156

GENITOURINARY SYSTEM

ACUTE POSTSTREPTOCCAL GLOMERULONEPHRITIS

K Problem
- Bilateral inflammation of the glomeruli that usually follows after a
streptococcal infection of the respiratory tract roles often after a skin
infection such as impetigo.
Manifestation
- Azotemia, Fatigue
- Oliguria, Edema
Causes
- Untreated pharyngitis
- Trapped antigen-antibody complexes in the glomerular capillary membranes
inducing inflammatory damage and impending glomerular function
Test Results
- Blood test shows elevated serum creatinine levels.
- 24-hour urine sample shows low creatinine clearance and impaired

E glomerular filtration.
- Urinalysis typically reveals proteinuria and hematuria. Red blood cells
(RBC’s), white blood cells, and mixed cells casts are common findings in
urinary sediment.
- Kidney-ureter-bladder (KUB) X-rays shows bilateral kidney enlargement
Treatment
- Bed rest
- Diuretics: metolazone (Zaroxolyn), furosemide (Lasix) to reduce extracellular
fluid overload
- Antihypertensive: hydralazine
- Fluid restriction
- High-calorie, low-sodium, low-potassium, low-protein diet
Intervention
- Check vital signs and electrolyte values.

Y
- Monitor intake and output and daily weight. Assess renal function daily
through serum creatinine and blood urea nitrogen (BUN) levels and urine
creatinine clearance.
- Watch for signs of acute renal failure (oliguria, azotemia, and acidosis).
- Provide good nutrition, use good hygienic technique, and prevent contact
with infected people.

ACUTE RENAL FAILURE

SPICING UP ON KEY CONCEPT

 157

Problem

K - Sudden interruption of renal function resulting from obstruction, poor

circulation or kidney disease
Manifestation
- Urine output less than 400 ml/day for 1 to 2 weeks followed by diuresis (3 to
5 L/day ) for 2 to 3 weeks
- Weight gain
Causes
- AGN, Burns
- Acute tubular necrosis
- BPH, anaphylaxis
Test Results

E -
-
Creatinine clearance estimates the number of functioning nephrons.
Glomerular filtration rate is 2O to 40 ml/minute (renal insufficiency); 10 to
20 ml/minute (renal failure); less than 10 ml/minute (end-stage renal
disease).

Treatment
- Continuous arteriovenous hemofiltration
- Low-protein, increased-carbohydrate, moderate fat, and moderate-calorie diet
with potassium, sodium, and phosphorus intake regulated according to
serum levels
- Peritoneal dialysis or hemodialysis

Y - Beta-adrenergic blocker: dopamine (Intropin) initially to improve renal

perfusion
- Diuretics: furosemide (Lasix), metolazone (Zaroxolyn)
Intervention
- Assess fluid balance, respiratory, cardiovascular, and neurologic status.
- Monitor and record vital signs and intake and output, central venous
pressure, daily weight, urine specific gravity, and laboratory studies.
- Monitor for arrhythmias.
- Maintain the patient's
BENIGN PROSTATIC HYPERPLASIA

SPICING UP ON KEY CONCEPT

 158

Problem

K - Enlarge prostate gland just enough to compress the urethra causing urinary

obstruction

Manifestation

- Decreased force and amount of urine

- Urgency, frequency, and burning on urination

Causes

- Aging

- Changes in male sex hormone

- Family history of prostate problem

E Test Results

- Cystoscopy shows enlarged prostate gland, obstructed urine flow, and

urinary stasis.

- Rectal examination shows enlarged prostate gland.

Treatment

- Forcing fluids

- Transurethral resection of the prostate (TURP) or prostatectomy

Y Intervention

 Force fluids.

REVIEW QUESTIONS

SPICING UP ON KEY CONCEPT

 159

1. A client with suspected urinary problem is scheduled for intravenous

pyelogram. The nurse should explain that on the day before the IVP, the client
must:
a. Avoid fats and proteins
b. Drinks a large amount of fluids
c. Omit dinner and limit beverages
d. Take a laxative before going to bed
2. To facilitate micturition in a male client, the nurse should instruct him to:
a. Use urinal for voiding
b. Drink cranberry juice daily
c. Wash his hands after voiding
d. Assume the standing position for voiding
3. A 45 year old client develops acute glomerulonephritis following streptococcal
infection. When performing the health assessment the nurse would expect the
client to report a history of:
a. Nocturia
b. Mild headache
c. Recent weight loss
d. An increased in appetite
4. To prevent future attack of AGN the nurse planning discharge teaching should
include instruction for the client to:
a. Take shower instead of bubble baths
b. Avoid situations that involve physical activity
c. Continue the same restriction on fluid intake
d. Seek early treatment for respiratory infections
5. The nurse is aware that the most serious complication for a client with acute
renal failure is:
a. Anemia
b. Infection
c. Weight loss
d. Platelet dysfunction
6. The nurse notes that the latest potassium level of a client with renal failure is
6.2 mEq. The first action by the nurse should be to:
a. Alert the cardiac arrest team
b. Call the laboratory to repeat the test
c. Take vital signs and notify the physician
d. Obtain an ECG strip and have lidocaine available at bedside
7. During peritoneal dialysis for a client who had just started the procedure, the
nurse should inform the client that if drainage of dialysate from the peritoneum
stops before the required amount has drain out the client should:
a. Drink 8 oz of water
b. Turn from side to side
c. Deep breath and cough
d. Periodically rotate and reposition the catheter
8. During dialysis, the nurse was ask by the client what substances are being are
being remove by the dialysis. The nurse identifies that one of the substances
passing through the membrane would be:
a. RBC c. Sodium
b. Glucose d. Bacteria

SPICING UP ON KEY CONCEPT

 160

CRITICAL THINKING
1. Explain how does renal failure affects the following:
a. Fluids and electrolyte balance (5 pts)
b. Normal excretion of the urine (5 pts)

2. What is the reason behind the appearance of edema and Azotemia in acute
glomerulonephritis?

BLADDER CANCER
Problem

K
- Cells in the bladder begins to grow abnormally and begins to mutate leading

to a growth that is out control until these abnormal cells form a tumor.

Manifestation

- Frequency of urination

- Painless hematuria

- Urgency of urination

Causes

- Smoking

- Exposure to chemicals

E - Past exposure to radiation

- Chronic irritation of the lining of the bladder

Test Results

- Cystoscopy reveals a mass.

Treatment

- Surgery, depending on the location and progress of the tumor

Intervention

- Provide postoperative care. (Closely monitor urine output; observe for

Y hematuria [reddish tint to gross bloodiness] or infection [cloudy, foul

SPICING UP ON KEY CONCEPT

 161

smelling, with sediment]; maintain continuous bladder irrigation, if indicated;

assist with turning, coughing, and deep breathing.)

- Force fluids.

BREAST CANCER
Problem

K - Breast cells grow abnormally beginning in the milk producing ducts

spreading to the lymph nodes and other parts of the body including the lungs
and bones.
Manifestation
- Cervical supraclavicular, or axillary lymph node lump or enlargement on
palpation
- Painless lump or on mass in the breast or thickening of breast tissue
- Skin changes
Causes
- Increase age, Family history of breast cancer
- Radiation exposure, Obesity

E
Test Results
- Breast self-examination reveals a lump or mass in the breast thickening of
breast tissue.
- Fine-needle aspiration and excisional biopsy provide histologic cells confirm
diagnosis.
- Mammography detects a tumor.
Treatment
- Bone marrow and peripheral stem cell therapy for advanced breast cancer
- Surgery: lumpectomy, skin-sparing mastectomy, partial mastectomy, total
mastectomy
- Chemotherapy: cyclophosphamide (Cytoxan), methotrexate (Folex),

Y
fluorouracil (Adrucil)
- Hormonal therapy: tamoxifen (Nolvadex), toremifene (Fareston),
aminoglutethimide (Cytadren), diethylstilbestrol, megestrol (Megace)
Intervention

SPICING UP ON KEY CONCEPT

 162

- Assess the patient’s feelings about her illness, and determine what she
knows about breast cancer and her expectations.
- Provide routine postoperative care.
- Perform comfort measures.
- Watch for treatment-related complications, such as nausea, vomiting,
anorexia, leukopenia, thrombocytopenia, GI ulceration, and bleeding.
CERVICAL CANCER
Problem

K - A slow growing cancer in the cervical tissue commonly related to various

strains of human papillomavirus (HPV).
Manifestation
- Pre-invasive: absence of symptoms
- Invasive: abnormal vaginal discharge (yellowish, blood-tinged, and foul-
smelling); post-coital pain and bleeding
Causes
- HPV virus
- Long term birth control use
- Early engagement in sexual contact
- Multiple sexual partners

E
Test Results
- Colposcopy determines the source of the abnormal cells seen on
Papanicolaou test.

Treatment
- Pre-invasive: conization, cryosurgery
- Invasive: radiation therapy (internal, external, or both); radical hysterectomy

Intervention
- Encourage the patient to use relaxation techniques.
- When assisting with a biopsy, drape and prepare the patient as for a routine

Y
pelvic examination. Have a container of formaldehyde ready. Assist the doctor
as needed, and provide support for the patient throughout the procedure.

SPICING UP ON KEY CONCEPT

 163

- If assisting with laser therapy drape and prepare the patient as for a routine
pelvic examination. Assist the doctor as needed and provide support to the
patient.
- Watch for complications related to therapy.

REVIEW QUESTIONS

1. A female who has recurrent urinary tract infection is inquiring about the
prevention of future UTI’s. What information should the nurse include when
teaching the client?
a. Avoid fluid intake after 6 PM
b. Drink 8-10 glasses of water each day
c. Increased the daily intake of carbonated drinks
d. Clean the perineal area with astringent soap twice a day
2. A client with bladder cancer has a prescription of cholinergic medication. The
nurse is aware that this type of medication is prescribe to prevent:
a. Kidney stones
b. Flaccid bladder
c. Spastic bladder
d. Urinary tract infection
3. Which of the following signs and symptoms is not related to cervical cancer?
a. Abnormal bleeding
b. Less frequent urination
c. Painful urination
d. Unusual consistency and color of vaginal discharge
4. A male client is being assessed for cancer of the urinary bladder. Of the
following signs and symptoms, the one significant of cancer of the urinary
tract is:
a. Dysuria
b. Retention
c. Hesitancy
d. Hematuria
5. Which of the following assessment is not a common findings in a female
client suspected of breast cancer?
a. Palpation of lump at the upper outer quadrant of the breast
b. Dimpled skin of breast
c. Symmetry of the breast
d. Nipple discharge and retraction
6. A female client with breast cancer will have to undergo radical mastectomy.
The knows that this procedure involves:
a. Removal of lump and surrounding breast tissue
b. Removal of breast only
c. Removal breast muscle layer down to the chest wall and axillary lymph
nodes

SPICING UP ON KEY CONCEPT

 164

d. Removal of both breast tissue and the surrounding layer

7. Which of the following is considered as the most common neoplasm in
women?
a. Cancer of the ovary
b. Breast cancer
c. Cancer of the uterus
d. Cancer of the cervix

CHLAMYDIA
Problem
- Sexually transmitted disease cause by chlamydia trachomatis commonly

K affecting the cervix, urethra, rectum or throat.

Manifestation
In women
- Dyspareunia
- Mucopurulent discharge
- Pelvic pain
In men
- Dysuria
- Erythema
- Tenderness of the meatus
- Urethral discharge

E -
Causes
Urinary frequency

- Chlamydia trachomatis
Test Results
- Antigen detection methods, including enzyme-linked immunosorbent assay
and direct fluorescent antibody test, are the diagnostic tests of choice for
identifying chlamydial infection, although tissue cell cultures are more
sensitive and specific.
-
Treatment
- Antibiotics: doxycycline (Vibramycin), azithromycin (Zithromax)

Y
SPICING UP ON KEY CONCEPT
 165

- For pregnant women with chlamydial infections, azithromycin in a single 1-

gdose
Intervention
- Practice standard precautions when caring for a patient with a chlamydial
infection.
- Make sure that the patient fully understands the dosage requirements of any
prescribed medications for this infection.
- Check newborns of infected mothers for signs of chlamydial infection.
- Obtain appropriate specimens for diagnostic testing.

CHRONIC GLOMERULONEPHRITIS

Problem

K - Long term inflammation and scarring of the glomeruli

Manifestation
- Edema
- Hematuria
- Hypertension

Causes
- Acute and chronic kidney disease
- Chronic UTI
- CHF and Pulmonary edema
Test results

E
- Kidney biopsy identifies the underlying disease and provides data needed to
guide therapy.
- Blood studies reveal rising BUN and serum creatinine levels which indicate
advanced renal insufficiency
- Urinalysis reveals proteinuria, hematuria, cylindruria, and RBC casts.
Treatments
- Dialysis
- Kidney transplant
Intervention

SPICING UP ON KEY CONCEPT

Y
 166

- Understand that patient care is primarily supportive, focusing on continual

observation and sound patient teaching.
- Accurately monitor vital signs, intake and output, and daily weight.
- Observe for signs of fluid, electrolytes, and acid-base imbalances.
- Administer medications.
- Provide good skin care.

CHRONIC RENAL FAILURE

Problem

K
- Progressive, irreversible destruction of the kidneys leading to loss of renal
function.
Manifestation
- Azotemia
- Decreased urine output
- Heart failure
- Lethargy
- Pruritus
- Weight gain
Causes
- Diabetes mellitus
- Hypertension
- Nephrotoxins
- Recurrent UTI
Test results

E - Blood chemistry shows increased BUN, creatinine, phosphorus and lipid

levels and decreased calcium, carbon dioxide, and albumin levels.

Treatment
- Limited fluids
- Low-protein, low-sodium, low-potassium, low-phosphorus; high-calorie, and
high-carbohydrate diet
- Peritoneal dialysis and hemodialysis
- Antacids: aluminum hydroxide gel (AlternaGEL)
- Antiemetic: prochlorperazine (Compazine)
- Calcium supplement calcium carbonate (Os-Cal)

SPICING UP ON KEY CONCEPT

Y
 167

- Cation exchange resin: sodium polystyrene sulfonate (Kayexalate)

- Diuretic: furosemide (Lasix)
Intervention
- Assess renal, respiratory, and cardiovascular status and fluid balance.
- Assess dialysis access for bruit and thrill.
- Maintain standard precautions.
- Restrict fluids.
-

REVIEW QUESTIONS

1. The nurse is caring for the client diagnosed with chronic kidney disease
(CKD) who is experiencing metabolic acidosis. Which statement best
describes the scientific rationale for metabolic acidosis in this client?
a. There is an increased excretion of phosphates and organic acids, which
leads to an increase in arterial blood ph
b. A shortened life span of red blood cells because of damage secondary to
dialysis treatments in turn leads to metabolic acidosis.
c. The kidney cannot excrete increased levels of acid because they cannot
excrete ammonia or cannot reabsorb sodium bicarbonate.
d. An increase in nausea and vomiting causes a loss of hydrochloric acid
and the respiratory system cannot compensate adequately.
2. The nurse in the dialysis center is initiating the morning dialysis run. Which
client should the nurse assess first?
a. The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%.
b. The client who does not have a palpable thrill or auscultated bruit.
c. The client who is complaining of being exhausted and is sleeping.
d. The client who did not take antihypertensive medication this morning.
3. The male client diagnosed with CKD has received the initial dose of
erythropoietin, a biologic response modifier, 1 week ago. Which complaint by
the client indicates the need to notify the health-care provider?
a. The client complains of flu-like symptoms.
b. The client complains of being tired all the time.
c. The client reports an elevation in his blood pressure.
d. The client reports discomfort in his legs and back.
4. The nurse is developing a nursing care plan for the client diagnosed with
CKD. Which nursing problem is priority for the client?
a. Low self-esteem.
b. 2. Knowledge deficit.
c. 3. Activity intolerance.
d. 4. Excess fluid volume.

SPICING UP ON KEY CONCEPT

 168

5. The client receiving dialysis is complaining of being dizzy and light-headed.

Which action should the nurse implement first?
a. Place the client in the Trendelenburg position.
b. Turn off the dialysis machine immediately.
c. Bolus the client with 500 mL of normal saline.
d. Notify the health-care provider as soon as possible.
6. The nurse caring for a client diagnosed with CKD writes a client problem of
“noncompliance with dietary restrictions.” Which intervention should be
included in the plan of care?
a. Teach the client the proper diet to eat while undergoing dialysis.
b. Refer the client and significant other to the dietician.
c. Explain the importance of eating the proper foods.
d. Determine the reason for the client not adhering to the diet.
7. The female client in an outpatient clinic is being sent home with a diagnosis
of urinary tract infection (UTI). Which instruction should the nurse teach to
prevent a recurrence of a UTI?
a. Clean the perineum from back to front after a bowel movement.
b. Take warm tub baths instead of hot showers daily.
c. Void immediately preceding sexual intercourse.
d. Avoid coffee, tea, colas, and alcoholic beverages.
8. The nurse is caring for a pregnant client diagnosed with acute
pyelonephritis. Which scientific rationale supports the client being
hospitalized for this condition?
a. The client must be treated aggressively to prevent maternal/fetal
complications.
b. The nurse can force the client to drink fluids and avoid nausea and
vomiting.
c. The client will be dehydrated and there won’t be sufficient blood flow to
the baby.
d. Pregnant clients historically are afraid to take the antibiotics as ordered.
9. The nurse is discharging a client with a health-care facility acquired urinary
tract infection. Which information should the nurse include in the discharge
teaching?
a. Limit fluid intake so the urinary tract can heal.
b. Collect a routine urine specimen for culture.
c. Take all the antibiotics as prescribed.
d. Tell the client to void every five (5) to six (6) hours.
10.The nurse is preparing a plan of care for the client diagnosed with acute
glomerulonephritis. Which statement is an appropriate long-term goal?
a. The client will have a blood pressure within normal limits.
b. The client will show no protein in the urine.
c. The client will maintain normal renal function.
d. The client will have clear lung sounds.
11.The elderly client is diagnosed with chronic glomerulonephritis. Which
laboratory value indicates to the nurse the condition has become worse?
a. The blood urea nitrogen is 15 mg/dL.
b. The creatinine level is 1.2 mg/dL.
c. The glomerular filtration rate is 40 mL/min.
d. The 24-hour creatinine clearance is 100 mL/min.

SPICING UP ON KEY CONCEPT

 169

CRITICAL THINGKING

1. Discuss the difference between acute renal failure and chronic renal failure
including its management. (10 pts)

CYSTITIS
Problem

K - Urinary bladder inflammation usually doesn’t extend to the bladder mucosa

Manifestation
- Dark, odoriferous urine
- Frequency of urination
- Urgency of urination
Causes
- Stagnation of urine in the bladder
- Obstruction of the urethra
- Kidney infection
- Incorrect perineal care
Test results

E
- Urine culture and sensitivity positively identifies organisms
- (Esherichia coli, Proteus vulgaris, and Streptocossus faecalis).
Treatment
- Diet increased intake of fluids and vitamin C

Intervention
- Assess renal status.
- Force fluids (cranberry or orange juice) to 3 qt (3 L)/day.
- Instruct the patient to decrease his intake of carbonated beverages and to
avoid coffee, tea, and alcohol.

Y
SPICING UP ON KEY CONCEPT
 170

GONORRHEA
Problem

K - Infection of the GUT especially the urethra and the cervix, and occasionally
the rectum, pharynx and the eyes
Manifestation
- Dysuria (painful urination)
- Purulent urethral or cervical discharge
- Itching, burning, and pain
Causes
- Exposure to Neisseria via blood and body fluid or through sexual contact
Test Results
- A culture from the site of infection (urethra, cervix, rectum, or pharynx),
grown on a Thayer-Martin or Transgrow medium, usually establishes the

E diagnosis by isolating the organisms.

Treatment
- Antibiotics: ceftriaxone (Rocephin), doxycycline (Vibramycin), erythromycin
(E-mycin)
- Prophylactic antibiotics: 1% silver nitrate or erythromycin (EryPed) eye drops
to prevent infection in neonates
Intervention
- Before treatment, establish whether the patient has any drug sensitivities,
and watch closely for adverse effects during therapy.
- Practice standard precautions.
- Routinely instill two drops of 1% silver nitrate or erythromycin in the eyes of

Y all neonates immediately after birth. Check neonate of infected mothers for
signs of infection. Take specimens for culture from the infant’s eyes, pharynx,
and rectum.

SPICING UP ON KEY CONCEPT

 171

HERPES SIMPLEX
Problem

K
- Recurrent viral infection cause by
Herpes Virus type 1: transmitted by oral and respiratory infection affecting
skin and mucus membrane
Herpes virus type 2: primarily affects the genital area and is transmitted via
sexual contact
Manifestation
- Blisters, which may form on any part of the mouth ' Dysuria (in genital
herpes)
- Erythema
- Flulike symptoms
- Skin lesions

E
Causes
- Exposure to the virus through sexual contact
- Contact with herpes virus through oral or respiratory infection
Test Results
- Confirmation requires isolation of the virus from local lesions and a histologic
biopsy.

Treatment
- Antiviral agents: idoxuridine (Herplex Liqufilm), trifluridine (Viprotic), and
vidarabine (Vtra-A)
- 5% acyclovir (Zovirax) ointment (possible relief to patients with genital herpes
or to immunosuppressed patients with Herpes-virus hominis skin infections;

Y I.V. acyclovir to help treat more severe infections)

Intervention
- Observe standard precautions. For patients with extensive cutaneous, oral,
or genital lesions, institute contact precautions.
- Administer pain medications and prescribed antiviral agents as ordered.
- Provide supportive care, as indicated, such as oral hygiene nutritional
supplementation, and antipyretics for fever.

SPICING UP ON KEY CONCEPT

 172

NEUROGENIC BLADDER
Problem

K - All types of bladder dysfunction cause by interruption of normal bladder

innervation
Manifestation
- Altered micturition
Causes
- Cerebral disorder
- Disorder of peripheral innervation
- Spinal cord disease or trauma
- Vascular diseases such as atherosclerosis
Test Results
- Voiding cystourethrography evaluates bladder neck function, vesicoureteral

E reflux, and commence.

Treatment
- Indwelling urinary catheter insertion (including teaching the patient seIf-
catheterization techniques)

Intervention
- Use strict aseptic technique during insertion of an indwelling urinary
catheter (a temporary measure to drain the incontinent patient’s bladder).
Don't interrupt the closed drainage system for any reason.
- Clean the catheter insertion site with soap and water at least twice a day.
- Clamp the tubing, or empty the catheter bag before transferring the patient

Y -
to a wheelchair or stretcher.
Watch for signs of infection (fever, cloudy or foul-smelling urine.

SPICING UP ON KEY CONCEPT

 173

OVARIAN CANCER
Problem

K - Uncontrolled proliferation of malignant cells in the ovary that commonly

occurs as metastatic cancer from the breast
Manifestation
- Abdominal distention
- Pelvic discomfort
- Urinary frequency
- Weight loss
Causes
- Menopausal age
- Infertility
- Family history of breast or uterine cancer

E Test Results
- Abdominal ultrasonography, computed tomography, or X-ray may delineate
tumor size.
Treatment
- Resection of the involved ovary
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy with
tumor resection, and appendectomy
- Antineoplastics: ciplastin (Platinol), paclitaxel (Taxol), topotecan (Hycamtin)
- Analgesics: morphine, fentanyl (Duragesic-25)
Intervention

Y
Before surgery

- Thoroughly explain all preoperative tests, the expected course of treatment,

and surgical and postoperative procedures.
After surgery
- Monitor vital signs frequently.
- Monitor intake and output while maintaining good catheter care.
- Check the dressing regularly for excessive drainage or bleeding, and watch
for signs of infection.
- Encourage coughing and deep breathing.
- Reposition the patient often and encourage her to walk shortly after surger

SPICING UP ON KEY CONCEPT

 174

PROSTATE CANCER
Problem

K - Malignant tumor of the prostate gland that can obstruct urine flow when
advance gradually to the neck of the bladder,
Manifestation
- Decreased size and force of urinary stream
- Difficulty and frequency of urination
- Urine retention
Causes
- No known etiology
Test results
- Carcinoembryonic antigen is elevated.
- Digital rectal examination reveals palpable firm nodule in gland or diffuse

E -
induration in posterior lobe.
Prostatic-specific antigen is increased.

Treatment
- Radiation implant
- Radical prostatectomy (for localized tumors without metastasis) or TURP (to
relieve obstruction in metastatic disease)
- Luteinizing hormone-releasing hormone agonists: goserelin acetate (Zoladex)
and leuprolide acetate (Lupron)
- Estrogen therapy diethylstilbestrol
- Key interventions

Y Intervention
- Assess renal and fluid status.
- Monitor for signs of infection.
- Assess pain and note the effectiveness of analgesia.
- Maintain the patient’s diet.
- Maintain the patency of the urinary catheter and note drainage.

SPICING UP ON KEY CONCEPT

 175

REVIEW QUESTIONS
1. Which data support to the nurse the client’s diagnosis of acute bacterial
prostatitis?
a. Terminal dribbling.
b. Urinary frequency.
c. Stress incontinence.
d. Sudden fever and chills.
2. Which nursing diagnosis is priority for the client who has undergone a
TURP?
a. Potential for sexual dysfunction.
b. Potential for an altered body image.
c. Potential for chronic infection.
d. Potential for hemorrhage.
3. The client who is postoperative TURP asks the nurse, “When will I know if I
will be able to have sex after my TURP?” Which response is most appropriate
by the nurse?
a. “You seem anxious about your surgery.”
b. “Tell me about your fears of impotency.”
c. “Potency can return in six (6) to eight (8) weeks.”
d. “Did you ask your doctor about your concern?”
4. The client asks, “What does an elevated PSA test mean?” On which scientific
rationale should the nurse base the response?
a. An elevated PSA can result from several different causes.
b. An elevated PSA can be only from prostate cancer.
c. An elevated PSA can be diagnostic for testicular cancer.
d. An elevated PSA is the only test used to diagnose BPH.
5. The client with a TURP who has a continuous irrigation catheter complains of
the need to urinate. Which intervention should the nurse implement first?
a. Call the surgeon to inform the HCP of the client’s complaint.
b. Administer the client a narcotic medication for pain.
c. Explain to the client this sensation happens frequently.
d. Assess the continuous irrigation catheter for patency.
6. Which modifiable risk factor should the nurse identify for the development of
cancer of the bladder in a client?
a. Previous exposure to chemicals.
b. Pelvic radiation therapy.
c. Cigarette smoking.
d. Parasitic infections of the bladder.
7. The client diagnosed with cancer of the bladder is scheduled to have a
cutaneous urinary diversion procedure. Which preoperative teaching
intervention specific to the procedure should be included?
a. Demonstrate turn, cough, and deep breathing.
b. Explain a bag will drain the urine from now on.
c. Instruct the client on the use of a PCA pump.
d. Take the client to the ICU so the client can become familiar with it.

SPICING UP ON KEY CONCEPT

 176

RENAL CALCULI/KIDNEY STONE

Problem

K - Formation of a crystalline substances in the kidney that vary in size causing

great pain and may sometimes lodge in the ureter
Manifestation
- Flank pain
Causes
- Hypercalcemia
- Gout
- Urinary stasis
- Urinary tract obstruction
Test Results
- Excretory urography reveals stones.

E - KUB X-rays reveal stones.

Treatment
- Diet for calcium stones, acid-ash with limited intake of calcium and milk
products; for oxalate stones, alkaline-ash with limited intake of foods high in
oxalate (cola, tea); for uric acid stones, alkaline-ash with limited intake of
foods high in purine
- Extracorporeal shock wave lithotripsy
- Surgery to remove the stone if other measures aren't effective (type of surgery
dependent on location of the stone)
Intervention

Y - Monitor the patient’s urine for evidence of renal calculi. Strain all urine and
save all solid material for analysis.
- Force fluids to 3 qt (3 L)/day
- If surgery was performed, check dressings regularly for bloody drainage and
report excessive amounts of bloody drainage to the doctor, use sterile
technique to change the dressing; maintain nephrostomy tube or indwelling
urinary catheter if indicated; and monitor the incision site for signs of
infection.

SPICING UP ON KEY CONCEPT

 177

SYPHILIS
Problem

K - Chronic STD that begins in the mucus membrane and quickly becomes
systemic spreading to nearby lymph nodes and the blood stream
Manifestation

Primary syphilis

- Chancres on the genitalia, anus, ting tonsils. or eyelids

Secondary syphilis

- Symmetrical mucocutaneous lesions

- Malaise
- Anorexia
- Weight loss
- Slight fever
Causes

E
- Exposure to spirochete “treponema pallidum” through sexual contact
- Transplacental transmission

Test Results
- Fluorescent treponemal antibody-absorption test identifies antigens of T.
pallidum in tissue, ocular fluid, cerebrospinal tracheobronchial secretions,
and exudates from lesions. This is the most sensitive test available for
detecting syphilis in all stages. Once reactive, it remains so permanently.
- Venereal Disease Research Laboratory (VDRL) slide test and rapid plasma
reagin test detect nonspecific antibodies. Both tests, if positive, become
reactive within 1 to 2 weeks after the primary lesion appears or 4 to 5 weeks
after the infection begins.
Treatment
- Antibiotic: penicillin G benzathine (Permapen); if allergic to. penicillin,
erythromycin (Erythrocin) or tetracycline (Panmycin)

Y Intervention

- Check for a history of drug sensitivity before administering the first dose of
penicillin.
- Urge the patient to seek VDRL testing after 3,6,12 and 24 months. A patients
treated for latent or late syphilis should receive blood tests at 6-month
intervals for 2 years.

SPICING UP ON KEY CONCEPT

 178

TESTICULAR CANCER
Problem

K - Malignant testicular tumor affecting young to middle age men

Manifestation
- Firm, painless, smooth testicular mass, varying in size and sometimes
producing a sense of testicular heaviness
- In advanced stages
- Ureteral obstruction
- Abdominal mass
- Weight loss
- Fatigue
- Pallor

Causes/ contributing factors

- Men between 20 and 40 years old
- Men with cryptorchidism

E
Test Results
- Regular self-examinations and testicular palpation during a routine physical
examination may detect testicular tumors.

Treatment
- Surgery: orchietomy (testicle removal; most surgeons remove the testicle but
not the scrotum to allow for a prosthetic implant)
- High-calorie diet provided in small frequent feedings
- I.V. fluid therapy
- Antineoplastics: bleomycin (Blenoxane), carboplatin (Paraplatin), cisplatin
(Platinol), dectinomycin (Cosmegen), etoposide (VePesid), ifosfamide (Iflex),
plicamycine (Mithracin), vinblastine (Velban)
- Analgesics: morphine, fentanyl (Duragesic-25)
- Antiemetics: thrimethobenzamide (Tigan), metoclopramide (Reglan),
ondansetron (Zofran)

Y Intervention
- Develop a treatment plan that addresses the patient’s psychological and
physical needs.
After orchiectomy
- For the first day after surgery, apply an ice pack to the scrotum and provide
analgesics.
- Check for excessive bleeding, swelling, and signs of infection.
- Give anti-emetics, as needed.
- Encourage small, frequent meals.
- Watch for signs of myelosuppression.

SPICING UP ON KEY CONCEPT

 179

REVIEW QUESTIONS

1. The laboratory data reveal a calcium phosphate renal stone for a client
diagnosed with renal calculi. Which discharge teaching intervention should the
nurse implement?
a. Encourage the client to eat a low-purine diet and limit foods such as organ
meats.
b. Explain the importance of not drinking water two (2) hours before bedtime.
c. Discuss the importance of limiting vitamin D–enriched foods.
d. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).
2. The client diagnosed with renal calculi is admitted to the medical unit. Which
intervention should the nurse implement first?
a. Monitor the client’s urinary output.
b. Assess the client’s pain and rule out complications.
c. Increase the client’s oral fluid intake.
d. Use a safety gait belt when ambulating the client.
3. The client with possible renal calculi is scheduled for a renal ultrasound.
Which intervention should the nurse implement for this procedure?
a. Ask if the client is allergic to shellfish or iodine.
b. Keep the client NPO eight (8) hours prior to the ultrasound.
c. Ensure the client has a signed informed consent form.
d. Explain the test is non-invasive and there is no discomfort.
4. Which clinical manifestations should the nurse expect to assess for the client
diagnosed with a ureteral renal stone?
a. Dull, aching flank pain and microscopic hematuria.
b. Nausea; vomiting; pallor; and cool, clammy skin.
c. Gross hematuria and dull suprapubic pain with voiding.
d. The client will be asymptomatic.
5. Which of the following symptom is consistent of primary syphilis?
a. A painless genital ulcer that appears about 3 weeks after unprotected sex
b. Copper colored macules ton the palms that appear
c. Patchy hair loss in red and broken skin involving the scalp
d. One or more flat wart-like papules
6. A 70 year old male client is diagnosed with secondary syphilis. Which finding
should the nurse expect during assessment?
a. Chronic bone and joint irritation
b. Tender lymphadenopathy
c. Generalized rash on the palms and soles
d. Personality changes and mental confusion
7. Which of the following statement shows the significance elevation in alpha-
fetoprotein level after orchiectomy for testicular cancer?
a. Fertility is maintained
b. The cancer has recurred
c. There is metastatic disease

SPICING UP ON KEY CONCEPT

 180

d. Testosterone levels are low

8. To maintain adequate glomerular filtration, it’s most important for a client to
have adequate:
a. Serum albumin and stroke volume.
b. Oncotic pressure and systemic vascular resistance
c. Intravascular volume and cardiac output.
d. Hydrostatic pressure and fluid intake.
9. A client with a fever and urinary urgency is asked to provide a urine specimen
for culture and sensitivity. The nurse should instruct the client to collect the
specimen from the:
a. First stream of urine from the bladder.
b. Middle stream of urine from the bladder.
c. Final stream of urine from the bladder.
d. Full volume of urine from the bladder.
10.A client is diagnosed with cystitis. The nurse recommends the client drink
cranberry juice. What assessment parameter should the nurse consider to
determine if this recommendation has been effective?
a. Urine specific gravity
b. White cell count
c. pH
d. Protein
11.A client with dysuria is prescribed phenazopyridine (Pyridium). The nurse
should teach the client to expect urine to be:
a. Greater in volume.
b. Orange in color.
c. Pungent in odor.
d. Concentrated in consistency.
12.A client is scheduled for extracorporeal shock wave lithotripsy (ESWL). In
teaching the client about ESWL, the nurse should inform the client that the
stones will be:
a. Dissolved.
b. Shattered.
c. Radiated.
d. Suctioned
13.A client with acute renal failure is being assessed to determine if the cause is
prerenal, renal, or postrenal. If the cause if prerenal which condition most
likely caused it?
a. Heart failure
b. Glomerular nephritis
c. Ureterolithiasis
d. Aminoglycoside toxicity

SPICING UP ON KEY CONCEPT

 181

CRITICAL THINKING

1. Explain how urinary calculi occurs. (5pts)

2. Discuss the most important management of sexually transmitted disease in
adults. (5 pts)

SPICING UP ON KEY CONCEPT