4/8/12

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GENITOURINARY REVIEW Rationale

Which laboratory test is the most accurate indicator of a client's renal function?

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1.  2.  3.  4. 

Blood urea nitrogen   Creatinine clearance   Serum creatinine   Urinalysis

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2.  Creatinine clearance

Creatinine clearance is the most accurate indicator of a client's renal function because it closely correlates with the kidney's glomerular filtration rate and tubular excretion ability. Results from the other options may be influenced by various conditions and aren't specific to renal disease.

the nurse is most likely to formulate which nursing diagnosis?   1.  Total urinary incontinence   2.4/8/12 A client with heart failure admitted to an acute care facility and is found to have a cystocele. When planning care for this client.  Functional urinary incontinence   3.  Reflex urinary incontinence   .

not cystocele. and difficulty emptying the bladder. urinary urgency.  Stress urinary incontinence  Stress urinary incontinence is a urinary problem associated with cystocele — herniation of the bladder into the birth canal. urinary tract infection (UTI). .4/8/12 4. functional incontinence. Other problems associated with this disorder include urinary frequency. and reflex incontinence usually result from neurovascular dysfunction. Total incontinence.

  2.  The pouch faceplate doesn't fit the stoma. weeping. What should the nurse conclude? 1.  The skin wasn't lubricated before the pouch was applied. the nurse observes that the area around the stoma is red. While changing this client's pouch.  A skin barrier was applied properly.   3. and painful.   4.  Stoma dilation wasn't performed.4/8/12  A client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion. .

weeping. and painful skin.    If 4/8/12 the pouch faceplate doesn't fit the stoma properly. causing excoriation and red.2. A lubricant shouldn't be used because it would prevent the pouch from adhering to the skin. When properly applied. the skin around the stoma will be exposed to continuous urine flow from the stoma. Stoma dilation isn't performed with an ileal .  The pouch faceplate doesn't fit the stoma. a skin barrier prevents skin excoriation.

  Taking the client to the bathroom twice per day   4.  Consulting with a dietitian .  Encouraging intake of at least 2 L of fluid daily   2. Which nursing intervention promotes urinary continence?   1.4/8/12  The nurse is caring for a client who had a stroke.  Giving the client a glass of soda before bedtime   3.

  Encouraging intake of at least 2 L of fluid daily  4/8/12 By encouraging a daily fluid intake of at least 2 L.1. The nurse shouldn't give the client soda before bedtime. thereby promoting bladder retraining by stimulating the urge to void. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day. Consultation with a dietitian won't address the problem of urinary . twice per day is insufficient. soda acts as a diuretic and may make the client incontinent. the nurse helps fill the client's bladder.

  4.4/8/12 A client develops decreased renal function and requires a change in antibiotic dosage.  3.  2. On which factor would the physician base the dosage change? GI absorption rate   Therapeutic index   Creatinine clearance   Liver function studies 1.  .

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3.  Creatinine clearance  
 The

physician orders tests for creatinine clearance to gauge the kidney's glomerular filtration rate; this 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.

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A

client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is most appropriate for this client? Impaired urinary elimination   Toileting self-care deficit   Risk for infection   Activity intolerance

  1.  2.  3.  4. 

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3.  Risk for infection
 RATIONALES:

The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. Therefore, the client is at risk for infection. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. The other options may be pertinent but are secondary to the risk for infection.

When the nurse gains the client's confidence and performs an assessment.4/8/12  An 85-year-old client is transferred from a local assisted living center to the emergency department with depression and behavioral changes. The nurse notes that the client cries out when she approaches. When the nurse asks the client about the injury. the nurse notes bruising of the labia and a lateral laceration in the perineal area. the client .

the nurse can notify the physician and the rape crisis team. . The family should be notified if the client consents.  Attend to the client's physiological needs. but not until the rape investigation is complete. Next.2.  The 4/8/12 nurse should attend to the client's immediate physiological needs including physical safety.

  2.6° F (39.  4.  .  3.4/8/12  The nurse suspects that a client with a temperature of 103. What is the most common cause of sepsis in hospitalized clients? Respiratory infection   Urinary tract infection (UTI)   Vasculitis   Osteomyelitis 1.8° C) and an elevated white blood cell count is in the initial stage of sepsis.

and gynecologic tracts. GI. vasculitis.  Urinary tract infection (UTI)    Sepsis most commonly results from a UTI caused by gram-negative bacteria. Respiratory infection. Other causes of sepsis include infections of the biliary.4/8/12 2. . and osteomyelitis rarely cause sepsis in hospitalized clients.

  Restrict fluids to prevent the client's bladder from becoming distended.   . Which nursing intervention is appropriate? 4/8/12 1. The client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation.   2.  Tell the client to try to urinate around the catheter to remove blood clots.

4.  Use aseptic technique when irrigating the catheter. it may be irrigated according to physician's orders or facility protocol.  If 4/8/12 the catheter is blocked by blood clots. Encourage the client to drink fluids to dilute the urine and . The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms.

  2.   Start hemodialysis after a 1. vomiting.V.  mg 3.4/8/12 A client is admitted with nausea. and diarrhea.  . The physician willmost likely write an order for which treatment? Force oral fluids. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. His blood pressure on admission is 74/30 mm Hg.   Administer furosemide (Lasix) 20 I.

fluids with a normal saline solution bolus followed by a maintenance dose.  Start I. and the BUN and creatinine levels to normalize.V. vomiting. The client isn't fluid-overloaded so his urine output won't increase with furosemide.V.V. therapy. causing his blood pressure to rise. and diarrhea. This treatment should rehydrate the client. which would actually worsen the client's condition. I. . his urine output to increase.4/8/12 4. fluids should be given with a bolus of normal saline solution followed by maintenance I. The client wouldn't be able to tolerate oral fluids because of the nausea.  The client is in prerenal failure caused by hypovolemia. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.

  Foul-smelling discharge from the .  Painful red papules on the shaft of the penis   4.4/8/12  The nurse is assessing a male client diagnosed with gonorrhea.  Rashes on the palms of the hands and soles of the feet   2. Which symptom most likely prompted the client to seek medical attention? 1.  Cauliflower-like warts on the penis   3.

.4. foul-smelling drainage from the penis and painful urination. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes. Cauliflower-like warts on the penis are a sign of human papillomavirus. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis.  Foul-smelling discharge from the penis  Symptoms 4/8/12 of gonorrhea in men include purulent.

  Change the subject to something more pleasant.4/8/12  During rounds.  Ask why the client is concerned about the diagnosis. a client admitted with gross hematuria asks the nurse about the physician's diagnosis.  Provide privacy for the conversation. what should the nurse do? 1.   2.   .   3. To facilitate effective communication.

  Provide privacy for the conversation. . or giving advice tends to block therapeutic communication. changing the subject. which focuses solely on the client's needs. Asking why the client is concerned.    Providing 4/8/12 privacy for the conversation is a form of active listening.3.

4/8/12  The nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra–highfrequency sound waves to shatter renal calculi. The nurse should instruct the client to: 1.  limit oral fluid intake for 1 to 2 weeks. In this procedure.   .

  notify the physician about cloudy or foul-smelling urine. Unless contraindicated. the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Hematuria is common after lithotripsy. .    The 4/8/12 client should report the presence of foul-smelling or cloudy urine. Sandlike debris is normal because of residual stone products.3.

  Obtaining consent for examination   4.  Collecting semen   2.  Supporting the client's emotional .4/8/12  The nurse is providing inservice education for the staff about evidence collection after sexual assault. The educational session is successful when the staff focuses their initial care on which step? 1.  Performing the pelvic examination   3.

.4. the nurses should gain consent to perform the pelvic examination. such as semen if present. Next.  Supporting the client's emotional status  The 4/8/12 teaching session is successful when the nurses focus on supporting the client's emotional status first. and collect evidence. perform the examination.

  3. Which type of drug should be withheld before this procedure? Phosphate binders   Insulin   Antibiotics   Cardiac glycosides 1.  .4/8/12 A client requires hemodialysis.  2.  4.

Hypokalemia is one of the electrolyte shifts that occur during dialysis. and a hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity. Some antibiotics are removed by dialysis and should be administered .4/8/12 4.  Cardiac glycosides  Cardiac glycosides such as digoxin should be withheld before hemodialysis. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis.

4/8/12  During a routine examination.  slowing the glomerular filtration rate.   3.   2. .   4.  stimulating or hindering micturition.  decreasing potassium excretion. the nurse notes that the client seems unusually anxious.  increasing sodium resorption. Anxiety can affect the genitourinary system by: 1.

when anxiety leads to generalized muscle tension.  stimulating or hindering micturition. it may hinder urination because the perineal muscles must relax to complete micturition.  Anxiety 4/8/12 may stimulate or hinder micturition. However. Its most noticeable effect is to cause frequent voiding and urinary urgency. increase sodium resorption. . Anxiety doesn't slow the glomerular filtration rate. or decrease potassium excretion.4.

0   Absence of protein   Absence of glucose 1.4/8/12  The nurse is reviewing the report of a client's routine urinalysis.  2.  4.  3.  . Which value should the nurse consider abnormal? Specific gravity of 1.03   Urine pH of 3.

bilirubin. or crystals.  Urine pH of 3. ketones.035. white blood cells. glucose. Urine should be clear. 0 to 4 per high-power field.0 is abnormal. Normally. with color ranging from pale . bacteria.0    Normal urine pH is 4.002 to 1. therefore. making this client's value normal.5 to 8. Red blood cells should measure 0 to 3 per highpower field. Urine specific gravity normally ranges from 1. a urine pH of 3. casts.4/8/12 2. urine contains no protein.

  4. The nurse knows that this disorder increases the client's risk of: 1.  water and sodium retention secondary to a severe decrease in the glomerular filtration rate.   2.   3.  a decreased serum phosphate level secondary to kidney failure.4/8/12 A client is admitted for treatment of chronic renal failure (CRF).  metabolic alkalosis secondary to .  an increased serum calcium level secondary to kidney failure.

or fluid retention if the kidneys fail to produce urine.  water and sodium retention secondary to a severe decrease in the glomerular filtration rate. CRF may cause metabolic acidosis. not metabolic .   A 4/8/12 client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine. such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus.1.

The nurse knows that this disorder increases the client's risk of: 1.   4.   2.  metabolic alkalosis secondary to .  a decreased serum phosphate level secondary to kidney failure.  water and sodium retention secondary to a severe decrease in the glomerular filtration rate.   3.4/8/12 A client is admitted for treatment of chronic renal failure (CRF).  an increased serum calcium level secondary to kidney failure.

1. not metabolic .  water and sodium retention secondary to a severe decrease in the glomerular filtration rate. such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus.   A 4/8/12 client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine. or fluid retention if the kidneys fail to produce urine.

Which STDmust be reported to the public health department? 1.  Gonorrhea   3. the physician orders diagnostic testing of the vaginal discharge.  Chlamydia   2.4/8/12 A client comes to the outpatient department complaining of vaginal discharge. Suspecting a sexually transmitted disease (STD). dysuria. and genital irritation.  Genital herpes   .

4/8/12 2. genital herpes.  Gonorrhea  Gonorrhea must be reported to the public health department. . Chlamydia. and human papillomavirus infection aren't reportable diseases.

  .4/8/12  The physician prescribes norfloxacin (Noroxin).  2.   7 to 10 days. for a client with a urinary tract infection (UTI).  3.  4.   12 to 14 days. For an uncomplicated UTI. the usual duration of norfloxacin therapy is: 3 to 5 days.   10 to 21 days. The client asks the nurse how long to continue taking the drug. 1.

Only a client with a complicated UTI must take norfloxacin for 10 to 21 days. Taking it for more than 10 days isn't necessary.4/8/12 2. .  7 to 10 days.  For an uncomplicated UTI. Taking the drug for less than 7 days wouldn't eradicate such an infection. norfloxacin therapy usually lasts 7 to 10 days.

therefore.  The most common treatment is metronidazole (Flagyl). What information is appropriate to tell this client? 1. she should have a Papanicolaou (Pap) smear annually.  This condition puts her at a higher risk for cervical cancer.   2. which should eradicate the problem 4/8/12 .A female client has just been diagnosed with condylomata acuminata (genital warts).

she should have a Papanicolaou (Pap) smear annually. Yearly Pap smears are very important for early detection. a condom won't protect sexual partners. Because condylomata acuminata can occur on the vulva.  This condition puts her at a higher risk for cervical cancer. oropharynx. there is no permanent cure. HPV can be transmitted to other parts of the body. and .1. Because condylomata acuminata is a virus.  Women 4/8/12 with condylomata acuminata are at risk for cancer of the cervix and vulva. therefore. such as the mouth.

  A 63-year-old client with uncontrolled diabetes mellitus who .  A 35-year-old client who underwent surgery 12 hours ago and has a suprapubic catheter in place that is draining burgundy colored urine   2. The registered nurse and nursing assistant are caring for a group of clients. Which client's care can safely be delegated to the nursing assistant? 4/8/12 1.

the registered nurse should . The client in option 1 had surgery 12 hours ago. the registered nurse should care for the client because the client requires close assessment. In addition.  A 45-year-old client diagnosed with renal calculi who must ambulate four times daily and drink plenty of fluids.    The 4/8/12 care of the client in option 3 can safely be delegated to the nursing assistant. therefore.3. The client in option 2 also requires careful assessment by the registered nurse because the client's diabetes mellitus is uncontrolled.

  retain the enema for 30 minutes to allow for sodium exchange. afterward.  retain the enema for 30 minutes .2 mEq/L.Correct administration and the effects of this enema would include having the client: 4/8/12   1. the client should have diarrhea. The nurse is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 6.   2.

Thus.1.    Kayexalate 4/8/12 is a sodium-exchange resin. the client will gain sodium as potassium is lost in the bowel. which increases potassium loss and decreases the potential for Kayexalate retention.  retain the enema for 30 minutes to allow for sodium exchange. Kayexalate must be in contact with the bowel for at least 30 minutes. . For the exchange to occur. the client should have diarrhea. Sorbitol in the Kayexalate enema causes diarrhea. afterward.

4/8/12  The nurse is caring for a client with acute pyelonephritis. Which nursing intervention is most important? 1.  Encouraging the client to drink .  Using an indwelling urinary catheter to measure urine output accurately   4.  Increasing fluid intake to 3 L/day   3.  Administering a sitz bath twice per day   2.

  Increasing fluid intake to 3 L/day    Acute 4/8/12 pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both kidneys.2. and urologic surgery) or from hematogenic infection. cystoscopy. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. The most important nursing intervention is to . Pyelonephritis may result from procedures that involve the use of instruments (such as catheterization.

How can the nursebest 4/8/12 . the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last two consecutive hours. After undergoing retropubic prostatectomy. While assessing the client. The client also has an indwelling urinary catheter that is draining light pink urine. a client returns to his room. infusing in his right forearm at a rate of 100 ml/hour.V. The client is on nothingby-mouth status and has an I.

  It's an abnormal finding that requires further assessment.    The drop in urine output to less than 30 ml/hour is abnormal and requires further assessment. The client's nothing-bymouth status isn't the cause of the low urine output because the client is receiving I. The reduction in urine output may be caused by an obstruction in the urinary catheter tubing or deficient fluid volume from blood loss. Ambulation .4/8/12 3. fluid to compensate for the lack of oral intake.V.

" Which answer is correct? The glomerulus   Bowman's capsule   The nephron   The tubular system 1.4/8/12 A client with suspected renal insufficiency is scheduled for a comprehensive diagnostic workup.  3.  . After the nurse explains the diagnostic tests.  4. the client asks which part of the kidney"does the work.  2.

Bowman's capsule.4/8/12 3. The glomerulus. and tubular system are components of the nephron. .  The nephron    The nephron is the functioning unit of the kidney.

V. pole.  Evaluating patency of the . The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged I. Which important procedural step did the nurse fail to follow? 1. and leaves the room. adjusts the flow rate. She then attaches the tubing to the client's three-way urinary catheter.4/8/12  The client is prescribed continuous bladder irrigation at a rate of 60 gtt/minute.

1. the solution infuses into the bladder but isn't eliminated through the drainage tubing. a situation that may cause client injury. pump isn't necessary for .V. Using an I. however.  Evaluating patency of the drainage lumen    The 4/8/12 nurse should evaluate patency of the drainage tubing before leaving the client's room. the nurse would have had to address this issue immediately after hanging the 2 L bag. If the lumen is obstructed. Balancing the pole is important.

and seizures. The nurse monitors the client closely for dialysis equilibrium syndrome. a complication that is most common during the first few dialysis sessions. headache.  acute bone pain and confusion. dialysis equilibrium syndrome causes: 1.  confusion.4/8/12 A client with acute renal failure is undergoing dialysis for the first time.   . Typically.   2.

The resultant organ swelling interferes with normal physiological functions. and seizures.  confusion.    Dialysis 4/8/12 equilibrium syndrome causes confusion. To prevent this syndrome. and seizures. which may last several days. headache. many dialysis centers keep . probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood.1. headache. a decreasing level of consciousness. These findings.

  2.   3.  she will be expected to use a .4/8/12 A client who has cervical cancer is scheduled to undergo internal radiation. In teaching the client about the procedure.  she will be in a private room with unrestricted activities. the nurse would bemost accurate in telling the client: 1.  a bowel-cleansing procedure will precede radioactive implantation.

an indwelling catheter will be used. and activities will be restricted in order to keep the implants in place.    The client will receive an enema before the procedure because bowel motility during cervical radiation implant therapy can disrupt or dislodge the implants.  a bowel-cleansing procedure will precede radioactive implantation. The client will be in a private room.4/8/12 2. To keep the bladder empty. Positioning in bed shouldn't exceed a 20-degree elevation because sitting up can cause the .

Amental health practitioner should be involved in the client's care to: 4/8/12 1.  assess whether the client is a .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.

2. Mental health practitioners don't evaluate whether the client is a surgical candidate. The mental health practitioner can help with client cope these feelings of anxiety. places the client at risk .  help the client cope with the anxiety  Many 4/8/12 clients who undergo surgery for creation of an ileal conduit experience anxiety associated with changes in body image. None of the evidence suggests that urinary diversion surgery. such as creation of an ileal conduit.

" How should the nurseproceed? . "This is my business and I'm not telling anyone. Beside. chlamydia doesn't cause any harm like the other STDs. stating. The client refuses.4/8/12  The nurse is caring for a 25-yearold female client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform her sexual partners of the infection.

Option 4 is judgmental. Further education allows the client to make an informed decision about notifying sexual contacts.    The 4/8/12 nurse should educate the client about the disease and how it impacts a person's health.1.  Educate the client about why it's important to inform sexual contacts so they can receive treatment. everyone is entitled to . The nurse must maintain client confidentiality unless law mandates reporting the illness. contacting sexual contacts breeches client confidentiality.

a client should be mildly hypovolemic (fluid depleted) before excretory urography.  Cystic fibrosis   . Which history finding would call for the client to bewell hydrated instead? 1.4/8/12 A client with suspected renal dysfunction is scheduled for excretory urography. Normally. The nurse reviews the history for conditions that may warrant changes in client preparation.

  Multiple myeloma    Fluid depletion before excretory urography is contraindicated in clients with multiple myeloma. Cystic fibrosis. If these clients must undergo excretory urography.4/8/12 2. and uric acid nephropathy — conditions that can seriously compromise renal function in fluid-depleted clients with reduced renal perfusion. severe diabetes mellitus. and . gout. they should be well hydrated before the test.

  "The combination of these two .  "Because there are many resistant strains of gonorrhea. The client asks the nurse why he's receiving two antibiotics. more than one antibiotic may be required for successful treatment."   2. The nurse is caring for a male client with gonorrhea who's receiving ceftriaxone and doxycycline. Howshould the nurse respond? 4/8/12 1.

Because many people with gonorrhea have a coexisting chlamydial infection. doxycycline or azithromycin is prescribed as well. This combination of .  "Many people infected with gonorrhea are infected with chlamydia as well."    Treatment 4/8/12 for gonorrhea includes the antibiotic ceftriaxone.3. but that isn't the reason for this dual therapy. There has been an increase in the number of resistant strains of gonorrhea.

4/8/12 A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate.  intermittent inflow and continuous outflow of irrigation solution.  continuous inflow and outflow of irrigation solution.   . thefunctions of the three lumens include: 1.   2. In addition to balloon inflation.

1.  continuous inflow and outflow of irrigation solution. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution. . a triple-lumen indwelling urinary catheter is inserted.    When 4/8/12 preparing for continuous bladder irrigation.

4/8/12 A client is scheduled for a renal clearance test.   1 hour.  .  3.   24 hours. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in: 1 minute. 1.  4.   30 minutes.  2.

4/8/12 1. . It doesn't measure the kidneys' ability to remove a substance over a longer period.  1 minute.    The renal clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute.

  Pyuria   4.  Low white blood cell (WBC) count .4/8/12  Which laboratory value supports a diagnosis of pyelonephritis? 1.  Ketonuria   3.  Myoglobinuria   2.

as indicated in option 4. Ketonuria indicates a diabetic state. pyuria. the WBC count is more likely to be high rather than low. hematuria. chills. Because there is often a septic picture.4/8/12 3. .  Pyuria    Pyelonephritis is diagnosed by the presence of leukocytosis. and flank pain. The client exhibits fever. and bacteriuria.

the client states. After the meeting. What am I going to do?" Which health team member should the nurseconsult to help with the . dietician. client educator. surgeon. "My life won't ever be the same. and mental health worker meet with the client. Before surgery. social worker. enterostomal therapist. the health care team consisting of a nurse.4/8/12  The client is scheduled for urinary diversion surgery to treat bladder cancer.

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4.  Client educator
 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. The dietician can help with dietary concerns but can't provide help with direct concerns about the surgery.

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A

client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?

1.  Establishing a predetermined fluid intake pattern for the client   2.  Encouraging the client to increase the time between voidings   3.  Restricting fluid intake to reduce the need to void  

4.  Assessing present elimination patterns
 The

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guidelines for initiating bladder retraining include assessing the client's 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 actually be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

  always be the evening's last void as the last sample. .   3.  start with the first voiding.4/8/12 A client receiving total parental nutrition is prescribed a 24-hour urine test.   4.  always be with the first morning urine.   2. the collectiontime should: 1.  start after a known voiding. When initiating a 24hour urine specimen.

   When initiating a 24-hour urine specimen. . have the client void. The collection should start on an empty bladder. then start the timing. The exact time the test starts isn't important but it's commonly started in the morning.4/8/12 2.  start after a known voiding.

  pruritus.V.   paresthesia.4/8/12 A client develops acute renal failure (ARF) after receiving I. 1.  2. Because the client's 24hour urine output totals 240 ml.  3. therapy with a nephrotoxic antibiotic.  . the nurse suspects that the client is at risk for: cardiac arrhythmia.  4.   dehydration.

possibly triggering a cardiac arrhythmia. Dehydration doesn't occur during this oliguric phase of ARF. pruritus results from . although typically it does arise during the diuretic phase. if it rises sufficiently. Hyperkalemia doesn't cause paresthesia (sensations of numbness and tingling).    As urine output decreases. hyperkalemia may occur.4/8/12 1. the serum potassium level rises.  cardiac arrhythmia. In a client with ARF.

  4.  initiate a stream of urine.   3.  breathe deeply. .  hold the labia or shaft of the penis.  turn to the side.4/8/12  The 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: 1.   2.

4/8/12 2. Initiating a stream of urine isn't recommended during catheter insertion. .    When inserting a urinary catheter. Doing this will relax the urinary sphincter.  breathe deeply. Turning to the side or holding the labia or penis won't ease insertion. and doing so may contaminate the sterile field. facilitate insertion by asking the client to breathe deeply.

4/8/12 A client with a urinary tract infection is prescribed cotrimoxazole (trimethoprimsulfamethoxazole)."   3. The nurse should provide which medication instruction? 1.  "Drink at least eight 8-oz glasses of fluid daily.  "Take the medication with food."   .  "Avoid taking antacids during cotrimoxazole therapy."   2.

"  When 4/8/12 receiving a sulfonamide such as co-trimoxazole. Otherwise. No evidence indicates that antacids interfere with the effects of .2. the client should take this drug at least 1 hour before or 2 hours after meals. inadequate urine output may lead to crystalluria or tubular deposits.  "Drink at least eight 8-oz glasses of fluid daily. the client should drink at least eight 8-oz glasses of fluid daily to maintain a urine output of at least 1.500 ml/day. For maximum absorption.

  Place cool compresses on the calf.   2.   4. in which the left groin was accessed.   3.  Assess peripheral pulses in the left leg. the client complains of left calf pain.  Exercise the leg and foot. Which intervention should the nurse performfirst? 1. .4/8/12  After undergoing renal arteriogram.  Assess for anaphylaxis.

 The 4/8/12 nurse should begin by assessing peripheral pulses in the left leg to determine if blood flow was interrupted by the procedure. Calf pain isn't a symptom of anaphylaxis. The leg should remain straight after the procedure. . Cool compresses aren't used to relieve pain and inflammation in thrombophlebitis. The client may also have thrombophlebitis.  Assess peripheral pulses in the left leg.1.

  4.  2.4/8/12 A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl.   epoetin alfa (Epogen)   filgrastim (Neupogen)   enoxaparin (Lovenox) 1. The most therapeutic pharmacologic intervention would be to administer: ferrous sulfate (Feratab).  .  3.

(Normal Hb level is 13 to 18 g/dl in men and 12 to 16 g/dl in women. administering ferrous sulfate .) An effective pharmacologic treatment for this is epoetin alfa. Because the client's anemia is caused by a deficiency of erythropoietin and not a deficiency of iron. a recombinant erythropoietin.4/8/12 2.  epoetin alfa (Epogen)  Chronic renal failure diminishes the production of erythropoietin by the kidneys and leads to a subnormal Hb level.

  stress incontinence.  functional incontinence. or urine leakage before reaching the bathroom.4/8/12 A female client reports to the nurse that she experiences a loss of urine when she jogs. The nurse explains to the client that this type of problem is called: 1.   2.   . The nurse's assessment reveals no nocturia. discomfort when voiding.   3. burning.  reflex incontinence.

jumping.4/8/12 3. sneezing. Functional incontinence is the inability of a usually continent client to reach the toilet in time to avoid unintentional loss of urine. and bending.  stress incontinence. such as running. These symptoms occur only in the daytime.  Stress incontinence is a small loss of urine with activities that increase intraabdominal pressure. coughing. laughing. Reflex incontinence is an involuntary loss of urine at predictable .

  2.  green-tinged urine.  generalized edema.  polyuria. .   4.4/8/12 A client is admitted for treatment of glomerulonephritis.   3. Such signs include: 1. the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset.  moderate to severe hypotension. especially of the face and periorbital area. On initial assessment.

proteinuria.  generalized edema. fever. especially of the face and periorbital area. is a classic sign of acute glomerulonephritis of sudden onset. . Other classic signs and symptoms of this disorder include hematuria (not green-tinged urine). especially of the face and periorbital area.1. 4/8/12  Generalized edema. chills.

and use a salt substitute.4/8/12 A client who has been treated for chronic renal failure (CRF) is ready for discharge.  "Increase your carbohydrate intake."   2."   4.  "Eat plenty of bananas." ."   3. The nurse should reinforce which dietary instruction? 1.  "Drink plenty of fluids.  "Be sure to eat meat at every meal.

the client must limit intake of sodium. which are high in potassium. meat. Therefore. potassium."    Extra 4/8/12 carbohydrates are needed to prevent protein catabolism. unrestricted intake of sodium. because . bananas. and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products. In a client with CRF. and fluid. which is high in protein.  "Increase your carbohydrate intake.3. protein. such as amino acids and ammonia.

.  Change the client's position and repeat the examination.   4.  Notify the physician. What should the nurse do next? 1. the nurse finds a nodule.4/8/12  When performing a scrotal examination.  Transilluminate the scrotum.   3.   2.  Perform a rectal examination.

A scrotum filled with serous fluid transilluminates as a red glow. 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. swelling. a more solid lesion. A nurse who discovers a nodule.  Transilluminate the scrotum. doesn't transilluminate and may appear as a dark shadow. . such as a hematoma or mass.4/8/12 4.

Her symptoms include burning on urination and frequent. Another medication is prescribed to decrease the pain and frequency. Which is themost likely medication prescribed for the pain? .4/8/12 A 25-year-old female client seeks care for a possible infection. urgent voiding of small amounts of urine. She's placed on trimethoprimsulfamethoxazole (Bactrim) to treat possible infection.

  phenazopyridine (Pyridium)  Phenazopyridine may be prescribed in conjunction with an antibiotic for painful bladder infections to promote comfort. Because of its local anesthetic action on the urinary mucosa. they don't exert a direct effect on the urinary . phenazopyridine specifically relieves bladder pain. Nitrofurantoin is a urinary antiseptic with no analgesic properties.4/8/12 4. Although ibuprofen and acetaminophen with codeine are analgesics.

  "Take your temperature every 4 hours."   3. the nurse should provide which instruction? 1.  "Apply an antibacterial dressing to the incision daily." .  "Increase your fluid intake to 2 to 3 L per day. Before discharge."   4."   2.  "Be aware that your urine will be cherry-red for 5 to 7 days.4/8/12 A client undergoes extracorporeal shock wave lithotripsy.

Lithotripsy doesn't require an incision.2. Measuring temperature every 4 hours isn't needed. Hematuria may occur for a few hours after lithotripsy but should then disappear."  Increasing 4/8/12 fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. .  "Increase your fluid intake to 2 to 3 L per day.

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