NCLEX Genitourinary Disorders

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

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

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

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

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

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 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.

• Trousseau's sign

• Cardiac arrhythmias

• Constipation

• Decreased clotting time

• Drowsiness and lethargy

• Fractures

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 receives her client care assignment. Following the report, she should give priority assessment to the client:

• With pinkish mucus discharge in the appliance bag 2 days after an ileal conduit.

• Who has a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L 7 days after a kidney transplant.

• Who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L.

• Who is experiencing mild pain from urolithiasis.

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

• Start with the first voiding.

• Start after a known voiding.

• Always be with the first morning urine.

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

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.

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 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.

Which clinical finding should a nurse look for in a client with chronic renal failure?

• Hypotension

• Uremia

• Metabolic alkalosis

• Polycythemia

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about:

• Chronic, excessive acetaminophen use.

• Recent streptococcal infection.

• Childhood asthma.

• Family history of pernicious anemia.

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.

Because of difficulties with hemodialysis, peritoneal dialysis is 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 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

Which statement best describes the therapeutic action of loop diuretics?

• They block reabsorption of potassium on the collecting tubule.

• They promote sodium secretion into the distal tubule.

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

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

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. 1. The level of estrogen in the blood peaks.
2. 2. Peak endometrial thickening occurs.
3. 3. Estrogen and progesterone levels increase.
4. 4. Top layer of the endometrium breaks occurs.
5. 5. Afollicle matures and ovulation occurs.
6. 6. The endometrium begins thickening.

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

• Administering a sitz bath twice per day

• Increasing fluid intake to 3 L/day

• Using an indwelling urinary catheter to measure urine output accurately

• Encouraging the client to drink cranberry juice to acidify the urine

A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to:

• Assess whether the client is a good candidate for surgery.

• Help the client cope with the anxiety associated with changes in body image.

• Assess suicidal risk postoperatively.

• Evaluate the client's need for mental health intervention.

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.

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?

• Increased pH with decreased hydrogen ions

• Increased serum levels of potassium, magnesium, and calcium

• Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl

• Uric acid analysis 3.5 mg/dl and phenolsulfonphthalein (PSP) excretion 75%

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 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:

• Functional incontinence.

• Reflex incontinence.

• Stress incontinence.

• Total incontinence.

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.

A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:

• Continuous inflow and outflow of irrigation solution.

• Intermittent inflow and continuous outflow of irrigation solution.

• Continuous inflow and intermittent outflow of irrigation solution.

• Intermittent flow of irrigation solution and prevention of hemorrhage.

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.

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.

To treat a urinary tract infection, a client is ordered trimethoprim-sulfamethoxazole (Bactrim). The nurse should teach the client that trimethoprim-sulfamethoxazole is most likely to cause which adverse effect?

• Anxiety

• Headache

• Diarrhea

• Dizziness

After a radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. The client then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first?

• Kegel exercises

• Fluid restriction

• Artificial sphincter use

• Self-catheterization

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?

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

• I should eat foods from all the food groups.

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

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

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 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.

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

• Encourage oral fluids.

• Administer furosemide (Lasix) 20 mg I.V.

• Start hemodialysis after a temporary access is obtained.

• Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.

A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs?

• I should wipe from back to front.

• I should take a tub bath at least 3 times per week.

• I should take at least 1,000 mg of vitamin C each day.

• I should limit my fluid intake to limit my trips to the bathroom.

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 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 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.

• Prostate problems

• Urinary tract infection (UTI)

• Acute renal failure

• Vitamin K deficiency

• Liver failure

Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with benign prostatic hyperplasia (BpH)?

• Voiding pattern

• Size of the prostate

• Creatinine clearance

• Serum testosterone level

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?

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

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

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

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

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 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.

A physician orders a single dose of trimethoprim/sulfamethoxazole (Bactrim) by mouth for a client diagnosed with an uncomplicated urinary tract infection. The pharmacy sends three unit-dose tablets. The nurse verifies the physician's order. What should the nurse do next?

• Administer the three tablets as the single dose.

• Call the physician to verify the order.

• Give one tablet, three times per day.

• Call the hospital pharmacist and question the medication supplied.

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?

• Collecting semen

• Performing the pelvic examination

• Obtaining consent for examination

• Supporting the client's emotional status

A nurse is caring for a client who also works in the hospital, has recently received a diagnosis of genital herpes, and is being treated for a urinary tract infection (UTI). While on lunch break in the cafeteria, the nurse sees the client's coworkers, who voice concern over his condition. The nurse's best response would be:

• He must be upset that everyone knows he has herpes.

• I'll be sure to tell him you're thinking of him.

• He's really upset about his medical condition. I'll get you the chart so you can review his laboratory values.

• The antibiotics are really helping with his UTI. He should be back to work in no time.

A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans?

• Cottage cheese–like discharge

• Yellow-green discharge

• Gray-white discharge

• Discharge with a fishy odor

Which nursing diagnosis is appropriate for a client with renal calculi?

• Ineffective tissue perfusion (renal)

• Functional urinary incontinence

• Risk for infection

• Decreased cardiac output

A female client seeks care for a possible infection. Her symptoms include burning on urination and frequent, urgent voiding of small amounts of urine. She's placed on trimethoprim-sulfamethoxazole (Bactrim) to treat the infection. Another medication is ordered to decrease the pain and frequency. Which is the most likely medication ordered for the pain?

• Nitrofurantoin (Macrodantin)

• Ibuprofen (Motrin)

• Acetaminophen with codeine

• Phenazopyridine (Pyridium)

A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis?

• Acute pain

• Risk for infection

• Impaired urinary elimination

• Imbalanced nutrition: Less than body requirements

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.