Genitourinary Disorders

A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged I.V. pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow?

• Evaluating patency of the drainage lumen

• Counter-balancing the I.V. pole

• Attaching the infusion set to an infusion pump

• Collecting a urine specimen before beginning irrigation

A nurse is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 6.2 mEq/L. Correct administration and the effects of this enema should include having the client:

• Retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.

• Retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea.

• Retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn't necessary to reduce the potassium level.

• Retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn't necessary to reduce the potassium level.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:

• Water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

• A decreased serum phosphate level secondary to kidney failure.

• An increased serum calcium level secondary to kidney failure.

• Metabolic alkalosis secondary to retention of hydrogen ions.

A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra–high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:

• Limit oral fluid intake for 1 to 2 weeks.

• Report the presence of fine, sandlike particles through the nephrostomy tube.

• Notify the physician about cloudy or foul-smelling urine.

• Report bright pink urine within 24 hours after the procedure.

A nurse is caring for a client diagnosed with ovarian cancer. Diagnostic testing reveals that the cancer has spread outside the pelvis. The client has previously undergone a right oophorectomyand receivedchemotherapy. The client now wants palliative care instead of aggressive therapy. The nurse determines that the care plan's priority nursing diagnosis should be:

• Acute pain

• Impaired home maintenance

• Noncompliance

• Ineffective breast-feeding

After a retropubic prostatectomy, a client needs continuous bladder irrigation. The client has an I.V. of dextrose 5% in water infusing at 40 ml/hour, and a triple-lumen urinary catheter with normal saline solution infusing at 200 ml/hour. The nurse empties the urinary catheter drainage bag three times during an 8-hour period for a total of 2,780 ml. How many milliliters does the nurse calculate as urine? Record your answer using a whole number. Answer: ___milliliters

After undergoing renal arteriogram, in which the left groin was accessed, a client complains of left calf pain. Which intervention should the nurse perform first?

• Assess peripheral pulses in the left leg.

• Place cool compresses on the calf.

• Exercise the leg and foot.

• Assess for anaphylaxis.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?

• Impaired urinary elimination

• Toileting self-care deficit

• Risk for infection

• Activity intolerance

A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?

• Rashes on the palms of the hands and soles of the feet

• Cauliflower-like warts on the penis

• Painful red papules on the shaft of the penis

• Foul-smelling discharge from the penis

A client requires hemodialysis. Which type of drug should be withheld before this procedure?

• Phosphate binders

• Insulin

• Antibiotics

• Cardiac glycosides

A nurse is explaining menstruation to a class. Place the steps of the menstrual cycle listed below in the correct order. Use all options.1. The level of estrogen in the blood peaks.2. Peak endometrial thickening occurs.3. Estrogen and progesterone levels increase.4. Top layer of the endometrium breaks down.5. A follicle matures and ovulation occurs.6. The endometrium begins thickening.

A client returns to an intensive care unit after coronary artery bypass graftsurgery, which was complicated by prolonged cardiopulmonary bypass and hypotension. After 3 hours in the unit, the client's condition stabilizes. However, the urine output has decreased despite adequate filling pressures. The nurse expects the physician to add which drug, at which flow rate, to the client's regimen?

• Dopamine (Intropin), 3 mcg/kg/minute

• Dobutamine (Dobutrex), 10 mcg/kg/minute

• Epinephrine, 4 mcg/kg/minute

• Norepinephrine (Levophed), 8 mcg/minute

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?

• Increase the I.V. flow rate.

• Notify the physician immediately.

• Assess the irrigation catheter for patency and drainage.

• Administer morphine sulfate, 2 mg I.V., as ordered.

A nurse is inserting a urinary catheter into a client who is extremely anxious about the procedure. The nurse can facilitate the insertion by asking the client to:

• Initiate a stream of urine.

• Breathe deeply.

• Turn to the side.

• Hold the labia or shaft of the penis.

Because of difficulties with hemodialysis, peritoneal dialysisis initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?

• Blood glucose level of 200 mg/dl

• White blood cell (WBC) count of 20,000/mm3

• Potassium level of 3.5 mEq/L

• Hematocrit (HCT) of 35%

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes:

• Confusion, headache, and seizures.

• Acute bone pain and confusion.

• Weakness, tingling, and cardiac arrhythmias.

• Hypotension, tachycardia, and tachypnea.

A registered nurse and a nursing assistant are caring for a group of clients. Which client's care may safely be delegated to the nursing assistant?

• A client who underwent surgery 12 hours ago whose suprapubic catheter is draining burgundy-colored urine

• A client with uncontrolled diabetes mellitus who underwent radical suprapubic prostatectomy 1 day ago and has an indwelling urinary catheter draining yellow urine with clots

• A client diagnosed with renal calculi who must ambulate four times daily and drink plenty of fluids.

• A client who requires neurological assessment every 4 hours after sustaining a spinal cord injury in a motor vehicle accident that left him with paraplegia

A nurse preceptor is observing a new graduate during care of a client in contact isolation. Which action by the new graduate indicates a need for further teaching about handling infectious materials?

• The nurse wears gloves during each client contact.

• The nurse washes her hands when entering and exiting the room.

• The nurse disposes of articles contaminated with blood in the room's biohazard container.

• The nurse uses alcohol gel to clean her hands after changing linen soiled with urine and feces.

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

• Tell the client to try to urinate around the catheter to remove blood clots.

• Restrict fluids to prevent the client's bladder from becoming distended.

• Prepare to remove the catheter.

• Use sterile technique when irrigating the catheter.

A physician enters a computer order for a nurse to irrigate a client's nephrostomy tube every 4 hours to maintain patency. The nurse irrigates the tube using sterile technique. After irrigating the tube, the nurse decides that she can safely use the same irrigation set for her 8-hour shift if she covers the set with a paper, sterile drape. This action by the nurse is:

• Appropriate because the irrigation just checks for patency.

• Inappropriate because irrigation requires strict sterile technique.

• Appropriate because the irrigation set will be used only during an 8-hour period.

• Inappropriate because the sterile drape must be cloth, not paper.

When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?

• The client sets the drainage bag on the floor while sitting down.

• The client keeps the drainage bag below the bladder at all times.

• The client clamps the catheter drainage tubing while visiting with the family.

• The client loops the drainage tubing below its point of entry into the drainage bag.

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation?

• Specific gravity of 1.03

• Urine pH of 3.0

• Absence of protein

• Absence of glucose

A client on the genitourinary floor has refused all medications for 3 days. A nurse caring for this client asks why he isn't complying with his medication. The client states, "I don't want to take those pills anymore." The nurse informs the client that he must take all the medication the physician orders. With this statement, the nurse has violated the:

• Health Insurance Portability and Accountability Act and the client's privacy.

• Client's right to refuse medication.

• Client's advance directive.

• Client's right to accurate medication administration.

A nurse is caring for an 8-year-old girl with multiple chronic urinary tract infections. The child's parents appear protective, never leaving their daughter's side. While the nurse helps the child's mother provide morning care, the child states, "My uncle doesn't clean me that way." Her mother becomes visibly upset and gives the girl a stern warning not to discuss the matter. She states, "Don't tell anyone about that again." The nurse has a legal responsibility to:

• Notify the nursing supervisor and the authorities of the possibility of abuse.

• Offer to clean the child the way her uncle does.

• Leave the room so the mother and daughter can have privacy.

• Note on the child's chart that the mother is overprotective.

A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 ml. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of:

• Microorganism transfer.

• Prostate irritation.

• Client discomfort.

• Incorrect urine output values.

A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in:

• 1 minute.

• 30 minutes.

• 1 hour.

• 24 hours.

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?

• The urine in the drainage bag appears red to pink.

• The client reports bladder spasms and the urge to void.

• The normal saline irrigant is infusing at a rate of 50 drops/minute.

• About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned.

A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal?

• Transurethral resection of the prostate (TURP)

• Suprapubic prostatectomy

• Retropubic prostatectomy

• Transurethral laser incision of the prostate

A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?

• Keep the AV fistula site dry.

• Keep the AV fistula wrapped in gauze.

• Take the client's blood pressure in the left arm.

• Assess the AV fistula for a bruit and thrill.

A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site?

• Kidney

• Ureter

• Bladder

• Urethra

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)?

• Blood urea nitrogen (BUN) level of 22 mg/dl

• Serum creatinine level of 1.2 mg/dl

• Temperature of 100.2° F (37.8° C)

• Urine output of 250 ml/24 hours

A nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way?

• Fluid intake should be double the urine output.

• Fluid intake should be about equal to the urine output.

• Fluid intake should be half the urine output.

• Fluid intake should be inversely proportional to the urine output.

A client with an indwelling urinary catheter is suspected of having a urinary tract infection. The nurse should collect a urine specimen for culture and sensitivity by:

• Disconnecting the tubing from the urinary catheter and letting the urine flow into a sterile container.

• Wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle.

• Draining urine from the drainage bag into a sterile container.

• Clamping the tubing for 60 minutes and inserting a sterile needle into the tubing above the clamp to aspirate urine.

Which statement describing urinary incontinence in an elderly client is true?

• Urinary incontinence is a normal part of aging.

• Urinary incontinence isn't a disease.

• Urinary incontinence in the elderly population can't be treated.

• Urinary incontinence is a disease.

A nurse is caring for a male client with gonorrhea. The client asks how he can reduce his risk of contracting another sexually transmitted disease (STD). The nurse should instruct the client to:

• Ask all potential sexual partners if they have an STD.

• Wear a condom every time he has intercourse.

• Consider intercourse safe if his partner has no visible discharge, lesions, or rashes.

• Expect to limit the number of sexual partners to less than five over his lifetime.

A client with a urinary tract infectionis ordered co-trimoxazole (trimethoprim-sulfamethoxazole). The nurse should provide which medication instruction?

• "Take the medication with food."

• "Drink at least eight 8-oz glasses of fluid daily."

• "Avoid taking antacids during co-trimoxazole therapy."

• "Don't be afraid to go out in the sun."

A nurse is planning a group teaching session on the topic of urinary tract infection(UTI) prevention. Which point should the nurse include?

• Limit fluid intake to reduce the need to urinate.

• Take medication ordered for a UTI until the symptoms subside.

• Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.

• Wear only nylon underwear to reduce the chance of irritation.

After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an I.V. infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output?

• It's a normal finding caused by blood loss during surgery.

• It's a normal finding associated with the client's nothing-by-mouth status.

• It's an abnormal finding that requires further assessment.

• It's an abnormal finding that will correct itself when the client ambulates.

A client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stomais red, weeping, and painful. What should the nurse conclude?

• The skin wasn't lubricated before the pouch was applied.

• The pouch faceplate doesn't fit the stoma.

• A skin barrier was applied properly.

• Stoma dilation wasn't performed.

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?

• "Take your temperature every 4 hours."

• "Increase your fluid intake to 2 to 3 L per day."

• "Apply an antibacterial dressing to the incision daily."

• "Be aware that your urine will be cherry-red for 5 to 7 days."

A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should:

• Keep the client's knee on the affected side bent for 6 hours.

• Apply pressure to the puncture site for 30 minutes.

• Check the client's pedal pulses frequently.

• Remove the dressing on the puncture site after vital signs stabilize.

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?

• GI absorption rate

• Therapeutic index

• Creatinine clearance

• Liver function studies

A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders diagnostic testing of the vaginal discharge. Which STD must be reported to the public health department?

• Bacterial vaginitis

• Gonorrhea

• Genital herpes

• Human papillomavirus (HPV)

A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence?

• Encouraging intake of at least 2 L of fluid daily

• Giving the client a glass of soda before bedtime

• Taking the client to the bathroom twice per day

• Consulting with a dietitian

A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include:

• Periorbital edema.

• Green-tinged urine.

• Moderate to severe hypotension.

• Polyuria.

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

• A client with a laceration to the left hand

• A client who's taking prednisone (Deltasone)

• A client with an indwelling urinary catheter

• A client with Crohn's disease

When performing a scrotal examination, a nurse finds a nodule. What should the nurse do next?

• Notify the physician.

• Change the client's position and repeat the examination.

• Perform a rectal examination.

• Transilluminate the scrotum.

Which laboratory value supports a diagnosis of pyelonephritis?

• Myoglobinuria

• Ketonuria

• Pyuria

• Low white blood cell (WBC) count