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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.

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

1. Total urinary incontinence 2. Functional urinary incontinence 3. Reflex urinary incontinence

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4. Stress urinary incontinence

Stress

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

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A client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude?

1. The skin wasn't lubricated before the pouch was applied. 2. The pouch faceplate doesn't fit the stoma. 3. A skin barrier was applied properly. 4. Stoma dilation wasn't performed.

2. The pouch faceplate doesn't fit the stoma.

If

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

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The

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

1. Encouraging intake of at least 2 L of fluid daily 2. Giving the client a glass of soda before bedtime 3. Taking the client to the bathroom twice per day 4. Consulting with a dietitian

1. Encouraging intake of at least 2 L of fluid daily

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

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client develops decreased renal function and requires a change in antibiotic dosage. On which factor would the physician base the dosage change? GI absorption rate Therapeutic index Creatinine clearance Liver function studies

1. 2. 3. 4.

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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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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.

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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 gains the client's confidence and performs an assessment, the nurse notes bruising of the labia and a lateral laceration in the perineal area. When the nurse asks the client about the injury, the client

2. Attend to the client's physiological needs.

The

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

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The

nurse suspects that a client with a temperature of 103.6 F (39.8 C) and an elevated white blood cell count is in the initial stage of sepsis. What is the most common cause of sepsis in hospitalized clients? Respiratory infection Urinary tract infection (UTI) Vasculitis Osteomyelitis

1. 2. 3. 4.

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2. Urinary tract infection (UTI)

Sepsis

most commonly results from a UTI caused by gram-negative bacteria. Other causes of sepsis include infections of the biliary, GI, and gynecologic tracts. Respiratory infection, vasculitis, and osteomyelitis rarely cause sepsis in hospitalized clients.

 The

client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?

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1. Tell the client to try to urinate around the catheter to remove blood clots. 2. Restrict fluids to prevent the client's bladder from becoming distended.

4. Use aseptic technique when irrigating the catheter.

If

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

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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 willmost likely write an order for which treatment? Force oral fluids. Administer furosemide (Lasix) 20 I.V. Start hemodialysis after a

1. 2. mg 3.

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

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

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The

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

1. Rashes on the palms of the hands and soles of the feet 2. Cauliflower-like warts on the penis 3. Painful red papules on the shaft of the penis 4. Foul-smelling discharge from the

4. Foul-smelling discharge from the penis

Symptoms

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

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During

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

1. Ask why the client is concerned about the diagnosis. 2. Change the subject to something more pleasant. 3. Provide privacy for the conversation.

3. Provide privacy for the conversation.

Providing

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privacy for the conversation is a form of active listening, which focuses solely on the client's needs. Asking why the client is concerned, changing the subject, or giving advice tends to block therapeutic communication.

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The

nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultrahighfrequency sound waves to shatter renal calculi. The nurse should instruct the client to:

1. limit oral fluid intake for 1 to 2 weeks.

3. notify the physician about cloudy or foul-smelling urine.

The

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

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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. Collecting semen 2. Performing the pelvic examination 3. Obtaining consent for examination 4. Supporting the client's emotional

4. Supporting the client's emotional status

The

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

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client requires hemodialysis. Which type of drug should be withheld before this procedure? Phosphate binders Insulin Antibiotics Cardiac glycosides

1. 2. 3. 4.

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4. Cardiac glycosides
Cardiac

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

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During

a routine examination, the nurse notes that the client seems unusually anxious. Anxiety can affect the genitourinary system by:

1. slowing the glomerular filtration rate. 2. increasing sodium resorption. 3. decreasing potassium excretion. 4. stimulating or hindering micturition.

4. stimulating or hindering micturition.

Anxiety

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

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The

nurse is reviewing the report of a client's routine urinalysis. Which value should the nurse consider abnormal? Specific gravity of 1.03 Urine pH of 3.0 Absence of protein Absence of glucose

1. 2. 3. 4.

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2. Urine pH of 3.0
Normal

urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal. Urine specific gravity normally ranges from 1.002 to 1.035, making this client's value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per highpower field; white blood cells, 0 to 4 per high-power field. Urine should be clear, with color ranging from pale

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client is admitted for treatment of chronic renal failure (CRF). 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. a decreased serum phosphate level secondary to kidney failure. 3. an increased serum calcium level secondary to kidney failure. 4. metabolic alkalosis secondary to

1. water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
A

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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. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic

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client is admitted for treatment of chronic renal failure (CRF). 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. a decreased serum phosphate level secondary to kidney failure. 3. an increased serum calcium level secondary to kidney failure. 4. metabolic alkalosis secondary to

1. water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
A

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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. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic

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client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders diagnostic testing of the vaginal discharge. Which STDmust be reported to the public health department?

1. Chlamydia 2. Gonorrhea 3. Genital herpes

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2. Gonorrhea
Gonorrhea

must be reported to the public health department. Chlamydia, genital herpes, and human papillomavirus infection aren't reportable diseases.

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The

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

1. 2. 3. 4.

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2. 7 to 10 days.
For

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

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

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

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

 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?

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1. 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. A 63-year-old client with uncontrolled diabetes mellitus who

3. A 45-year-old client diagnosed with renal calculi who must ambulate four times daily and drink plenty of fluids.
The

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care of the client in option 3 can safely be delegated to the nursing assistant. The client in option 1 had surgery 12 hours ago; therefore, the registered nurse should care for the client because the client requires close assessment. The client in option 2 also requires careful assessment by the registered nurse because the client's diabetes mellitus is uncontrolled. In addition, the registered nurse should

 The

nurse is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 6.2 mEq/L.Correct administration and the effects of this enema would include having the client:

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1. retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. 2. retain the enema for 30 minutes

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

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is a sodium-exchange resin. Thus, the client will gain sodium as potassium is lost in the bowel. For the exchange to occur, Kayexalate must be in contact with the bowel for at least 30 minutes. Sorbitol in the Kayexalate enema causes diarrhea, which increases potassium loss and decreases the potential for Kayexalate retention.

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The

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

1. Administering a sitz bath twice per day 2. Increasing fluid intake to 3 L/day 3. Using an indwelling urinary catheter to measure urine output accurately 4. Encouraging the client to drink

2. Increasing fluid intake to 3 L/day

Acute

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pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both kidneys. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. Pyelonephritis may result from procedures that involve the use of instruments (such as catheterization, cystoscopy, and urologic surgery) or from hematogenic infection. The most important nursing intervention is to

 After

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

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3. 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 reduction in urine output may be caused by an obstruction in the urinary catheter tubing or deficient fluid volume from blood loss. The client's nothing-bymouth status isn't the cause of the low urine output because the client is receiving I.V. fluid to compensate for the lack of oral intake. Ambulation

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client with suspected renal insufficiency is scheduled for a comprehensive diagnostic workup. After the nurse explains the diagnostic tests, the client asks which part of the kidney"does the work." Which answer is correct? The glomerulus Bowman's capsule The nephron The tubular system

1. 2. 3. 4.

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3. The nephron
The

nephron is the functioning unit of the kidney. The glomerulus, Bowman's capsule, and tubular system are components of the nephron.

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The

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

1. Evaluating patency of the

1. Evaluating patency of the drainage lumen

The

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

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client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes:

1. confusion, headache, and seizures. 2. acute bone pain and confusion.

1. confusion, headache, and seizures.

Dialysis

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

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client who has cervical cancer is scheduled to undergo internal radiation. In teaching the client about the procedure, the nurse would bemost accurate in telling the client:

1. she will be in a private room with unrestricted activities. 2. a bowel-cleansing procedure will precede radioactive implantation. 3. she will be expected to use a

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2. a bowel-cleansing procedure will precede radioactive implantation.

The

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

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. Amental health practitioner should be involved in the client's care to:

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1. assess whether the client is a

2. help the client cope with the anxiety

Many

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

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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. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs." How should the nurseproceed?

1. Educate the client about why it's important to inform sexual contacts so they can receive treatment.
The

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nurse should educate the client about the disease and how it impacts a person's health. Further education allows the client to make an informed decision about notifying sexual contacts. The nurse must maintain client confidentiality unless law mandates reporting the illness; contacting sexual contacts breeches client confidentiality. Option 4 is judgmental; everyone is entitled to

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

1. Cystic fibrosis

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2. Multiple myeloma
Fluid

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

 The

nurse is caring for a male client with gonorrhea who's receiving ceftriaxone and doxycycline. The client asks the nurse why he's receiving two antibiotics. Howshould the nurse respond?

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1. "Because there are many resistant strains of gonorrhea, more than one antibiotic may be required for successful treatment." 2. "The combination of these two

3. "Many people infected with gonorrhea are infected with chlamydia as well."
Treatment

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for gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin is prescribed as well. There has been an increase in the number of resistant strains of gonorrhea, but that isn't the reason for this dual therapy. This combination of

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

1. continuous inflow and outflow of irrigation solution. 2. intermittent inflow and continuous outflow of irrigation solution.

1. continuous inflow and outflow of irrigation solution.

When

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preparing for continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

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client is scheduled for a renal 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.

1. 2. 3. 4.

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1. 1 minute.
The

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

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Which

laboratory value supports a diagnosis of pyelonephritis?

1. Myoglobinuria 2. Ketonuria 3. Pyuria 4. Low white blood cell (WBC) count

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3. Pyuria
Pyelonephritis

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

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The

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

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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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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.

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client receiving total parental nutrition is prescribed a 24-hour urine test. When initiating a 24hour urine specimen, the collectiontime should:

1. start with the first voiding. 2. start after a known voiding. 3. always be with the first morning urine. 4. always be the evening's last void as the last sample.

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2. start after a known voiding.

When

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

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

1. 2. 3. 4.

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1. cardiac arrhythmia.
As

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

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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. initiate a stream of urine. 2. breathe deeply. 3. turn to the side. 4. hold the labia or shaft of the penis.

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2. breathe deeply.
When

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

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client with a urinary tract infection is prescribed cotrimoxazole (trimethoprimsulfamethoxazole). The nurse should provide which medication instruction?

1. "Take the medication with food." 2. "Drink at least eight 8-oz glasses of fluid daily." 3. "Avoid taking antacids during cotrimoxazole therapy."

2. "Drink at least eight 8-oz glasses of fluid daily."

When

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receiving a sulfonamide such as co-trimoxazole, 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. Otherwise, inadequate urine output may lead to crystalluria or tubular deposits. For maximum absorption, the client should take this drug at least 1 hour before or 2 hours after meals. No evidence indicates that antacids interfere with the effects of

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After

undergoing renal arteriogram, in which the left groin was accessed, the client complains of left calf pain. Which intervention should the nurse performfirst?

1. Assess peripheral pulses in the left leg. 2. Place cool compresses on the calf. 3. Exercise the leg and foot. 4. Assess for anaphylaxis.

1. Assess peripheral pulses in the left leg.

The

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

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

1. 2. 3. 4.

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2. epoetin alfa (Epogen)

Chronic

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

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female client reports to the 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:

1. functional incontinence. 2. reflex incontinence. 3. stress incontinence.

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3. stress incontinence.
Stress

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

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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:

1. generalized edema, especially of the face and periorbital area. 2. green-tinged urine. 3. moderate to severe hypotension. 4. polyuria.

1. generalized edema, especially of the face and periorbital area.

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Generalized

edema, 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), proteinuria, fever, chills,

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client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?

1. "Be sure to eat meat at every meal." 2. "Eat plenty of bananas." 3. "Increase your carbohydrate intake." 4. "Drink plenty of fluids, and use a salt substitute."

3. "Increase your carbohydrate intake."

Extra

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carbohydrates are needed to prevent protein catabolism. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because

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When

performing a scrotal examination, the nurse finds a nodule. What should the nurse do next?

1. Notify the physician. 2. Change the client's position and repeat the examination. 3. Perform a rectal examination. 4. Transilluminate the scrotum.

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4. Transilluminate the scrotum.

A

nurse who discovers a nodule, swelling, or other abnormal finding during a scrotal examination should transilluminate the scrotum by darkening the room and shining a flashlight through the scrotum behind the mass. A scrotum filled with serous fluid transilluminates as a red glow; a more solid lesion, such as a hematoma or mass, doesn't transilluminate and may appear as a dark shadow.

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25-year-old 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 trimethoprimsulfamethoxazole (Bactrim) to treat possible infection. Another medication is prescribed to decrease the pain and frequency. Which is themost likely medication prescribed for the pain?

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4. 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, phenazopyridine specifically relieves bladder pain. Nitrofurantoin is a urinary antiseptic with no analgesic properties. Although ibuprofen and acetaminophen with codeine are analgesics, they don't exert a direct effect on the urinary

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

1. "Take your temperature every 4 hours." 2. "Increase your fluid intake to 2 to 3 L per day." 3. "Apply an antibacterial dressing to the incision daily." 4. "Be aware that your urine will be cherry-red for 5 to 7 days."

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

Increasing

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fluid intake flushes the renal calculi fragments through and prevents obstruction of the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.