationale: The response "Increase your fluid intake and urinate at regular intervals" will improve bladder tone, which should alleviate dribbling. The response "I know you're worried, but it will go away in a few days" identifies feelings but does not actively help the client solve the problem. Limiting fluid intake and urinating at the urge do not increase bladder tone; the client should increase his fluid intake and gradually increase the time between voiding attempts. Continuous bladder decompression from a catheter will reduce bladder tone; bladder tone will improve after removal of the indwelling catheter.

Which action would the nurse include when developing a postprocedure plan of care for a client with continuous bladder irrigations after a transurethral vaporization of the prostate? 1. Measure the output hourly and monitor total output trends. 2. Monitor the specific gravity of the urine each shift. 3. Irrigate the triple-lumen catheter with normal saline three times daily. 4. Deduct the amount of instilled irrigant from the total output.

4. Deduct the amount of instilled irrigant from the total output. Rationale: The amount of irrigant instilled into the bladder must be deducted from the total output to determine the amount of urine produced. The client will have an indwelling catheter, and hourly measurements are not possible because the irrigant is mixing with the urine. Abnormal specific gravity values are not associated with this procedure and would be inaccurate because the irrigant is mixing with the urine. Because the bladder is being irrigated continuously, no additional irrigations are needed.

A client is admitted to the hospital with a tentative diagnosis of urinary retention related to benign prostatic hyperplasia. The primary health care provider notes a secondary diagnosis of delirium related to urosepsis and prescribes the insertion of an indwelling urinary retention catheter. Which nursing action is most important at this time? 1. Secure a prescription for wrist restraints. 2. Orient the client to time, place, and person. 3. Involve family members in the client's care. 4. Determine whether any unsafe behavior patterns exist.

4. Determine whether any unsafe behavior patterns exist. Rationale: The nurse should determine whether the client is a danger to self or others before planning and implementing care. In the absence of unsafe behavior, the nurse should not apply wrist restraints, because there is not a risk of the client pulling the urinary catheter. Pulling on the indwelling urinary catheter may be a concern because this may cause an injury; however, the nurse would attempt less restrictive alternatives first. Use of a restraint is a last resort. Orienting the client to time, place, and person is appropriate for the client with delirium; however, this will not protect the client from attempting to pull out the urinary catheter or from engaging in other unsafe behaviors. Although family members should be involved in the client's care, assessing the client or protecting the client from injury is not the responsibility of family members.

After an unsuccessful lithotripsy to break up renal calculi, a nephrolithotomy was successful in removing the client's renal calculi. Which clinical indicator would the nurse monitor during the postoperative period and report immediately to the primary health care provider? 1. Continuous passage of pink-tinged urine 2. Pink drainage on the client's surgical dressing 3. Total intake volume of 2000 mL in 24 hours 4. Urinary output of 20 to 30 mL/h

4. Urinary output of 20 to 30 mL/h Rationale: The client's urinary output should be at least 30 mL/h; a decreased output may indicate obstruction, impaired kidney function, or fluid volume deficit. Blood, tinting the urine pink, is expected. Drainage on the surgical dressing may be pink; the nurse would report bright red drainage. The intake of 2000 mL in 24 hours is adequate; however, a higher intake usually is preferred to prevent fluid volume deficit (e.g., >2000-3000 mL).

Elbow restraints have been prescribed for a confused client to keep the client from pulling out a nasogastric tube and indwelling urinary retention catheter. Which nursing intervention is correct regarding restraints? 1. Have the prescription renewed every 48 hours. 2. Assess the client's condition per hospital protocol. 3. Provide range-of-motion exercises to the client's elbows every shift. 4. Document output from the tube and catheter every 2 hours.

2. Assess the client's condition per hospital protocol. Rationale: A restraint impedes the movement of a client; therefore a client's condition needs to be assessed every hour. All restraints are required to be represcribed every 24 hours. Restraints should be removed and activity and skin care provided at least every 2 hours to prevent contractures and skin breakdown. Output from tubes may be monitored hourly, but generally does not need to be documented as frequently as every 2 hours. Generally, output from tubes is emptied, measured, and documented at the end of each shift. A client who is in critical condition or in the immediate postoperative period may have urinary output measured hourly because this reflects cardiovascular status.

An ambulatory client with benign prostatic hyperplasia reports to the morning nurse his inability to void all night long. Upon assessment, the nurse identifies distention of the client's bladder. Which action would the nurse implement? 1. Ask him to use a urinal. 2. Encourage increased fluids. 3. Assist him into a warm shower. 4. Exert pressure over the pubic area.

3. Assist him into a warm shower. Rationale: Warm water often will relax the urinary sphincter, enabling a client to void. The client already indicated an inability to void, so asking him to use a urinal is inappropriate; plus, the client is ambulatory, able to stand, and go to the bathroom, which is a more natural method than the urinal. The distended bladder indicates adequate fluid intake, increasing fluid intake will increase pressure and may result in hydronephrosis. Pressure over a distended bladder induces pain, which causes muscular contraction of the urinary sphincter.

Four days after a client had a cystectomy and formation of an ileal conduit, the nurse observes mucus threads in the client's urine. Which action would the nurse take? 1. Recognize that this is an expected response. 2. Obtain a specimen for culture and sensitivity. 3. Notify the primary health care provider immediately. 4. Increase the client's fluid intake for the next 12 hours.

1. Recognize that this is an expected response. Rationale: This response is expected after a diversion because mucus is secreted continually by the intestinal mucosa. Reporting this to the primary health care provider immediately is not necessary; mucus is expected with an ileal conduit. Obtaining a specimen for culture and sensitivity is not necessary. At this point postsurgically, the mucus is not an indication of infection. Although fluids should be encouraged to maintain urine flow, increasing the client's fluid intake for the next 12 hours will not eliminate mucus, which is discharged continually from the intestinal segment.

Which action would the nurse plan for a client during the early postoperative period after a prostatectomy? 1. Have the client stand to void. 2. Discourage straining for a bowel movement. 3. Use a bulb syringe to aspirate urine from the retention catheter. 4. Notify the primary health care provider if the client does not void by bedtime.

2. Discourage straining for a bowel movement. Rationale: Straining applies pressure to the operative site, which can precipitate bleeding and should be avoided. A retention catheter is routinely put into place, so standing to void and not voiding by bedtime are not applicable. To prevent trauma, negative pressure should not be exerted on the bladder by using a bulb syringe to aspirate.

Which urinary diversion surgery involves the transplantation of the ureters to a section of the colon, with one end attached to the abdominal wall as an ileostomy? 1. Cystostomy 2. Ileal conduit 3. Ureterosigmoidostomy 4. Cutaneous ureterostomy

2. Ileal conduit Rationale: An ileal conduit is the transplantation of the ureters to a section of the colon with one end attached to the abdominal wall. A cystostomy is an opening into the bladder through the abdominal wall that allows urine to flow out. An ureterosigmoidostomy involves transplanting the ureter into the colon so that the urine is excreted through the rectum. A cutaneous ureterostomy involves the surgical creation of an opening from the ureter to the skin surface of the abdomen.

Which action would the nurse take first for a client who just had a transurethral resection of the prostate and reports pain in the operative area? 1. Administer the prescribed analgesic. 2. Inspect the drainage tubing for patency. 3. Encourage intake of fluids to dilute urine. 4. Take a full set of vital signs.

2. Inspect the drainage tubing for patency. Rationale: Pain after a prostatectomy may indicate retention of urine as a result of blocked drainage tubes or infection, or it may be an expected response to surgery. The possibility of any complication must be investigated. Analgesics can be administered after the cause of pain is investigated. Encouraging fluids without a patent drainage tube will increase pressure and discomfort; assessment should occur before implementation. The need to measure vital signs is dependent upon the analgesic prescribed; assessing the cause of pain takes priority.

The nurse is reviewing the clinical record of a client with a diagnosis of benign prostatic hyperplasia (BPH). Which test result would confirm the diagnosis? 1. Digital rectal examination 2. Serum phosphatase level 3. Biopsy of prostatic tissue 4. Massage of prostatic fluid

3. Biopsy of prostatic tissue Rationale: A definitive diagnosis of the cellular changes associated with BPH is made by biopsy, with subsequent microscopic evaluation. Palpation of the prostate gland through rectal examination is not a definitive diagnosis; this only reveals size and configuration of the prostate. The serum phosphatase level will provide information for prostatic cancer; a definitive diagnosis cannot be made with this test for BPH. A sample of prostatic fluid helps diagnosis prostatitis.

A client admitted with urinary retention has an indwelling urinary catheter prescribed. Which action would the nurse implement to prevent the client from developing a urinary tract infection? 1. Assess urine specific gravity. 2. Collect a weekly urine specimen. 3. Maintain the prescribed hydration. 4. Empty the drainage bag once a day.

3. Maintain the prescribed hydration. Rationale: Promoting hydration maintains urine production that flushes the bladder, thereby preventing urinary stasis and possible infection. Although assessing urine specific gravity and collecting a weekly urine specimen for culture and sensitivity may help identify a urinary tract infection, these actions will not prevent it. The nurse should empty the collection bag once every shift unless the bag is full and needs emptying sooner.

A client, transferred to the postanesthesia care unit after a transurethral resection of the prostate (TURP), has an intravenous (IV) line and a urinary retention catheter. During the immediate postoperative period, for which potentially critical complication would the nurse monitor? 1. Sepsis 2. Phlebitis 3. Hemorrhage 4. Leakage around urinary catheter

3. Hemorrhage Rationale: After transurethral surgery, hemorrhage is common because of venous oozing and bleeding from many small arteries in the area. Sepsis is unusual, and if it occurs, it will manifest later in the postoperative course. The nurse assesses for phlebitis, but phlebitis is not the most important complication. Hemorrhage is more important than phlebitis. Leaking around the IV catheter is not a major complication.

After a transurethral prostatectomy (TURP), a client returns to the postanesthesia care unit with a three-way indwelling catheter and a continuous bladder irrigation. Which nursing action would the nurse monitor during the initial recovery phase? 1. Observe the suprapubic dressing for drainage. 2. Maintain the client in a semi-Fowler position. 3. Monitor for bright red blood in the urinary drainage bag. 4. Encourage fluids by mouth as soon as the gag reflex returns.

3. Monitor for bright red blood in the urinary drainage bag. Rationale: Blood clots are normal 24 to 36 hours after the TURP surgery, but bright red blood can indicate hemorrhage. The surgeon performs the surgery by accessing the prostate through the urinary meatus and urethra; there is no suprapubic incision. The client does not need to maintain a semi-Fowler position. Initially, the client may not have anything by mouth (NPO) until the gag reflex returns and the anesthesia nausea decreases. Then the client advances to clear liquids and to a regular diet as tolerated. Continuous irrigation supplies enough fluid to flush the bladder.

The nurse provides discharge teaching for a client who had a transurethral vaporization of the prostate. Which statement by the client indicates successful learning? 1. "I should sit for several hours throughout the day." 2. "I should attempt to void every 2 hours when I am awake." 3. "I should avoid vigorous exercises for at least 6 months after surgery." 4. "I should notify my primary health care provider if my urinary stream decreases."

4. "I should notify my primary health care provider if my urinary stream decreases." Rationale: The surgical procedure affects the urethral mucosa in the area of the prostate, and strictures may form with healing. The client should notify his or her primary health care provider if his or her urinary stream decreases. The client should ambulate; sitting for several hours at a time is contraindicated because sitting promotes venous stasis and thrombus formation. The client should void as the need arises; straining to urinate can cause pressure in the operative area, precipitating hemorrhage. Although the client should avoid vigorous exercise immediately after surgery and during the healing process, 6 months is too long for this restriction.

A client's clinical manifestations include dysuria, hesitancy, urinary urgency, and urinary leakage. The client's serum prostate-specific antigen (PSA) level is 5 ng/mL, and the client has an elevated prostatic acid phosphatase (PAP) level. Which disorder would the nurse suspect? 1. Orchitis 2. Hydrocele 3. Prostatitis 4. Prostate cancer

4. Prostate cancer Rationale: Symptoms of prostate cancer include dysuria, hesitancy, urinary urgency, and leaking or dribbling. PSA is a blood test used to confirm prostate cancer. An elevated level of prostatic isoenzyme of serum acid phosphatase (PAP) is another indicator of prostate cancer. The normal range of a PSA level is 0 to 4 ng/mL. The client has an elevated PSA level. Acute inflammation of the testis indicates orchitis, characterized by a painful, tender, and swollen testis. A hydrocele is nontender, scrotal swelling caused by an accumulation of serous fluid in the scrotum. PSA levels are not elevated with a hydrocele. Prostatitis is a condition involving inflammation of the prostate gland and characterized by fever, chills, back pain, and perineal pain, along with acute urinary symptoms such as dysuria, urinary frequency, urgency, and cloudy urine. Increased PSA levels also indicate prostatitis, but the symptoms such as hesitancy and dribbling and elevated levels of PAP are not associated with prostatitis.

A client with positive family history of testicular cancer arrives at the hospital and reports testicular pain. The primary health care provider reviews the laboratory reports and makes a diagnosis of testicular cancer. After surgery, the client will undergo chemotherapy. Which conditions might occur in this client after chemotherapy? Select all that apply. One, some, or all responses may be correct. 1. Infertility 2. Varicocele 3. Heart disease 4. Penile carcinoma 5. Metabolic syndrome

ANS: 1, 3, 5 Rationale: A family history of testicular cancer is a risk factor for testicular cancer. The client with testicular cancer may report pain in the testicular region. Radical inguinal orchiectomy, chemotherapy, and radiotherapy would be beneficial for this client. Chemotherapy can cause infertility. It can also cause cardiovascular disease and metabolic syndrome. Varicocele is characterized by elongation, dilation, and tortuosity of the veins of the spermatic cord superior to the testicle, not with chemotherapy for testicular cancer. Penile carcinoma is commonly associated with human papillomavirus type 16 infection.

The registered nurse (RN) is caring for a client with renal calculi. To which health care professional will the RN delegate the task of administering oral medications to this client? 1. Certified technician 2. Patient care associate 3. Licensed practical nurse (LPN) 4. Unlicensed assistive personnel

3. Licensed practical nurse (LPN) Rationale: Administering oral medications can be safely delegated to an LPN or a licensed vocational nurse (LVN) as per guidelines. Certified technicians are licensed assistive personnel whose scope of practice is limited for administering medications. The scope of practice of the patient care associate and unlicensed assistive personnel is limited to performing basic care, feeding, and hygiene.

The registered nurse is caring for a client with renal calculi. Which health care professional is most suitable to be delegated the task of administering urinary alkalinizer by mouth to the client? 1. Certified technician 2. Patient care associate (PCA) 3. Licensed practical nurse (LPN) 4. Unlicensed assistive personnel (UAP)

3. Licensed practical nurse (LPN) Rationale: Administering oral medications such as urinary alkalinizer can be delegated safely to an LPN or licensed vocational nurse as per guidelines. The certified technician is an example of licensed assistive personnel whose scope of practice is limited in administering medication. The scope of practice of the PCA and UAP is limited to performing basic care, feeding, and hygiene.

A client with a femoral fracture and osteomyelitis is immobilized for 3 weeks. Which rationale explains the nurse's plan to assess for the development of renal calculi? 1. The client's dietary patterns have changed since admission. 2. The client has more difficulty urinating in a supine position. 3. Lack of weight-bearing activity promotes bone demineralization. 4. Fracture healing requires more calcium, which increases calcium metabolism.

3. Lack of weight-bearing activity promotes bone demineralization. Rationale: All clients who are confined to bed for any considerable period risk losing calcium from bones. Calcium precipitates in the urine, resulting in formation of calculi. There is no indication that the client's diet has changed. Although the client may have more difficulty urinating in a supine position because of an inability to assume the preferred anatomic position and the emotional effects of using a urinal, it usually does not predispose the client to developing renal calculi. The presence of a healing fracture does not increase total calcium metabolism; however, deposition of bone at the fracture site will be increased.

Which clinical manifestations would the nurse identify as indicators suggesting a client has urinary retention and overflow after sustaining a cerebrovascular accident (CVA, also known as a "brain attack")? Select all that apply. One, some, or all responses may be correct. 1. Edema 2. Oliguria 3. Frequent voiding 4. Suprapubic distention 5. Continual incontinence

ANS: 3, 4 Rationale: With retention, the total amount of urine produced is unaffected. Atony permits the bladder to fill without being able to empty. As pressure builds within the bladder, the urge to void occurs, and the client eliminated just enough urine to relieve the pressure and the urge to void. The cycle repeats as pressure again builds. Thus small amounts are voided without emptying the bladder. As the client retains urine and the bladder enlarges, suprapubic distention occurs. Edema is a sign of fluid volume excess, not urinary retention. Oliguria (urinary output less than 400 mL/day) is a sign of acute kidney injury. Continual incontinence does not occur with urinary retention.

The nurse reviews the prescriptions for the newly admitted emergency department client with urolithiasis. Which order is the priority nursing action? 1. Strain the client's urine. 2. Place the client in the high-Fowler position. 3. Administer the prescribed morphine. 4. Collect a urine specimen for culture and sensitivity.

3. Administer the prescribed morphine. Rationale: Pain relief is the priority. Client's report that ureteral colic is excruciatingly painful. Once pain is under control and the client is comfortable, the nurse may implement the other medical and nursing interventions. Although straining all urine is required, pain relief is the priority. Once the client receives the medication for pain control, the nurse will be able to strain the set-aside urine specimen. The high-Fowler position is not necessary. The client can be assisted to assume a position of comfort. The emergency department will have sent the urine to the laboratory for a culture and sensitivity.

Which instructions would the nurse include when teaching a client with multiple sclerosis (MS) about managing urinary retention? Select all that apply. One, some, or all responses may be correct. 1.Using the Credé maneuver 2. Using an indwelling catheter 3. Using anticholinergic medications 4. Monitoring and restricting fluid intake to 800 mL daily 5. Monitoring for and reporting signs of urinary tract infection

ANS: 1, 5 Rationale: The Credé maneuver is the use of manual pressure over the suprapubic area to compress the bladder and promote emptying. Urinary retention is a risk factor for urinary tract infection. Physical stressors, such as infections, can trigger exacerbations in clients with MS. Early recognition and treatment of infection are important to decrease the risk of exacerbation in the client with MS. Use of an indwelling urinary catheter puts the client at risk for urinary tract infection. Some clients with urinary retention are taught intermittent self-catheterization. Risk of urinary tract infection is lower with intermittent catheterization than with the use of an indwelling urinary catheter. Acetylcholine is the primary neurotransmitter of the parasympathetic nervous system. Stimulation of the parasympathetic nervous system causes the detrusor muscle to contract, which promotes bladder emptying. Anticholinergic medications inhibit the cholinergic response and lead to urinary retention. Oral fluids should be encouraged in the client with voiding difficulties, as concentrated urine increases the risk of urinary tract infection.

Which information about benign prostatic hyperplasia (BPH) is important for the nurse to consider when caring for a client with that condition? 1. It is a congenital abnormality. 2. A malignancy usually results. 3. It predisposes to hydronephrosis. 4. Prostate-specific antigen decreases.

3. It predisposes to hydronephrosis. Rationale: Inability to empty the bladder as a result of pressure exerted by the enlarging prostate on the urethra causes a backup of urine into the ureters and finally the kidneys (hydronephrosis). BPH develops over the client's life span; it is not congenital. It is uncommon for BPH to become malignant. Prostate-specific antigen will increase.

The nurse provides preoperative teaching for a client scheduled for a transurethral resection of the prostate (TURP). To prepare the client for postoperative care, which instructions would the nurse include in the teaching session? 1. The urine will be bright red for 24 to 48 hours. 2. Spasms of the bladder occur during the first 24 to 48 hours. 3. To decrease bladder contractions, the Valsalva maneuver and Kegel exercises will be encouraged. 4. To maintain proper fluid balance, oral fluids are restricted during continuous urinary bladder irrigations.

2. Spasms of the bladder occur during the first 24 to 48 hours. Rationale: Spasms are common postoperatively as a result of irritation of the bladder during surgery. However, it is important to let the client know that the spasms typically decrease in intensity and frequency as healing occurs. Bright red urine for 24 to 48 hours should be reported. This indicates hemorrhage, which requires immediate intervention. Drainage should be dark red at first and after the first few hours will gradually turn pink. The Valsalva maneuver should be avoided because it may initiate prostatic bleeding, not decrease bladder contractions. The presence of continuous bladder irrigation (CBI) is unrelated to the amount of oral fluids that should be consumed; once the CBI is discontinued, oral fluids should be encouraged.

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 reports the need to urinate. What would the nurse do first? 1. Encourage the client to drink fluids. 2. Review the client's intake and output. 3. Assess that the tubing attached to the collection bag is patent. 4. Explain that the balloon inflated in the bladder causes this feeling.

3. Assess that the tubing attached to the collection bag is patent. Rationale: 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, but will be assessed often in the postoperative period. 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.

Which instructions would the nurse provide to adolescent boys regarding the usual procedure to be followed and normal findings observed during testicular self-examination? Select all that apply. One, some, or all responses may be correct. 1. A firm, smooth, egg-shaped organ can be palpated. 2. Each testicle is examined individually after relaxing the scrotal skin. 3. A hard mass can be palpated on anterior or lateral aspect of testicle. 4. The thumb and fingers of both hands can be used to apply firm and gentle pressure. 5. A raised swelling that can be palpated on the superior aspect of the testicle is the epididymis.

ANS: 1, 2, 4, 5 Rationale: Testicular self-examination is usually performed after a warm bath when the scrotal skin is relaxed. A firm organ with smooth and egg-shaped contours that can be palpated is the testicle. Each testicle is examined individually using thumbs and fingers of both hands while applying firm and gentle pressure. A raised swelling that can be palpated on the superior aspect of testicle is the epididymis. Testicular cancer can be suspected if a hard mass can be palpated on the anterior or lateral aspect of the testicle.