Genitourinary Disorders

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

• A.

  Encouraging intake of at least 2 L of fluid daily

• B.

  Giving the client a glass of soda before bedtime

• C.

  Taking the client to the bathroom twice per day

• D.

  Consulting with a dietitian

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:

• A.

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

• B.

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

• C.

  Draining urine from the drainage bag into a sterile container.

• D.

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

A nurse is caring for a client with chronic renal failure. The laboratory results indicate hypocalcemia and hyperphosphatemia. When assessing the client, the nurse should be alert for which signs and symptoms? Select all that apply.

• A.

  Trousseau's sign

• B.

  Cardiac arrhythmias

• C.

  Constipation

• D.

  Decreased clotting time

• E.

  Drowsiness and lethargy

• F.

  Fractures

A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address?

• A.

  "I've had diabetes for 4 years."

• B.

  "I'm allergic to shellfish."

• C.

  "I haven't eaten since midnight."

• D.

  "My physician diagnosed me with hypertension 3 months ago."

A client receiving total parenteral nutritionis ordered a 24-hour urine test. When initiating a 24-hour urine specimen, the collection time should:

• A.

  Start with the first voiding.

• B.

  Start after a known voiding.

• C.

  Always be with the first morning urine.

• D.

  Always be the evening's last void as the last sample.

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?

• A.

  Evaluating patency of the drainage lumen

• B.

  Counter-balancing the I.V. pole

• C.

  Attaching the infusion set to an infusion pump

• D.

  Collecting a urine specimen before beginning irrigation

Which statement best describes the therapeutic action of loop diuretics?

• A.

  They block reabsorption of potassium on the collecting tubule.

• B.

  They promote sodium secretion into the distal tubule.

• C.

  They block sodium reabsorption in the ascending loop and dilate renal vessels.

• D.

  They promote potassium secretion into the distal tubule and constrict renal vessels.

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:

• A.

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

• B.

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

• C.

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

• D.

  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:

• A.

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

• B.

  A decreased serum phosphate level secondary to kidney failure.

• C.

  An increased serum calcium level secondary to kidney failure.

• D.

  Metabolic alkalosis secondary to retention of hydrogen ions.

A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD?

• A.

  The client is blind in his right eye.

• B.

  The client has a history of severe anemia during hemodialysis.

• C.

  The client has a history of diverticulitis.

• D.

  The client is on the kidney transplant waiting list.

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:

• A.

  Limit oral fluid intake for 1 to 2 weeks.

• B.

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

• C.

  Notify the physician about cloudy or foul-smelling urine.

• D.

  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:

• A.

  Acute pain

• B.

  Impaired home maintenance

• C.

  Noncompliance

• D.

  Ineffective breast-feeding

A client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for:

• A.

  Cardiac arrhythmia.

• B.

  Paresthesia.

• C.

  Dehydration.

• D.

  Pruritus.

During a rectal examination, which finding is evidence of a urethral injury?

• A.

  A low-riding prostate

• B.

  The presence of a boggy mass

• C.

  Absent sphincter tone

• D.

  A positive Hemoccult

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:

• A.

  Periorbital edema.

• B.

  Green-tinged urine.

• C.

  Moderate to severe hypotension.

• D.

  Polyuria.

During rounds, a client admitted with gross hematuriaasks the nurse about the physician's diagnosis. To facilitate effective communication, what should the nurse do?

• A.

  Ask why the client is concerned about the diagnosis.

• B.

  Change the subject to something more pleasant.

• C.

  Provide privacy for the conversation.

• D.

  Give the client some good advice.

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

• A.

  A client with a laceration to the left hand

• B.

  A client who's taking prednisone (Deltasone)

• C.

  A client with an indwelling urinary catheter

• D.

  A client with Crohn's disease

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?

• A.

  Assess peripheral pulses in the left leg.

• B.

  Place cool compresses on the calf.

• C.

  Exercise the leg and foot.

• D.

  Assess for anaphylaxis.

A nurse is teaching a client with genital herpes. Education for this client should include an explanation of:

• A.

  The need for the use of petroleum products.

• B.

  Why the disease is transmittable only when visible lesions are present.

• C.

  The option of disregarding safer-sex practices now that he's already infected.

• D.

  The importance of informing his partners of the disease.

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

• A.

  Impaired urinary elimination

• B.

  Toileting self-care deficit

• C.

  Risk for infection

• D.

  Activity intolerance

A female client reports to a nurse that she experiences a loss of urine when she jogs. The nurse's assessment reveals no nocturia, burning, discomfort when voiding, or urine leakage before reaching the bathroom. The nurse explains to the client that this type of problem is called:

• A.

  Functional incontinence.

• B.

  Reflex incontinence.

• C.

  Stress incontinence.

• D.

  Total incontinence.

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

• A.

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

• B.

  Cauliflower-like warts on the penis

• C.

  Painful red papules on the shaft of the penis

• D.

  Foul-smelling discharge from the penis

A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is:

• A.

  Renal calculi.

• B.

  An overdistended bladder.

• C.

  Interstitial cystitis.

• D.

  Acute prostatitis.

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

• A.

  Phosphate binders

• B.

  Insulin

• C.

  Antibiotics

• D.

  Cardiac glycosides

A client with a history of chronic cystitis comes to an outpatient clinic with signs and symptoms of this disorder. To prevent cystitis from recurring, the nurse recommends maintaining an acid-ash diet to acidify the urine, thereby decreasing the rate of bacterial multiplication. On an acid-ash diet, the client must restrict which beverage?

• A.

  Cranberry juice

• B.

  Coffee

• C.

  Prune juice

• D.

  Milk

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?

• A.

  Dopamine (Intropin), 3 mcg/kg/minute

• B.

  Dobutamine (Dobutrex), 10 mcg/kg/minute

• C.

  Epinephrine, 4 mcg/kg/minute

• D.

  Norepinephrine (Levophed), 8 mcg/minute

A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important?

• A.

  Administering a sitz bath twice per day

• B.

  Increasing fluid intake to 3 L/day

• C.

  Using an indwelling urinary catheter to measure urine output accurately

• D.

  Encouraging the client to drink cranberry juice to acidify the urine

A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?

• A.

  This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.

• B.

  The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days.

• C.

  The potential for transmission to her sexual partner will be eliminated if condoms are used every time she and her partner have sexual intercourse.

• D.

  The human papillomavirus (HPV), which causes condylomata acuminata, can't be transmitted during oral sex.

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?

• A.

  Increase the I.V. flow rate.

• B.

  Notify the physician immediately.

• C.

  Assess the irrigation catheter for patency and drainage.

• D.

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

A client admitted to the unit with a diagnosis of end-stage renal disease is scheduled to undergo hemodialysis. He voices anxiety over shunt placement and management of care at home. A nurse initiates a referral to which members of the interdisciplinary team?

• A.

  Physical and occupational therapist, dietitian, and home health aide

• B.

  Home health nurse, nutritionist, and social worker

• C.

  Physician, physical therapist, and family

• D.

  Dialysis nurse, physician, and family

A client with heart failureis admitted to an acute care facility and is found to have a cystocele. When planning care for this client, the nurse is most likely to formulate which nursing diagnosis?

• A.

  Total urinary incontinence

• B.

  Functional urinary incontinence

• C.

  Reflex urinary incontinence

• D.

  Stress urinary incontinence

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:

• A.

  Initiate a stream of urine.

• B.

  Breathe deeply.

• C.

  Turn to the side.

• D.

  Hold the labia or shaft of the penis.

An elderly client with a diagnosis of chronic renal failure is being discharged to home with his wife. The home health nurse visits the hospital before discharge to discuss home safety with the client, who reports decreased mobility and a need for greater assistance with activities of daily living. The nurse focuses her home-safety teaching on:

• A.

  Having adequate lighting, removing cluttered paths, and using nonskid bathroom surfaces.

• B.

  Avoiding unsteady ladders, overloaded electrical outlets, and pesticides.

• C.

  Properly storing plastic bags and guns and replacing steps without handrails.

• D.

  Replacing defective smoke detectors, storing flammable liquids properly, and repairing steps with broken concrete.

Two weeks after being diagnosed with a streptococcal infection, a client develops fatigue, a low-grade fever, and shortness of breath. The nurse auscultates bilateralcracklesand observes jugular vein distention. Urinalysis reveals red and white blood cells and protein. After the physician diagnoses poststreptococcalglomerulonephritis, the client is admitted to the medical-surgical unit. Which immediate action should the nurse take?

• A.

  Place the client on bed rest.

• B.

  Provide a high-protein, fluid-monitored diet.

• C.

  Prepare to assist with insertion of a Tenckhoff catheter for hemodialysis.

• D.

  Place the client on a sheepskin, and monitor for increasing edema.

A nurse is caring for an elderly male client who complains that he can't pass urine. A bladder scan reveals 600 ml of urine present in the bladder. The nurse attempts to place the indwelling catheter the physician ordered, but resistance prevents her from placing it. A serum prostate-specific antigen (PSA) test indicates a level of 29 g/L. The physician places an indwelling catheter and the urine specimen returns positive for nitrites, leukocytes, and bacteriuria. Which conditions should the nurse suspect? Select all that apply.

• A.

  Prostate problems

• B.

  Urinary tract infection (UTI)

• C.

  Acute renal failure

• D.

  Vitamin K deficiency

• E.

  Liver failure

A client scheduled for a vasectomy asks the nurse how soon after the procedure he can have sexual intercourse without using an alternative birth control method. How should the nurse respond?

• A.

  "You can safely have unprotected intercourse after 6 to 10 ejaculations."

• B.

  "You can safely have unprotected intercourse when your sperm count indicates sterilization."

• C.

  "You can safely have unprotected intercourse immediately after the procedure."

• D.

  "You can safely have unprotected intercourse as soon as discomfort from the procedure disappears."

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

• A.

  Urinary incontinence is a normal part of aging.

• B.

  Urinary incontinence isn't a disease.

• C.

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

• D.

  Urinary incontinence is a disease.

A nurse is providing inservice education for staff members about evidence collection after sexual assault. The educational session is successful when staff members focus their initial care on which step?

• A.

  Collecting semen

• B.

  Performing the pelvic examination

• C.

  Obtaining consent for examination

• D.

  Supporting the client's emotional status

A client with depression and behavioral changes is transferred from a local assisted living center to the emergency department. The nurse notes that the client cries out when she approaches. When the nurse gains the client's confidence and performs an assessment, the nurse notes bruising of the labia and a lateral laceration in the perineal area. When the nurse asks the client about the injury, the client shakes her head and begins to cry "don't tell, don't tell." The nurse suspects sexual abuse. How should the nurse proceed?

• A.

  Notify the physician of her findings immediately.

• B.

  Attend to the client's physiological needs.

• C.

  Notify the client's family.

• D.

  Notify the rape crisis team.

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?

• A.

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

• B.

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

• C.

  It's an abnormal finding that requires further assessment.

• D.

  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?

• A.

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

• B.

  The pouch faceplate doesn't fit the stoma.

• C.

  A skin barrier was applied properly.

• D.

  Stoma dilation wasn't performed.

After undergoing a total cystectomy and urinary diversion, a client has a Kock pouch (continent internal reservoir) in place. Which statement by the client indicates a need for further teaching?

• A.

  "I'll have to wear an external collection pouch for the rest of my life."

• B.

  "I should eat foods from all the food groups."

• C.

  "I'll need to drink at least eight glasses of water a day."

• D.

  "I'll have to catheterize my pouch every 2 hours."

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

• A.

  Blood glucose level of 200 mg/dl

• B.

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

• C.

  Potassium level of 3.5 mEq/L

• D.

  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:

• A.

  Confusion, headache, and seizures.

• B.

  Acute bone pain and confusion.

• C.

  Weakness, tingling, and cardiac arrhythmias.

• D.

  Hypotension, tachycardia, and tachypnea.

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

• A.

  "Take your temperature every 4 hours."

• B.

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

• C.

  "Apply an antibacterial dressing to the incision daily."

• D.

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

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important?

• A.

  Encouraging coughing and deep breathing

• B.

  Promoting carbohydrate intake

• C.

  Limiting fluid intake

• D.

  Providing pain-relief measures

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:

• A.

  Ask all potential sexual partners if they have an STD.

• B.

  Wear a condom every time he has intercourse.

• C.

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

• D.

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

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.

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

• B.

  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

• C.

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

• D.

  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