NCLEX Genitourinary Disorders

RATIONALE: If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn't be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn't performed with an ileal conduit, although it may be done with a colostomy if ordered.

RATIONALE: Mumps is the childhood infectious disease that most significantly affects male fertility. Chickenpox, measles, and scarlet fever don't affect male fertility.

RATIONALE: Preparing the client and equipment, creating a sterile field, putting on gloves, cleaning the urinary meatus, and inserting the catheter until urine flows are all the vital steps for inserting a straight catheter. The nurse must prepare the client and equipment before creating a sterile field. Putting on gloves before creating a sterile field and performing the other tasks is incorrect. Testing the catheter balloon describes the procedure for inserting a retention catheter, rather than a straight catheter.

RATIONALE: Co-trimoxazole is a sulfonamide antibiotic used to treat urinary tract infections. Therefore, absence of bacteria on urine culture indicates that the drug has achieved its desired effect. Although flank pain may decrease as the infection resolves, this finding isn't a reliable indicator of the drug's effectiveness. Co-trimoxazole doesn't affect urine output or the RBC count.

RATIONALE: Infection can occur with renal calculi from urine stasis caused by obstruction. Ineffective tissue perfusion (renal) and Decreased cardiac output aren't appropriate for this client, and retention of urine, rather than incontinence, usually occurs.

RATIONALE: The nurse should begin by assessing peripheral pulses in the left leg to determine if blood flow was interrupted by the procedure. The client may also have thrombophlebitis. Cool compresses aren't used to relieve pain and inflammation in thrombophlebitis. The leg should remain straight after the procedure. Calf pain isn't a symptom of anaphylaxis.

RATIONALE: ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

RATIONALE: The nurse should be alert for pruritus and urticaria, which may indicate a mild anaphylactic reaction to the arteriogram dye. Decreased (not increased) alertness may occur as well as dyspnea (not hypoventilation). Unusually smooth skin isn't a sign of anaphylaxis.

RATIONALE: Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

RATIONALE: The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

RATIONALE: Using alcohol gel isn't acceptable after the nurse has been in contact with soiled material. The nurse should wash her hands with soap and water. The nurse demonstrates appropriate handling of infectious materials by wearing gloves with each client contact, washing her hands with soap and water when she enters and exits the room, and disposing contaminated articles in the room's biohazard container.

RATIONALE: Cardiac glycosides such as digoxin (Lanoxin) should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digoxin toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.

RATIONALE: The nurse who discovers a nodule, swelling, or other abnormal finding during a scrotal examination should transilluminate the scrotum by darkening the room and shining a flashlight through the scrotum behind the mass. A scrotum filled with serous fluid transilluminates as a red glow; a more solid lesion, such as a hematoma or mass, doesn't transilluminate and may appear as a dark shadow. Although the nurse should notify the physician of the abnormal finding, performing transillumination first provides the physician with additional information. The nurse can't uncover more information about a scrotal mass by changing the client's position and repeating the examination or by performing a rectal examination.

RATIONALE: The nurse should evaluate patency of the drainage tubing before leaving the client's room. If the lumen is obstructed, the solution infuses into the bladder but isn't eliminated through the drainage tubing, a situation that may cause client injury. Balancing the pole is important; however, the nurse would have had to address this issue immediately after hanging the 2 L bag. Using an I.V. pump isn't necessary for continuous bladder irrigation. Unless specifically ordered, obtaining a urine specimen before beginning continuous bladder irrigation isn't necessary.

RATIONALE: The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4⅜″) long, 5 to 5.8 cm (2″ to 2¼″) wide, and 2.5 cm (1″) thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae.

RATIONALE: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

RATIONALE: After a vasectomy, sterilization isn't ensured until the client's sperm count measures zero. This usually requires 6 to 36 ejaculations. Having intercourse immediately after the procedure or as soon as discomfort disappears may lead to pregnancy.

RATIONALE: Phenazopyridine may be ordered in conjunction with an antibiotic for painful bladder infections to promote comfort. Because of its local anesthetic action on the urinary mucosa, phenazopyridine specifically relieves bladder pain. Nitrofurantoin is a urinary antiseptic with no analgesic properties. Although ibuprofen and acetaminophen with codeine are analgesics, they don't exert a direct effect on the urinary mucosa.

RATIONALE: Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.

RATIONALE: The nurse should instruct the client to report the presence of foul-smelling or cloudy urine to the physician. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal because of residual stone products. Hematuria is common after lithotripsy.

RATIONALE: Bladder ultrasonic scanning, a noninvasive way of calculating the amount of urine in the bladder, reduces the risk of transferring microorganisms into the bladder. Use of a straight catheter to measure residual urine increases the transfer of microorganisms into the bladder, and increases, rather than reduces, client discomfort. A bladder ultrasonic scan doesn't reduce the risk of prostate irritation or incorrect urine output values.

RATIONALE: Most catheters have a self-sealing port for obtaining a urine specimen. Antiseptic solution is used to reduce the risk of introducing microorganisms into the catheter. Tubing shouldn't be disconnected from the urinary catheter. Any break in the closed urine drainage system may allow the entry of microorganisms. Urine in urine drainage bags may not be fresh and may contain bacteria, giving false test results. When there's no urine in the tubing, the catheter may be clamped for no more than 30 minutes to allow urine to collect.

RATIONALE: The client requires additional teaching if he states that he'll have to wear an external collection pouch for the rest of his life. An internal collection pouch, such as the Kock pouch, allows the client to perform self-catheterization for ileal drainage. This pouch is an internal reservoir, eliminating the need for an external collection pouch. A well-balanced diet is essential for healing; the client need not include or exclude particular foods. The client should drink at least eight glasses of fluid daily to prevent calculi formation and urinary tract infection. Intervals between pouch drainings should be increased gradually until the pouch is emptied two to four times daily.

RATIONALE: Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of Acute pain takes highest priority. Diagnoses of Risk for infection and Impaired urinary elimination are appropriate when the client's pain is controlled. A diagnosis of Imbalanced nutrition: Less than body requirements isn't pertinent at this time.

RATIONALE: The drop in urine output to less than 30 ml/hour is abnormal and requires further assessment. The reduction in urine output may be caused by an obstruction in the urinary catheter tubing or deficient fluid volume from blood loss. The client's nothing-by-mouth status isn't the cause of the low urine output because the client is receiving I.V. fluid to compensate for the lack of oral intake. Ambulation promotes urination; however, the client should produce at least 30 ml of urine/hour.

RATIONALE: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.

RATIONALE: The guidelines for initiating bladder retraining include assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

RATIONALE: The teaching session is successful when staff members focus first on supporting the client's emotional status. Next, staff members should gain consent to perform the pelvic examination, perform the examination, and collect evidence, such as semen if present.

RATIONALE: Loop diuretics block sodium reabsorption in the ascending loop of Henle, which promotes water diuresis. They also dilate renal vessels. Although loop diuretics block potassium reabsorption, this isn't a therapeutic action. Thiazide diuretics, not loop diuretics, promote sodium secretion into the distal tubule.

RATIONALE: During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

RATIONALE: RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.

RATIONALE: Urinary incontinence isn't a normal part of aging nor is it a disease. It may be caused by confusion, dehydration, fecal impaction, restricted mobility, or other causes. Certain medications, including diuretics, hypnotics, sedatives, anticholinergics, and antihypertensives, may trigger urinary incontinence. Most clients with urinary incontinence can be treated; some can be cured.

RATIONALE: Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. Administering glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.

RATIONALE: BUN and creatinine levels should be closely monitored to detect elevations caused by nephrotoxicity. Sodium level should be routinely monitored in all hospitalized clients. Alkaline phosphatase helps evaluate liver function. The WBC count should be monitored to evaluate the effectiveness of the antibiotic; it doesn't help evaluate kidney function.

RATIONALE: Periorbital edema is a classic sign of acute glomerulonephritis of sudden onset. Other classic signs and symptoms of this disorder include hematuria (not green-tinged urine), proteinuria, fever, chills, weakness, pallor, anorexia, nausea, and vomiting. The client also may have moderate to severe hypertension (not hypotension), oliguria or anuria (not polyuria), headache, reduced visual acuity, and abdominal or flank pain.

RATIONALE: Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine.

RATIONALE: When the urethra is ruptured, a hematoma or collection of blood separates the two sections of the urethra. This condition may feel like a boggy mass on rectal examination. Because of the rupture and hematoma, the prostate becomes high riding. A palpable prostate gland usually indicates a nonurethral injury. Absent sphincter tone would refer to a spinal cord injury. The presence of blood (a positive Hemoccult) would probably correlate with GI bleeding or a colon injury.

RATIONALE: As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn't cause paresthesia (sensations of numbness and tingling). Dehydration doesn't occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. In the client with ARF, pruritus results from increased phosphates and isn't associated with hyperkalemia.

RATIONALE: The client's voiding pattern should be checked to evaluate the effectiveness of alpha-adrenergic blockers. These drugs relax the smooth muscle of the bladder neck and prostate, so the urinary symptoms of BPH are reduced in many clients. These drugs don't affect the size of the prostate, production or metabolism of testosterone, or renal function.

RATIONALE: The creatinine clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.

RATIONALE: This client is at high risk for acute prerenal failure secondary to decreased renal perfusion during surgery. To dilate the renal arteries and help prevent renal shutdown, the physician is likely to order dopamine at a low flow rate (2 to 5 mcg/kg/minute). Although this drug has mixed dopaminergic and beta activity when given at 5 to 10 mcg/kg/minute, the client is stabilized and thus doesn't need the beta effects from the higher flow rate — or the sympathomimetic effects of epinephrine. The dopaminergic effects of dopamine increase renal perfusion, contractility, and vasodilation. Dobutamine is used to increase cardiac output. Norepinephrine is a potent vasoconstrictor that shunts blood away from the kidneys to increase blood pressure.

RATIONALE: The nurse should call the hospital pharmacy and question the medication supplied. The hospital pharmacist should be able to tell the nurse whether three tablets are necessary for the single dose or whether a dispensing error occurred. It isn't clear whether the three tablets are the single dose because they were packaged as a unit-dose. The physician's order was clearly written, so clarifying the order with the physician isn't necessary. Administering the tablets without clarification might cause a medication error.

RATIONALE: The nurse should tell the client that she'll receive an enema before the procedure because bowel motility during cervical radiation implant therapy can disrupt or dislodge the implants. The client will be in a private room, but activities will be restricted to keep the implants in place. To keep the bladder empty, an indwelling catheter will be used. Positioning in bed shouldn't exceed a 20-degree elevation because sitting up can cause the implants to move from their intended locations. Semi-Fowler's position is 45 degrees.

RATIONALE: Red, sensitive skin around the stoma site may indicate an ill-fitting appliance Beefy redness at a stoma site that isn't sensitive to touch is a normal assessment finding. Urine mixed with mucus is also a normal finding.

RATIONALE: Fluid depletion before excretory urography is contraindicated in clients with multiple myeloma, severe diabetes mellitus, and uric acid nephropathy — conditions that can seriously compromise renal function in fluid-depleted clients with reduced renal perfusion. If these clients must undergo excretory urography, they should be well hydrated before the test. Cystic fibrosis, gout, and myasthenia gravis don't necessitate changes in client preparation for excretory urography.

RATIONALE: A small quantity of the fungus Candida albicans commonly exists in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Candidiasis is rare before menarche and after menopause. Using hormonal contraceptives, not spermicidal jelly, and pregnancy, not nulliparity, increase the risk of candidiasis.

RATIONALE: The nurse should consult the client educator to help the client with his fears and concerns. Providing the client with information can greatly allay the client's fears. The social worker can provide the client with services he may need after discharge. Although the surgeon tells the client about the surgery, he isn't the best person to help the client with fears and concerns. The dietitian can help with dietary concerns but can't provide help with direct concerns about the surgery.

RATIONALE: A history of diverticulitis contraindicates CAPD because CAPD has been associated with the rupture of diverticulum. A history of severe anemia while on hemodialysis or being on the transplant waiting list doesn't contraindicate CAPD. The client who's blind or partially blind can still learn to perform CAPD.

RATIONALE: Trimethoprim-sulfamethoxazole is most likely to cause diarrhea. Nausea and vomiting are other common adverse effects. This drug rarely causes anxiety, headache, or dizziness.

RATIONALE: Offering to tell the client that his coworkers are thinking of him is the only appropriate response. Discussing his diagnosis or condition violates his right to privacy.

RATIONALE: Intrinsic renal failure results from damage to the kidney, such as from nephrotoxic injury caused by contrast media, antibiotics, corticosteroids, or bacterial toxins. Poor perfusion to the kidneys may result in prerenal failure. Damage to the epithelial cells of the renal tubules results from nephrotoxic injury, not damage to the adrenal cortex. Obstruction of the urinary collecting system may cause postrenal failure.

RATIONALE: The nurse should attend to the client's immediate physiological needs, including physical safety. Next, the nurse can notify the physician and the rape crisis team. The family should be notified if the client consents, but not until the rape investigation is complete.

RATIONALE: The charge nurse should assign the new nurse to the elderly client newly diagnosed with bladder cancer awaiting surgery, the elderly client who recently had a prostatectomy with bladder irrigation, and the elderly client with renal insufficiency. These clients have conditions common to the genitourinary floor. The charge nurse should assign the agency nurse to the client who had an ileo conduit, the older adult client with a UTI, and the adolescent with kidney stones. Their conditions have lesser acuity. The charge nurse should assign the experienced nurse to the most acute clients: the middle-age kidney-transplant recipient, the older adult client in acute renal failure, the older adult client with urinary sepsis, the older adult client just admitted for acute stroke, the young adult client with suspected kidney stones, and the middle-age client with suspected pyelonephritis.

RATIONALE: A client on an acid-ash diet must avoid milk and milk products because these make the urine more alkaline, encouraging bacterial growth. Other foods to avoid on this diet include all vegetables except corn and lentils; all fruits except cranberries, plums, and prunes; and any food containing large amounts of potassium, sodium, calcium, or magnesium. Cranberry and prune juice are encouraged because they acidify the urine. Coffee and tea are considered neutral because they don't alter the urine pH.

RATIONALE: When initiating a 24-hour urine specimen, have the client void, then start the timing. The collection should start on an empty bladder. The exact time the test starts isn't important but the test is commonly started in the morning.

RATIONALE: Stress urinary incontinence is a urinary problem associated with cystocele — herniation of the bladder into the birth canal. Other problems associated with this disorder include urinary frequency, urinary urgency, urinary tract infection, and difficulty emptying the bladder. Total incontinence, functional incontinence, and reflex incontinence usually result from neurovascular dysfunction, not cystocele.

RATIONALE: The average dwell time is about 20 minutes. The fluid infuses within 10 minutes, dwells for 20 minutes, and then drains in about 20 minutes. The diffusion on the small particles into the dialysate peaks in the first 10 minutes.

RATIONALE: Home care for a client with end-stage renal disease requires ongoing education and referral; team members include the home health nurse, the nutritionist, and social services in this process. The home health nurse assists with client teaching and support, completion of physical assessments, and evaluation of outcomes. The nutritionist explains dietary needs and necessary changes in the diet. The social worker assists with finding resources and provides counseling and support to the client and family members. Physical and occupational therapy and dialysis aren't components of home care. Family members aren't part of the interdisciplinary health care team.

RATIONALE: An elevated PSA level and lower urinary tract symptoms may indicate a prostate problem. A urine specimen positive for leukocytes, nitrites, and bacteriuria indicates UTI. The client's signs and symptoms don't indicate acute renal failure, liver failure, or a vitamin K deficiency.

RATIONALE: To prevent errors, the charge nurse should ask the admissions department to assign the elderly client to another room. Making signs and verbally alerting staff members don't eliminate the risk of error. It isn't appropriate to ask the client if he'd be willing to answer to a different last name.

RATIONALE: The nurse must provide a high-protein diet to supply energy and reduce catabolism of protein. The nurse must also closely monitor the client's fluid intake and output. It isn't necessary for the client to be on bed rest. Because of the risk of altered urinary elimination related to oliguria, this client may require hemodialysis or plasmapheresis for several weeks until renal function improves; however, a Tenckhoff catheter is used in peritoneal dialysis, not hemodialysis. Although providing comfort measures (such as placing the client on a sheepskin) are important, this action isn't a priority.

RATIONALE: Treatment for gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin (Zithromax) is also ordered. There has been an increase in the number of resistant strains of gonorrhea, but that isn't the reason for this dual therapy. This combination of antibiotics doesn't reduce the risk of reinfection or provide a faster cure.

RATIONALE: Hypocalcemia is a calcium deficit that causes nerve fiber irritability and repetitive muscle spasms. Signs and symptoms of hypocalcemia include Trousseau's sign, cardiac arrhythmias, diarrhea, increased clotting times, anxiety, and irritability. The calcium-phosphorus imbalance leads to brittle bones and pathologic fractures.

Correct answer is 1180.
RATIONALE: During 8 hours, 1,600 ml of bladder irrigation has been infused (200 ml × 8 hour = 1,600 ml/8 hour). The nurse then subtracts this amount of infused bladder irrigation from the total volume in the drainage bag (2,780 ml − 1,600 ml = 1,180 ml) to determine urinary output.

Correct answer is 4,6,1,5,2,3
RATIONALE: The menstrual cycle begins with the first day of menstruation, when the top layer of the endometrium breaks down and sloughs. The endometrium thickens and the level of estrogen in the blood peaks. Next, a follicle matures and ovulation occurs. Peak endometrial thickening occurs and the estrogen and progesterone levels increase, inhibiting luteinizing hormone.