urinary

A client just had a suprapubic prostatectomy. Which action should the nurse implement to prevent a secondary bladder infection? 1 Observe for signs of uremia 2 Attach the catheter to suction 3 Clamp off the connecting tube 4 Change the dressings frequently

4 Change the dressings frequently After a suprapubic prostatectomy, leakage of urine generally is identified around the suprapubic tube; this creates an environment in which bacteria can flourish if the dressing is not changed frequently

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 intravesicular pressure, causing discomfort similar to the urge to void. The client's vital signs are not related to the complaint. 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. 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.

A nurse instructs a client with a history of frequent urinary tract infections to drink cranberry juice to: Decrease the urinary pH Exert a bactericidal effect Improve glomerular filtration Relieve the symptoms of dysuria

Decrease the urinary pH Rationale Cranberry juice is excreted as hippuric acid, which helps acidify the urine (decrease the pH) and inhibit bacterial growth. Although bacterial growth may be inhibited, bacteria are not destroyed. Glomerular filtration is unaffected by cranberry juice. Cranberry juice acidifies the urine and may increase the burning sensation associated with urination when an infection is present.

The nurse is caring for a client with ureteral colic. To prevent the development of renal calculi in the future, the client's plan of care should include: Interventions to decrease the serum creatinine level Excluding milk products from the diet Instructing the client to drink 8 to 10 glasses of water daily A goal of 2000 mL/24 hours urinary output

Instructing the client to drink 8 to 10 glasses of water daily 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 or calcium oxalate basis. Producing only 2000 mL of urine per 24 hours is inadequate; urine output should be maintained at 3000 to 4000 mL to limit calculus formation.

When a client returns from the postanesthesia care unit after a kidney transplant, the nurse should plan to measure the client's urinary output every:

One hour

The nurse provides discharge instructions to a male client that had a ureterolithotomy. The client has a history of recurrent urinary tract infections (UTIs). The teaching should include that indicators of a UTI are: Urgency or frequency of urination The inability to maintain an erection Pain radiating to the external genitalia An increase in the alkalinity of the urine

Urgency or frequency of urination

The nurse explains that the negative feedback system controls hormone release by communication between:

the pituitary and the target organ. -blood receptor send signal to pituitary gland to release insulin

A client arrives at a health clinic reporting hematuria, frequency, urgency, and pain on urination. What does the nurse suspect is the cause of these signs and symptoms? Chronic glomerulonephritis Cystitis Nephrotic syndrome Pyelonephritis

Rationale Cystitis is an inflammation of the bladder that causes frequency and urgency of urination, pain on micturition, and hematuria. Chronic glomerulonephritis is atrophy 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.

A nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet because:

Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats.

A client is scheduled for a transurethral resection of the prostate. What should the nurse tell the client to expect after surgery? "Urinary control may be permanently lost to some degree." "An indwelling urinary catheter is required for at least a day." "Your ability to perform sexually will be impaired permanently." "Burning on urination will last while the cystotomy tube is in place."

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 cystotomy tube is not used if a client has a transurethral resection; however, it is used if a suprapubic resection is done.

A nurse reviews the history of a client who is hospitalized with a diagnosis of urinary calculi and identifies which factor may have contributed to the development of the calculi? Increased fluid intake Urine specific gravity of 1.017 History of hyperparathyroidism Jogging 3 miles a day

Rationale Hyperparathyroidism results in high serum calcium levels; as the blood is filtered through the nephron, precipitates of calcium may form calculi. Increased fluid intake will discourage stone formation by preventing stagnation of urine. A urine specific gravity of 1.017 is within the expected range of 1.010 to 1.030 and will not increase the risk of developing urinary calculi. A jogging schedule of 3 miles daily reduces the risk of developing urinary calculi; activity improves glomerular filtration and inhibits calcium from leaving the bone.

A client who has had a transurethral prostatectomy (TURP) experiences dribbling after the indwelling catheter is removed. To address this problem, an appropriate nursing response is: 1 "Increase your fluid intake and urinate at regular intervals." 2 "I know you're worried, but it will go away in a few days." 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."

Rationale Increasing fluid intake and urinating 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; fluids should be increased and the time between voidings should be increased gradually. Continuous bladder decompression will reduce bladder tone; reduced bladder tone will persist when the indwelling catheter is removed until bladder tone improves.

A nurse is caring for a client who just had surgery to repair an inguinal hernia. To limit a common complication associated with this surgery, the nurse should: Apply an abdominal binder Place a support under the scrotum Teach the client to cough several times an hour Encourage the client to eat a high carbohydrate diet

After inguinal hernia repair, the scrotum commonly becomes edematous and painful; drainage is facilitated by elevating the scrotum on rolled linen or using a scrotal support. An abdominal binder will not support the operative site; the incision is too low. Coughing increases intraabdominal pressure and should be avoided because it strains the operative site. Obesity is a factor in the development of hernias; high carbohydrate diets should be discouraged.

A client with acute glomerulonephritis reports feeling thirsty. What should the nurse offer the client? Ginger ale Milkshake Hard candy Chicken broth

Rationale Sucking on hard candy moistens the mouth, but it does not supply extra fluid, which may be restricted due to impaired kidney function. Carbonated beverages are high in sodium and provide additional fluid, which must be restricted. Milk shakes contains both fluid and protein, which must be restricted. Broth contains sodium, which can compound fluid retention problems.

A client is scheduled to have an indwelling urinary catheter inserted before abdominal surgery. The nurse should insert the catheter in what location in the illustration?

Rationale B is the urethral orifice, which anatomically is between the clitoris and the vagina; it is the opening into the urethra, the tubular structure that drains urine from the bladder. A is the clitoris, which is situated beneath the anterior commissure, partially hidden between the anterior extremities of the labia minora. C is the opening of the vagina; it is the part of the female genitalia that forms a canal from the vaginal orifice through the vestibule to the uterine cervix. D is the anus; it is the terminal end of the anal canal that is connected to the rectum; the rectum is a portion of the large intestine that is between the anal canal and the descending sigmoid colon.

Despite receiving 2900 mL intake for two days, the client's urine output has progressively diminished. The nurse identifies that the urinary output is less than 40 mL/hr over the past three hours. What action should the nurse take? Assess breath sounds and obtain vital signs Decrease the intravenous (IV) flow rate and increase oral fluids Insert an indwelling catheter to facilitate emptying of the bladder Check for dependent edema by assessing the lower extremities

1 Assess breath sounds and obtain vital signs The imbalance in intake and output, with a decreasing urinary output, may indicate kidney failure. The retention of excess body fluid can precipitate the development of heart failure. Assessing breath sounds and obtaining the vital signs are necessary when monitoring for these complications.

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? Drink a glass of water Turn from side to side Deep breathe and cough Rotate the catheter periodically

Rationale 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 health care provider.

After a nephrectomy a client arrives in the post-anesthesia care unit in the supine position. Which action should be employed by the nurse to assess the client for signs of hemorrhage? Turn the client to observe the dressings. Press the client's nail beds to assess capillary refill. Observe the client for hemoptysis when suctioning. Monitor the client's blood pressure for a rapid increase

1 Turn the client to observe the dressings. Because of the anatomic position of the incision, drainage will flow by gravity and accumulate under the client lying in the supine position.

A nurse is caring for a client with a diagnosis of renal calculi secondary to hyperparathyroidism. Which type of diet should the nurse explore with the client when providing discharge information? 1 Low purine 2 Low calcium 3 High phosphorus 4 High alkaline ash

2 Low calcium 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. Foods high in phosphorus must be avoided.

A nurse teaches the signs of organ rejection to a client who had a kidney transplant. What should be included in the education? 1 Weight loss 2 Subnormal temperature 3 Elevated blood pressure 4 Increased urinary output

3 Elevated blood pressure Hypertension is caused by hypervolemia because of the failure of the new kidney. Weight gain, not loss, occurs with a rejection of the kidney because of fluid retention. The client will have an elevated temperature exceeding 100° F with kidney rejection. Urine output will be decreased or absent, depending on the degree of kidney rejection.

A nurse is caring for a client with an undescended testicle. The nurse teaches the client that the main reason why the testicles are suspended in the scrotum is to: Protect the sperm from the acidity of urine. Facilitate the passage of sperm through the urethra. Protect the sperm from high abdominal temperatures. Facilitate their maturation during embryonic development.

Protect the sperm from high abdominal temperatures. Rationale Sperm cells are fragile and can be destroyed by heat, causing sterility. Sperm do not move through the urine; they are found in semen. Sperm achieve motion from their flagella; they move from the epididymis to the vas deferens to the ejaculatory ducts to the urethra. During embryonic development the testes are not suspended.

A client is admitted to the hospital for acute gastritis and ascites secondary to alcoholism and cirrhosis. It is most important for the nurse to assess this client for: <p>A client is admitted to the hospital for acute gastritis and ascites secondary to alcoholism and cirrhosis. It is <b>most</b> important for the nurse to assess this client for:</p> Blood in the stool Food intolerances Complaints of nausea Hourly urinary output

4 "There will be an indwelling urinary catheter and a continuous bladder irrigation in place." 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 older adult client states, "I walk 2 miles a day for exercise, but now that the weather is hot, I am worried about becoming dehydrated." What should the nurse teach the client? Drink fruit juices if you start to feel dehydrated. Thirst is a good guide to use to determine fluid intake. Fluids should be increased if the urine is getting darker. Water should be consumed when the skin becomes dry

Rationale In hot weather, dark-colored urine indicates dehydration. The amount of fluid to be excreted is less, and the body is attempting to conserve fluid. Fruit juices should be avoided during rehydration because of their high sugar content. By the time people become thirsty, they already are dehydrated, especially older adults. Dry skin in older adults may be related to aging rather than to dehydration. Water intake should be adequate (in hot weather, dark-colored urine indicates dehydration. The amount of fluid to be excreted is less, and the body is attempting to conserve fluid. Approximately 2000 mL daily is needed) and spaced throughout the day.

A client who had a suprapubic prostatectomy returns from the post-anesthesia care unit and accidentally pulls out the urethral catheter. What should the nurse do first? Reinsert a new catheter. Notify the health care provider. Check for bleeding by irrigating the suprapubic tube. Take no immediate action if the suprapubic tube is draining.

Rationale The catheter must be reinserted by the health care provider to ensure bladder emptying, maintain pressure at the operative site, and prevent hemorrhage. Because of the danger of further trauma to the urethra and surgical site, the health care provider should insert the catheter. Irrigations require a health care provider's prescription. In addition to urinary drainage, the balloon of the urethral catheter exerts pressure against the prostate to help control bleeding and should be reinserted.

A nurse is notified that the latest potassium level for a client in acute renal failure is 6.2 mEq. What action should the nurse take? Alert the cardiac arrest team Call the laboratory to repeat the test Take vital signs and notify the primary health care provider Obtain an ECG strip and obtain an antiarrhythmic medication

Rationale Vital signs monitor the cardiopulmonary status; the health care provider must treat this hyperkalemia to prevent cardiac dysrhythmias. The cardiac arrest team responds to a cardiac arrest; there is no sign of arrest in this client. A repeat laboratory test will take time and probably reaffirm the original results; the client needs medical attention. Obtaining an ECG strip and having an antiarrhythmic available are correct interventions if available, but the priority is medical attention and the health care provider should be notified immediately.

During discharge teaching, a client with an ileal conduit asks how frequently the urine pouch should be emptied. The best reply by the nurse is: 1 "To prevent leakage and pulling of the pouch from the skin, it should be emptied every few hours." 2 "To prevent skin irritation, it should be emptied every hour if any urine has collected in the bag." 3 "To reduce the risk of infection, the system should be opened as little as possible; two times a day is adequate." 4 "To reduce the cost of drainage pouches, it should be emptied once the system is switched to a bedside collection bag."

1 "To prevent leakage and pulling of the pouch from the skin, it should be emptied every few hours."

A client has undergone surgery with general anesthesia. Within how many hours after surgery should the nurse notify the health care provider if the client does not void? 1. 4 hours 2. 8 hours 3. 12 hours 4. 16 hours

2. 8 hours Rationale Decreased bladder muscle tone results from the depressant effects of anesthesia and the handling of tissues and adjacent organs during surgery. Catheterization may be necessary to prevent overdistention of the bladder. Four hours may be too early to expect recovery from the depressant effects of anesthesia. Twelve and 16 hours are too long to wait to call the health care provider. This length of time without voiding may result in overdistention of the bladder.

A client is injured in a motor vehicle accident and admitted for observation. Damage to the bladder is evident. The nurse takes the client's history and concludes that the client is at increased risk of bladder rupture based on the history of:

Not having voided for six hours Rationale The walls of a full bladder are stretched thinner and are more susceptible to rupture when traumatized. A history of cystitis predisposes the client to developing future bladder infections, not to rupturing the bladder. A family member with bladder cancer might increase the risk of cancer; however, it will not predispose the client to bladder rupture. Drinking two cups of coffee will not result in a significant amount of urine production

A nurse is monitoring a client with renal failure for signs of fluid excess. Which finding does the nurse identify as inconsistent with fluid excess? Increased weight Distended neck veins Orthostatic hypotension Abnormal breath sounds

Orthostatic hypotension

A client with a history of benign prostatic hypertrophy asks whether cranberry juice prevents bladder infections. The nurse replies that cranberry juice may be helpful because it: 1.Increases acidity of the urine 2.Soothes irritated bladder walls 3.Improves glomerular filtration rate 4.Destroys microorganisms in the bladder

1.Increases acidity of the urine Rationale An acid-ash diet, including cranberries, lowers the pH of the urine and discourages pathogenic growth. Acid urine does not soothe bladder walls. The glomerular filtration rate is not affected. An acid medium will discourage further growth but will not kill existing organisms.

What does the nurse determine is the most likely cause of renal calculi in clients with paraplegia? High fluid intake Increased intake of calcium Inadequate kidney function Accelerated bone demineralization

4 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.

A nurse is caring for a client who had a kidney transplant. What sign indicates that the client may be rejecting the transplanted kidney? 1.Fever 2.Hematuria 3.Moon face 4.Yellow sclera

FEVER Rationale Fever is a characteristic of the systemic inflammatory response to the antigen (transplanted kidney). Hematuria is not indicative of rejection; however, its occurrence necessitates further investigation. A moon face (moon facies) is an effect of steroid therapy and does not indicate rejection. Jaundice is unrelated to rejection of a transplanted kidney.

A pathology report states that a client's urinary calculus is composed of uric acid. Which should the nurse instruct the client to avoid? Milk Liver Cheese Vegetables

LIVER Uric acid stones are controlled by a low-purine diet. Foods high in purine, such as organ meats and extracts, should be avoided. Milk should be avoided with calcium, not uric acid, stones. Cheese should be avoided with cystine, not uric acid, stones. Vegetables do not have to be avoided; however, legumes should be kept to a minimum.

A client with an ileal conduit is being prepared for discharge. As part of the discharge teaching, the nurse instructs the client to: Abstain from beer and alcohol consumption Maintain fluid intake of at least 2 L daily Notify the health care provider if the stoma size decreases Avoid getting soap and water on the peristomal skin

Maintain fluid intake of at least 2 L daily Rationale 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. Notifying the health care provider if the stoma size decreases is expected; as edema decreases, the stoma will become smaller. Soap and water on the peristomal area help prevent irritation from waste products.

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 three months ago. The physical assessment and the serologic test findings indicate a diagnosis of syphilis. The nurse recognizes that the client is experiencing what stage of syphilis?

secoundary Rationale The client has secondary syphilis, which occurs one to three 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; 20% to 40% do not demonstrate signs and symptoms during this stage. At this stage it is a slowly progressive inflammatory disease that can involve many organs; common complications include paresis, brain attack, dementia, psychosis, aortitis, and meningitis.

A nurse is caring for a client who had a kidney transplant. Which test is most important for determining whether a client's newly transplanted kidney is working effectively? 1.Renal scan 2.Serum creatinine 3. 24-hour urine output 4.White blood cell (WBC) count

2.Serum creatinine Rationale 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. 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.

The nurse reviews a client's medication history, which includes a cholinergic medication. The client states, "I take that for some kind of urinary problem." The nurse recalls that cholinergic medications are prescribed primarily for what type of urinary condition? Kidney stones Flaccid bladder Spastic bladder Urinary tract infections

2 Flaccid bladder Cholinergics intensify and prolong the action of acetylcholine, which increases the tone in the genitourinary tract, preventing urinary retention.

The nurse is caring for a client with acute renal failure. The most serious complication for this client is: 1 Anemia 2 Infection 3 Weight loss 4 Platelet dysfunction

2 Infection Infection is responsible for one third of the traumatic or surgically induced deaths of clients with acute renal failure, as well as for medically induced acute renal failure.

A client is admitted to the hospital with severe flank pain, nausea, and hematuria caused by a ureteral calculus. A lithotripsy is scheduled. What should be the nurse's initial intervention? Strain all urine output. Increase oral fluid intake. Obtain a urine specimen for culture. Administer the prescribed analgesic.

Administer the prescribed analgesic Rationale Pain of renal colic may be excruciating; unless relief is obtained, the client will be unable to cooperate with other therapy. Urine can be saved and strained after the client's priority needs are met. Increasing fluid intake helps to mobilize the stone, but a client in severe pain may be nauseated and unable to drink. Although a culture generally is prescribed, this is not the priority when a client has severe pain.

A client with acute kidney failure is to receive peritoneal dialysis and asks why the procedure is necessary. The nurse's best response is, "It: Prevents the development of serious heart problems." Helps perform some of the work usually done by the kidneys." Removes toxic chemicals from the body so you will not get worse." Speeds recovery because the kidneys are not responding to other therapy."

Helps perform some of the work usually done by the kidneys." Dialysis removes chemicals, wastes, and fluids usually removed from the body by the kidneys. The mention of heart problems is a threatening response and may cause increased fear or anxiety. Stating that peritoneal dialysis "removes toxic chemicals from the body so you will not get worse" is threatening and can cause an increase in anxiety. Dialysis helps maintain fluid and electrolyte balance; there are no data to indicate the cause of the acute kidney failure or previous therapy.

A female client who has recurrent urinary tract infections (UTIs) is inquiring about the prevention of future UTIs. What information should the nurse include when teaching the client? (Select all that apply.)

Drink 8 to 10 glasses of water each day Urinate immediately after sexual intercourse Rationale Drinking 8 to 10 glasses of water spaced throughout the day flushes the urinary tract and minimizes urinary stasis. Urination flushes the urethra and urinary meatus, limiting the presence of microorganisms. Limiting fluid intake contributes to stasis of urine. Carbonated and caffeinated beverages irritate the bladder and should be avoided. Cleaning the perineum with harsh soaps is irritating to the skin and mucous membranes, and can contribute to the development of UTIs in susceptible women.

A client with a history of chronic kidney disease is hospitalized. The nurse assesses the client for signs of related kidney insufficiency, which include: Facial flushing Edema and pruritus Dribbling after voiding Diminished force and caliber of stream

Edema & pruritus Rationale The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur after prostate surgery. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease.

16. A client with tuberculosis is started on a chemotherapy protocol that includes rifampin (RIF). The nurse evaluates that the teaching about rifampin is effective when the client states:

i can expect my urine to turn orange from this medication Rationale RIF causes body fluids, such as sweat, tears, and urine, to turn orange. It is not necessary to drink large amounts of fluid with this drug; it is not nephrotoxic. Damage to the eighth cranial nerve is not a side effect of rifampin; it is a side effect of streptomycin sulfate, sometimes used to treat tuberculosis. A skin rash is not a side effect of rifampin.

Trimethoprim-sulfamethoxazole (Septra) is prescribed for a client with cystitis. When teaching about the medication, the nurse instructs the client to: Drink 8 to 10 glasses of water daily Drink two glasses of orange juice daily Take the medication with meals Take the medication until symptoms subside

1.Drink 8 to 10 glasses of water daily Rationale A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine). Orange juice produces an alkaline ash, which results in an alkaline urine that supports the growth of bacteria. Trimethoprim-sulfamethoxazole should be taken one hour before meals for maximum absorption. A prescribed course of antibiotics must be completed to eliminate the infection, which can exist on a subclinical level after symptoms subside.

A client with a urinary retention catheter reports discomfort in the bladder and urethra. What should the nurse do first? Milk the tubing gently. Notify the health care provider. Check the patency of the catheter. Irrigate the catheter with prescribed solutions.

3.Check the patency of the catheter Rationale Checking the patency of the catheter ensures drainage and prevents bladder distention and other complications. Patency of the catheter should be established before any other intervention. Milking the tubing gently is premature; this may be necessary if the catheter is clogged and usually is required when the drainage is viscous rather than liquid. Assessment is necessary before consultation with the health care provider. Irrigation is avoided if possible because of the associated risk for infection.

A nurse is reviewing the clinical record of a client with a diagnosis of benign prostatic hyperplasia (BPH). Which test result confirmed the diagnosis? Rectal examination Serum phosphatase level Biopsy of prostatic tissue Pap smear of prostatic fluid

Biopsy of prostatic tissue Rationale A definitive diagnosis of the cellular changes associated with benign prostatic hyperplasia 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 as to the activity of phosphorus in the body; a definitive diagnosis cannot be made with this test. The Pap smear of prostatic fluid test will not yield a definitive diagnosis because malignant cells might not be present in the fluid.

A nurse is caring for a client who reports urinary problems, and the health care provider prescribes a cholinergic medication. Which response is prevented that helps the nurse determine that the medication is effective? Bladder spasticity Bladder flaccidity Urinary tract calculi Urinary tract infections

Bladder flaccidity Cholinergics intensify and prolong the action of acetylcholine, which increases tone in the genitourinary tract, preventing urinary retention. Anticholinergics are prescribed for frequency and urgency associated with a spastic bladder. Cholinergics will not prevent renal calculi. Urinary tract infections are a secondary gain because cholinergics help prevent urinary retention that can lead to urinary tract infection, but this is not the primary purpose for administering a cholinergic.

A nurse obtains a health history from a client with the diagnosis of renal calculi. The nurse concludes that the factor that most likely contributed to the calculi development is the client's:

Excess ingestion of antacids An excessive use of antacids may result in hypercalciuria; most calculi contain calcium combined with phosphate or other substances. Cholesterol is unrelated to the formation of renal calculi; cholesterol stones in the gallbladder are the result of increased cholesterol synthesis in the liver. Immobility with the associated demineralization of bone, not exercise, contributes to the formation of renal calculi. Alcohol intake is unrelated to renal calculi formation.

A nurse evaluates that a client understands the side effects of hydrochlorothiazide (HCTZ) therapy when the client states, "I should call my health care provider if I develop: Insomnia." A stuffy nose." An increase in thirst." Generalized weakness."

Generalized weakness."

A nurse is preparing to discharge a client who had a transurethral prostatectomy for benign prostatic hyperplasia. The nurse evaluates that the client understands the discharge teaching when the client states: I will drink 6-8 cups of fluid daily and no fluids near bedtime." "Now I don't have to go back to my health care provider's office." "I will use stool softeners regularly for the next one to two months." "I plan to go home and have sexual intercourse with my spouse."

"I will use stool softeners regularly for the next one to two months." Rationale Straining at stool should be avoided for four to six weeks after surgery, or until permitted by the health care provider; avoiding straining supports healing and limits precipitation of bleeding. Eight glasses of fluid a day is insufficient fluid; between 2500 and 3000 mL/day should be consumed to ensure adequate flushing of the bladder and urethra. The client should have continued medical supervision. Sexual intercourse should be avoided until permitted by the health care provider.

A client is receiving furosemide (Lasix) to relieve edema. The nurse should monitor the client for which response to the medication? Retention of sodium ions Negative nitrogen balance Excessive loss of potassium ions Increase in the urine specific gravity

Excessive loss of potassium ions Rationale Furosemide is a potent diuretic used to provide rapid diuresis; it acts in the loop of Henle and causes depletion of electrolytes, such as potassium and sodium. Furosemide inhibits the reabsorption, not retention, of sodium. Furosemide does not affect protein metabolism. With edema, the specific gravity of the fluid more likely will be low.

A client who has repeated episodes of cystitis is scheduled for a cystoscopy to determine the possibility of urinary tract abnormalities. The client asks the nurse to describe the procedure. The nurse's most appropriate response is, "This procedure is: 1 A computerized scan that outlines the bladder and surrounding tissue." 2 An x-ray film of the abdomen, kidneys, ureters, and bladder after administration of dye." 3 The visualization of the inside of the bladder with an instrument connected to a source of light." 4 The visualization of the urinary tract through ureteral catheterization and the use of radiopaque material."

3 The visualization of the inside of the bladder with an instrument connected to a source of light." Rationale The response that the procedure is "the visualization of the inside of the bladder with an instrument connected to a source of light" answers the client's question and provides an accurate description of a cystoscopy. A cystoscopy is not a computerized examination. A cystoscopy does not involve x-ray films or dye. Radiopaque material is not used in a cystoscopy and the catheter is inserted into the bladder via the urethra, not the ureters.

A client will be taking nitrofurantoin (Macrobid) 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client? Increase the intake of fluids. Strain the urine for crystals and stones. Stop the drug if urinary output increases. Maintain the exact time schedule for taking the drug.

Increase the intake of fluids. Rationale To prevent crystal formation, the client should have sufficient intake to produce 1000 to 1500 mL of urine daily while taking this drug. Straining urine is not indicated when the client is taking a urinary antiinfective. Urinary decrease is of concern because it may indicate renal failure. If fluids are encouraged, the client's output should increase. The drug need not be taken at a strict time daily.

A nurse is caring for a client who is experiencing urinary incontinence. The client has an involuntary loss of small amounts (25 to 35 mL) of urine from an overdistended bladder. This should be documented in the medical record as: Urge incontinence Stress incontinence Reflex incontinence Overflow incontinence

Overflow incontinence Rationale Overflow incontinence describes what is happening with this client; overflow incontinence occurs with retention of urine with overflow of urine. Urge incontinence describes a strong need to void that leads to involuntary urination. Stress incontinence occurs when a small amount of urine is expelled because of an increase in intraabdominal pressure that occurs with coughing, lifting, or sneezing. Reflex incontinence is an involuntary loss of urine at fairly predictable intervals when certain urinary bladder intervals are reached.

A male client reports dysuria, nocturia, and difficulty starting the urinary stream. A cystoscopy and biopsy of the prostate gland have been scheduled. After the procedure the client reports an inability to void. Which action should the nurse take

Palpate above the pubic symphysis. Rationale A full bladder is palpable with urinary retention and distention, which are common problems after a cystoscopy because of urethral edema. Fluids dilute the urine and reduce the chance of infection after cystoscopy and should not be limited. Although urinary retention can occur, it is not expected; the nurse must assess the extent of bladder distention and discomfort. More conservative nursing methods, such as running water or placing a warm cloth over the perineum, should be attempted to precipitate voiding; catheterization carries a risk of infection.

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

Proximity of the urethra to the anus Rationale Because the female's urethra is closer to the anus than the male's, it is at greater risk for becoming contaminated. Urinary pH is within the same range in both males and females. Hormonal secretions have no effect on the development of bladder infections. The position of the bladder is the same in males and females.

A client who had a transurethral resection of the prostate is transferred to the post-anesthesia care unit with an IV and a urinary retention catheter. For which major complication is it most important for the nurse to assess during the immediate postoperative period?

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. Leaking around the catheter is not a major complication. Urinary retention is unlikely with an indwelling catheter in place.

For which clinical indicator should a nurse monitor a client with end-stage renal disease? Polyuria Jaundice Azotemia Hypotension

Rationale Azotemia is an increase in nitrogenous waste (particularly urea) in the blood, which is common with end-stage renal disease. Excessive nephron damage in end-stage renal disease causes oliguria, not polyuria; excessive urination is common in early kidney insufficiency because of the inability to concentrate urine. Jaundice is common to biliary obstruction, not to end-stage renal disease. The blood pressure may be elevated as a result of hypervolemia associated with increased total body fluid.

The nurse reviews the medical records of four male clients and concludes that the client that is at highest risk of developing prostate cancer is the: Black 55-year-old White 45-year-old Asian 55-year-old Hispanic 45-year-old

Rationale Cancer of the prostate is rare before age 50 but increases with each decade; black men develop cancer of the prostate twice as often and at an earlier age than white men. White men develop prostatic cancer half as often as black men, but more commonly than Asian or Hispanic men. Asian and Hispanic men have a lower incidence of prostatic cancer and a lower mortality rate than white and black men.

A nurse is reviewing the laboratory reports of a client with a diagnosis of end-stage renal disease. What test result should the nurse anticipate? Arterial pH 7.5 Hematocrit of 54% Creatinine of 1.2 mg/dL Potassium of 6.3 mEq/L

Rationale Clients with end-stage renal disease have impaired potassium excretion so the nurse should anticipate a potassium level more than the expected range of 3.5 to 5 mEq/L. Clients with end-stage renal disease usually have a serum pH that is less than 7.35 due to metabolic acidosis. A pH of 7.5 that exceeds the expected range of 7.35 to 7.45 is not anticipated. Clients with end-stage renal disease have decreased erythropoietin which leads to decreased red blood cell production and hematocrit (HCT); a hematocrit of 54% exceeds the expected range for HCT, which is 42% to 52% for males and 35% to 47% for females; therefore, it is not anticipated. Clients with end-stage renal disease have a decreased ability to eliminate nitrogenous wastes, which leads to increased creatinine levels; a creatinine level of 1.2 mg/dL is within the expected range of 0.7-1.4 mg/dL and therefore is not anticipated.

A female client has a history of frequent urinary tract infections (UTIs). To decrease the incidence of the infections, the nurse instructs the client to increase fluid intake and: 1.Empty the bladder every three hours 2.Take warm bubble baths 3.Wipe from back to front 4.Take a prophylactic antibiotic after sexual intercourse

Rationale Emptying the bladder every three hours helps prevent stasis of urine; urinary stasis supports bacterial growth. Tub baths with soapy bubbles are thought to increase, not decrease, the risk of UTIs because soap is irritating to mucous membranes. It is not necessary to wash the perineal area from the urethra toward the rectum. The concern about wiping from back to front is allowing fecal material to enter the perineal area and potentially cause irritation. The nurse should, however, take into consideration the different schools of thought about wiping from the urethral area to the rectal area. Taking a prophylactic antibiotic after sexual intercourse is an inappropriate use of antibiotics that may support the development of resistant strains of bacteria; antibiotics should be used judiciously and be prescribed by a licensed health care provider.

A client has surgery to repair a bladder laceration. The nursing intervention that takes priority in the postoperative care of this client is: <p>A client has surgery to repair a bladder laceration. The nursing intervention that takes <b>priority</b> in the postoperative care of this client is:</p> Repositioning frequently Giving lower back care Implementing range-of-motion (ROM) exercises Providing teaching related to incision care

Rationale Frequent position changes are important to ensure efficient urinary drainage; gravity promotes flow, which prevents obstruction. Back care is necessary but is not a priority. ROM is of minimal importance because the client will be able to move without limitation. Teaching information related to discharge care is not a priority at this time.

To help prevent a cycle of recurring urinary tract infections, the nurse should plan to instruct a female client to: Increase the daily intake of citrus juice Douche regularly with alkaline agents Urinate as soon as possible after intercourse Wipe carefully from back to front

Rationale Intercourse may cause urethral inflammation, increasing the risk of infection; voiding clears the urinary meatus and urethra of microorganisms. Most fruit juices, with the exception of cranberry juice, cause alkaline urine, which promotes bacterial growth. Douching is no longer recommended because it alters the vaginal flora. Perineal care should be accomplished with wipes from the urinary meatus toward the rectum to help prevent microorganisms from the vaginal or rectal areas from reaching the urinary meatus.

A client is admitted to the hospital with urinary retention, and an indwelling urinary catheter is prescribed by the health care provider. What should the nurse do to help prevent the client from developing a urinary tract infection? <p>A client is admitted to the hospital with urinary retention, and an indwelling urinary catheter is prescribed by the health care provider. What should the nurse do to help prevent the client from developing a urinary tract infection?</p> Assess urine specific gravity Maintain the prescribed hydration Collect a weekly urine specimen Empty the drainage bag frequently

Rationale 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; changing the bag periodically, not emptying it, may help prevent infection.

The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis results. The nurse concludes that the presence of what substance in the urine needs to be reported to the health care provider? Sodium Potassium Urea nitrogen Large proteins

Rationale 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 proximal tubules are responsible for regulating water, electrolytes (including sodium and potassium), urea nitrogen, and pH; the byproducts of this regulation appear in normal urine.

What should a nurse do when caring for a client with continuous bladder irrigation? Measure the output hourly. Monitor the specific gravity of the urine. Irrigate the catheter with saline three times daily. Subtract the amount of irrigant instilled from the output.

Subtract the amount of irrigant instilled from the output. Rationale The amount of irrigant instilled must be deducted from the total output to determine the amount of urine voided. Measuring the output hourly is unnecessary. Specific gravity measures the concentration of urine; this measurement will be inaccurate because the urine is diluted with irrigant. Irrigating the catheter with saline three times daily is unnecessary; the bladder is being irrigated constantly.

The laboratory values of a client with renal calculi reveal a serum calcium within expected limits and an elevated serum purine. The nurse concludes that the stone probably is composed of:

Uric acid Rationale Purines are precursors of uric acid, which crystallizes. Cystine stones are caused by a rare hereditary defect resulting in inadequate renal tubular reabsorption of cystine (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 with coliform bacteria.

A client who is recovering from deep partial-thickness burns develops chills, fever, flank pain, and malaise. The health care provider makes a tentative diagnosis of urinary tract infection. Which diagnostic tests should the nurse expect the health care provider to prescribe to confirm this diagnosis? Urinalysis and urine culture and sensitivity Cystoscopy and bilirubin level Creatinine clearance and albumin/globulin (A/G) ratio Specific gravity and pH of the urine

Urinalysis and urine culture and sensitivity Rationale The client's adaptations may indicate a urinary tract infection; a culture of the urine will identify the microorganism. A cystoscopy is too invasive as a screening procedure; altered bilirubin results indicate liver or biliary problems, not urinary signs and symptoms. Creatinine clearance reflects renal function; A/G ratio reflects liver function. Although an increased urine specific gravity may indicate red blood cells (RBCs), white blood cells (WBCs), or casts in the urine, which are associated with urinary tract infection, it will not identify the causative organism.

A female client has a history of recurrent urinary tract infections. What should the nurse include in the teaching plan when teaching the client about health practices that may help decrease future urinary tract infections? Wear cotton underpants. Void at least every 6 hours. Increase alkaline ash foods in the diet. Wipe from back to front after toileting.

Wear cotton underpants. Rationale Cotton allows air to circulate and does not retain moisture the way synthetic fabrics do; microorganisms multiply in warm, moist environments. Drinking 3 L of fluids a day and voiding every 2 hours help to flush ascending microorganisms from the bladder, thereby reducing the risk for urinary tract infections. Foods high in acid, not alkaline, ash help to acidify urine; this urine is less likely to support bacterial growth. Wiping from back to front after toileting may transfer bacteria from the perianal area toward the urinary meatus, which will increase the risk for urinary tract infection.

A nurse administers trimethoprim-sulfamethoxazole (Bactrim) to a client diagnosed with a urinary tract infection. What should the nurse monitor to determine the therapeutic effectiveness of the drug? Breath sounds Hemoglobin level Consistency of stool White blood cell (WBC) count

White blood cell (WBC) count Rationale Trimethoprim-sulfamethoxazole blocks two consecutive steps in the bacterial synthesis of essential nucleic acids and protein; resolution of infection is reflected by a WBC in the expected range. This drug may be used to treat various types of infections; therapeutic responses will depend on the location of the infection, which is not specified. This drug may cause hemolytic anemia, which alters the hemoglobin level, but this is a side effect. This drug may be used to treat various types of infections; therapeutic responses will depend on the location of the infection, which is not specified.

A client experiences difficulty in voiding after an indwelling urinary catheter is removed. The nurse determines that this difficulty most likely is related to: Fluid imbalance Sedentary lifestyle Interruption in previous voiding habits Nervous tension following the procedure

interruption in previous voiding habits Rationale An indwelling catheter dilates the urinary sphincters, keeps the bladder empty, and short-circuits the reflex mechanism based on bladder distention. When the catheter is removed, the body must adapt to functioning once again. Although fluid imbalance may cause difficulty in voiding, there are no data presented to draw this conclusion. A sedentary lifestyle and nervous tension will not cause this problem.