Test 10

A client who had transurethral resection of the prostate has dribbling urine after his Foley catheter is removed on the second postoperative day. The nurse notes that the client had 200 mL of urine output in the last 8 hours with a 1,000-mL intake. What should the nurse do first?

Assess for bladder distention

The nurse is assessing a client's abdominal incision 48 hours after surgery. Which finding indicates that the wound is inflamed?

localized warmth over the incisional area

After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?

Client reports bladder spasms and the urge to void

A client has stress incontinence. Which data from the client's history contributes to the client's incontinence?

Client with 3 full term pregnancies

A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?

Use sterile technique when irrigating the bladder

A client undergoes extracorporeal shock wave lithotripsy (ESWL) to break up and remove renal calculi. Which nursing measure is appropriate for the postoperative care of this client?

Anticipate hematuria

The nurse has been teaching the client about maintaining a high-fiber diet. The client's selection of which breakfast menu indicates an understanding of the instructions?

Oatmeal, milk, grapefruit, bran muffin

A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which statement, if made by a group member, would indicate understanding of the teaching?

"I should notify the physician if urinary urgency, burning, frequency, or difficulty urinating occurs."

A client was treated for a streptococcal throat infection 2 weeks ago. The client now has been diagnosed with acute poststreptococcal glomerulonephritis. The client asks the nurse how he could have prevented this condition. What should the nurse tell the client?

"See your health care provider (HCP) for an early diagnosis and treatment of a sore throat."

The client with acute renal failure asks the nurse, "Will my kidneys ever function normally again?" What should the nurse tell the client?

"You will continue to improve over a period of weeks."

A nurse is assessing a client brought to the emergency room by his daughter. Which statement by the daughter would most likely lead the nurse to suspect that the client may have an infection?

"all of the sudden my dad seemed to become confused"

After undergoing transurethral resection of the prostate to treat benign prostatic hyperplasia, a client returns to the room with continuous bladder irrigation. On the first day after surgery, the client reports bladder pain. What should the nurse do first?

Assess the irrigation catheter for patency and drainage

The nurse explains to the client the importance of drinking large quantities of fluid to prevent cystitis. How much fluid should the nurse tell the client to drink?

At least 3,000 mL daily

A client with stress incontinence asks the nurse what kind of diet to follow at home. The nurse should recommend that the client:

Avoid caffeine and alcohol

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

Urine output of 250 ml/24 hours

The most significant sign of acute renal failure is:

Decreased urine output

The nurse is assessing a client who has benign prostatic hypertrophy (BPH). The nurse should determine if the client has which symptom?

Difficulty starting urinary stream

A client is diagnosed with acute pyelonephritis. What should the nurse instruct the client to do?

Empty the bladder every 2-3 hours

A nurse asks a client who had abdominal surgery 3 days ago if they have moved their bowels since surgery. The client states, "I haven't moved my bowels, but I am passing gas." How should the nurse intervene?

Encourage the client to ambulate at least three times a day

A client has had an exacerbation of ulcerative colitis with cramping and diarrhea persisting longer than 1 week. The nurse should assess the client for which complication?

Hypokalemia

The client with a urinary tract infection is given a prescription for trimethoprim. Which statement indicates that the client understands how to take the medication?

I will take all the pills then return to my doctor

A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client's discharge teaching plan?

Increase daily fluid intake to at least 2 to 3 L.

The client has a continuous bladder irrigation after a transurethral resection. A major goal related to the irrigation is to:

Maintain catheter patency

Which client is at highest risk for developing a urinary tract infection?

Man with an indwelling catheter

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?

Start IV fluids with normal saline bolus followed by maintenance dose

During chemotherapy for lymphocytic leukemia, a client develops abdominal pain, fever, and foul smelling diarrhea. Which priority order should the nurse anticipate from the health care provider?

Stool sample for Cdiff

An elderly male client has been taking doxazosin 2 mg daily for 4 weeks for treatment of benign prostatic hypertrophy. The client reports feeling dizzy. The nurse should first:

Take the blood pressure lying, sitting, standing

The client with first-time bacterial cystitis is being treated with an antibiotic to be taken for 7 days. What should the nurse instruct the client to do?

Take the entire dose as ordered

Which teaching instructions by the nurse is appropriate for a client with constipation?

The client will consume foods high in fiber

The nurse would observe an elevated leukocyte count and a fever accompanied by warm, flushed skin during the assessment of the client

With an over whelming bacterial infection

The client with pyelonephritis asks the nurse, "How will I know whether the antibiotics are treating my infection?" What should the nurse tell the client?

Your health care provider will take a urine culture

Which client is at highest risk for developing a hospital-acquired infection?

A client with an indwelling catheter

A client has prostatic hypertrophy. What should the nurse assess when conducting a focused assessment of the client's ability to urinate?

difficulty starting the flow of urine